|
STERLING SL OTW 4*120*150
|
Facility
|
IP
|
$3,668.74
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.94 |
| Max. Negotiated Rate |
$3,521.99 |
| Rate for Payer: Aetna Commercial |
$2,824.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,861.62
|
| Rate for Payer: Cash Price |
$1,834.37
|
| Rate for Payer: Cigna Commercial |
$3,045.05
|
| Rate for Payer: First Health Commercial |
$3,485.30
|
| Rate for Payer: Humana Commercial |
$3,118.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,008.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,707.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,100.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,228.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,751.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$733.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.31
|
| Rate for Payer: PHCS Commercial |
$3,521.99
|
| Rate for Payer: United Healthcare All Payer |
$3,228.49
|
|
|
STERLING SL OTW 4*150*150
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING SL OTW 4*150*150
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
STERLING SL OTW 4*80*150
|
Facility
|
IP
|
$3,477.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.03 |
| Max. Negotiated Rate |
$3,338.06 |
| Rate for Payer: Aetna Commercial |
$2,677.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.18
|
| Rate for Payer: Cash Price |
$1,738.58
|
| Rate for Payer: Cigna Commercial |
$2,886.03
|
| Rate for Payer: First Health Commercial |
$3,303.29
|
| Rate for Payer: Humana Commercial |
$2,955.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,059.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,607.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.92
|
| Rate for Payer: PHCS Commercial |
$3,338.06
|
| Rate for Payer: United Healthcare All Payer |
$3,059.89
|
|
|
STERLING SL OTW 4*80*150
|
Facility
|
OP
|
$3,477.15
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
27000009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.03 |
| Max. Negotiated Rate |
$3,338.06 |
| Rate for Payer: Aetna Commercial |
$2,677.41
|
| Rate for Payer: Anthem Medicaid |
$1,195.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.18
|
| Rate for Payer: Cash Price |
$1,738.58
|
| Rate for Payer: Cigna Commercial |
$2,886.03
|
| Rate for Payer: First Health Commercial |
$3,303.29
|
| Rate for Payer: Humana Commercial |
$2,955.58
|
| Rate for Payer: Humana KY Medicaid |
$1,195.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,207.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,219.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,059.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,607.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.92
|
| Rate for Payer: PHCS Commercial |
$3,338.06
|
| Rate for Payer: United Healthcare All Payer |
$3,059.89
|
|
|
STERNAL DEBRIDEMENT
|
Facility
|
OP
|
$2,545.00
|
|
|
Service Code
|
HCPCS 21627
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.85 |
| Max. Negotiated Rate |
$2,443.20 |
| Rate for Payer: Aetna Commercial |
$1,959.65
|
| Rate for Payer: Anthem Medicaid |
$875.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,985.10
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cigna Commercial |
$2,112.35
|
| Rate for Payer: First Health Commercial |
$2,417.75
|
| Rate for Payer: Humana Commercial |
$2,163.25
|
| Rate for Payer: Humana KY Medicaid |
$875.23
|
| Rate for Payer: Kentucky WC Medicaid |
$884.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,086.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,878.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$892.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,239.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,908.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$788.95
|
| Rate for Payer: PHCS Commercial |
$2,443.20
|
| Rate for Payer: United Healthcare All Payer |
$2,239.60
|
|
|
STERNAL DEBRIDEMENT
|
Professional
|
Both
|
$2,545.00
|
|
|
Service Code
|
HCPCS 21627
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.61 |
| Max. Negotiated Rate |
$2,545.00 |
| Rate for Payer: Aetna Commercial |
$799.66
|
| Rate for Payer: Anthem Medicaid |
$334.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,545.00
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cigna Commercial |
$879.23
|
| Rate for Payer: Healthspan PPO |
$724.32
|
| Rate for Payer: Humana Medicaid |
$334.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$690.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.30
|
| Rate for Payer: Molina Healthcare Passport |
$334.61
|
| Rate for Payer: Multiplan PHCS |
$1,527.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,781.50
|
| Rate for Payer: UHCCP Medicaid |
$890.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.96
|
|
|
STERNAL DEBRIDEMENT
|
Facility
|
IP
|
$2,545.00
|
|
|
Service Code
|
HCPCS 21627
|
| Hospital Charge Code |
76100402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$330.85 |
| Max. Negotiated Rate |
$2,443.20 |
| Rate for Payer: Aetna Commercial |
$1,959.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,985.10
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cigna Commercial |
$2,112.35
|
| Rate for Payer: First Health Commercial |
$2,417.75
|
| Rate for Payer: Humana Commercial |
$2,163.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,086.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,878.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$763.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,239.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,908.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$330.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$788.95
