|
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 |
$1,527.00 |
| Rate for Payer: Aetna Commercial |
$799.66
|
| Rate for Payer: Ambetter Exchange |
$518.87
|
| Rate for Payer: Anthem Medicaid |
$334.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$518.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$518.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$622.64
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$518.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.87
|
| 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 |
$674.53
|
| Rate for Payer: UHCCP Medicaid |
$890.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$518.87
|
|
|
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 |
$1,527.00 |
| Rate for Payer: Aetna Commercial |
$799.66
|
| Rate for Payer: Ambetter Exchange |
$518.87
|
| Rate for Payer: Anthem Medicaid |
$334.61
|
| Rate for Payer: Buckeye Individual/Medicaid |
$518.87
|
| Rate for Payer: Buckeye Medicare Advantage |
$518.87
|
| Rate for Payer: CareSource Just4Me Medicare |
$622.64
|
| 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: Medical Mutual Of Ohio Medicare Advantage |
$518.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.87
|
| 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 |
$674.53
|
| Rate for Payer: UHCCP Medicaid |
$890.75
|
| Rate for Payer: Wellcare CHIP/Medicaid |
$337.96
|
| Rate for Payer: Wellcare Medicare Advantage |
$518.87
|
|
|
STERNAL TALON THORACIC LG 11MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC LG 11MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC LG 14MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC LG 14MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC LG 17MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC LG 17MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC MED 14M
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC MED 14M
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC SM 11MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC SM 11MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC SM 14MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC SM 14MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC SM 17MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THORACIC SM 17MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THRACIC MED 11MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
STERNAL TALON THRACIC MED 11MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
STERNAL TALON THRACIC MED 17MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THRACIC MED 17MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THRACIC MED 20MM
|
Facility
|
IP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THRACIC MED 20MM
|
Facility
|
OP
|
$8,212.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,463.66 |
| Max. Negotiated Rate |
$7,883.71 |
| Rate for Payer: Aetna Commercial |
$6,323.39
|
| Rate for Payer: Anthem Medicaid |
$2,824.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,405.52
|
| Rate for Payer: Cash Price |
$4,106.10
|
| Rate for Payer: Cigna Commercial |
$6,816.13
|
| Rate for Payer: First Health Commercial |
$7,801.59
|
| Rate for Payer: Humana Commercial |
$6,980.37
|
| Rate for Payer: Humana KY Medicaid |
$2,824.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,852.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,734.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,060.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,463.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,880.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,226.74
|
| Rate for Payer: Ohio Health Group HMO |
$6,159.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,569.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,144.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,666.42
|
| Rate for Payer: PHCS Commercial |
$7,883.71
|
| Rate for Payer: United Healthcare All Payer |
$7,226.74
|
|
|
STERNAL TALON THRACIC XSM 11MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
STERNAL TALON THRACIC XSM 11MM
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
|
STERNAL TALON THRACIC XSM 14MM
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.20 |
| Max. Negotiated Rate |
$7,645.44 |
| Rate for Payer: Aetna Commercial |
$6,132.28
|
| Rate for Payer: Anthem Medicaid |
$2,738.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,211.92
|
| Rate for Payer: Cash Price |
$3,982.00
|
| Rate for Payer: Cigna Commercial |
$6,610.12
|
| Rate for Payer: First Health Commercial |
$7,565.80
|
| Rate for Payer: Humana Commercial |
$6,769.40
|
| Rate for Payer: Humana KY Medicaid |
$2,738.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,766.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,530.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,877.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,793.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,008.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,371.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,928.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,495.16
|
| Rate for Payer: PHCS Commercial |
$7,645.44
|
| Rate for Payer: United Healthcare All Payer |
$7,008.32
|
|