|
| Rate for Payer: PHCS Commercial |
$2,443.20
|
| Rate for Payer: United Healthcare All Payer |
$2,239.60
|
|
|
STERNAL DEBRIDEMENT(P
|
Professional
|
Both
|
$2,545.00
|
|
|
Service Code
|
HCPCS 21627
|
| Hospital Charge Code |
761P0402
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$334.61 |
| Max. Negotiated Rate |
$2,545.00 |
| Rate for Payer: Aetna Commercial |
$799.66
|
| Rate for Payer: Anthem Medicaid |
$334.61
|
| Rate for Payer: Buckeye Medicare Advantage |
$2,545.00
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cash Price |
$1,272.50
|
| Rate for Payer: Cigna Commercial |
$879.23
|
| Rate for Payer: Healthspan PPO |
$724.32
|
| Rate for Payer: Humana Medicaid |
$334.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$690.57
|
| Rate for Payer: Molina Healthcare CHIP/Medicaid |
$341.30
|
| Rate for Payer: Molina Healthcare Passport |
$334.61
|
| Rate for Payer: Multiplan PHCS |
$1,527.00
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$1,781.50
|
| Rate for Payer: UHCCP Medicaid |
$890.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.96
|
|
|
STERNAL TALON THORACIC LG 11MM
|
Facility
|
IP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC LG 11MM
|
Facility
|
OP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem Medicaid |
$2,755.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Humana KY Medicaid |
$2,755.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,783.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,810.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC LG 14MM
|
Facility
|
OP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem Medicaid |
$2,755.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Humana KY Medicaid |
$2,755.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,783.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,810.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC LG 14MM
|
Facility
|
IP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC LG 17MM
|
Facility
|
IP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC LG 17MM
|
Facility
|
OP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem Medicaid |
$2,755.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Humana KY Medicaid |
$2,755.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,783.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,810.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC MED 14M
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THORACIC MED 14M
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THORACIC SM 11MM
|
Facility
|
OP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem Medicaid |
$2,755.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Humana KY Medicaid |
$2,755.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,783.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,810.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC SM 11MM
|
Facility
|
IP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC SM 14MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THORACIC SM 14MM
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THORACIC SM 17MM
|
Facility
|
OP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem Medicaid |
$2,755.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Humana KY Medicaid |
$2,755.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,783.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,810.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THORACIC SM 17MM
|
Facility
|
IP
|
$8,012.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.59 |
| Max. Negotiated Rate |
$7,691.71 |
| Rate for Payer: Aetna Commercial |
$6,169.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,249.52
|
| Rate for Payer: Cash Price |
$4,006.10
|
| Rate for Payer: Cigna Commercial |
$6,650.13
|
| Rate for Payer: First Health Commercial |
$7,611.59
|
| Rate for Payer: Humana Commercial |
$6,810.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,570.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,913.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,403.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,050.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,009.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,041.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,483.78
|
| Rate for Payer: PHCS Commercial |
$7,691.71
|
| Rate for Payer: United Healthcare All Payer |
$7,050.74
|
|
|
STERNAL TALON THRACIC MED 11MM
|
Facility
|
OP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem Medicaid |
$2,670.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Humana KY Medicaid |
$2,670.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,723.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
|
STERNAL TALON THRACIC MED 11MM
|
Facility
|
IP
|
$7,764.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.32 |
| Max. Negotiated Rate |
$7,453.44 |
| Rate for Payer: Aetna Commercial |
$5,978.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,055.92
|
| Rate for Payer: Cash Price |
$3,882.00
|
| Rate for Payer: Cigna Commercial |
$6,444.12
|
| Rate for Payer: First Health Commercial |
$7,375.80
|
| Rate for Payer: Humana Commercial |
$6,599.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,366.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,729.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,832.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,823.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,552.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.84
|
| Rate for Payer: PHCS Commercial |
$7,453.44
|
| Rate for Payer: United Healthcare All Payer |
$6,832.32
|
|
