|
DYNANAIL MINI 7MM*60MM
|
Facility
|
OP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem Medicaid |
$7,575.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Humana KY Medicaid |
$7,575.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,652.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,727.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 7MM*60MM
|
Facility
|
IP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 7MM*70MM
|
Facility
|
IP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 7MM*70MM
|
Facility
|
OP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem Medicaid |
$7,575.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Humana KY Medicaid |
$7,575.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,652.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,727.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 7MM*80MM
|
Facility
|
IP
|
$13,803.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,794.42 |
| Max. Negotiated Rate |
$13,251.11 |
| Rate for Payer: Aetna Commercial |
$10,628.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,766.53
|
| Rate for Payer: Cash Price |
$6,901.62
|
| Rate for Payer: Cigna Commercial |
$11,456.69
|
| Rate for Payer: First Health Commercial |
$13,113.08
|
| Rate for Payer: Humana Commercial |
$11,732.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,318.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,186.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,140.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,146.85
|
| Rate for Payer: Ohio Health Group HMO |
$10,352.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,760.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,794.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,279.00
|
| Rate for Payer: PHCS Commercial |
$13,251.11
|
| Rate for Payer: United Healthcare All Payer |
$12,146.85
|
|
|
DYNANAIL MINI 7MM*80MM
|
Facility
|
OP
|
$13,803.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,794.42 |
| Max. Negotiated Rate |
$13,251.11 |
| Rate for Payer: Cigna Commercial |
$11,456.69
|
| Rate for Payer: First Health Commercial |
$13,113.08
|
| Rate for Payer: Humana Commercial |
$11,732.75
|
| Rate for Payer: Humana KY Medicaid |
$4,746.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,795.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,318.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,186.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,140.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,842.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,146.85
|
| Rate for Payer: Ohio Health Group HMO |
$10,352.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,760.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,794.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,279.00
|
| Rate for Payer: PHCS Commercial |
$13,251.11
|
| Rate for Payer: United Healthcare All Payer |
$12,146.85
|
| Rate for Payer: Aetna Commercial |
$10,628.49
|
| Rate for Payer: Anthem Medicaid |
$4,746.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,766.53
|
| Rate for Payer: Cash Price |
$6,901.62
|
|
|
DYNANAIL MINI 7MM*90MM
|
Facility
|
IP
|
$13,803.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,794.42 |
| Max. Negotiated Rate |
$13,251.11 |
| Rate for Payer: Aetna Commercial |
$10,628.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,766.53
|
| Rate for Payer: Cash Price |
$6,901.62
|
| Rate for Payer: Cigna Commercial |
$11,456.69
|
| Rate for Payer: First Health Commercial |
$13,113.08
|
| Rate for Payer: Humana Commercial |
$11,732.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,318.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,186.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,140.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,146.85
|
| Rate for Payer: Ohio Health Group HMO |
$10,352.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,760.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,794.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,279.00
|
| Rate for Payer: PHCS Commercial |
$13,251.11
|
| Rate for Payer: United Healthcare All Payer |
$12,146.85
|
|
|
DYNANAIL MINI 7MM*90MM
|
Facility
|
OP
|
$13,803.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,794.42 |
| Max. Negotiated Rate |
$13,251.11 |
| Rate for Payer: Aetna Commercial |
$10,628.49
|
| Rate for Payer: Anthem Medicaid |
$4,746.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,766.53
|
| Rate for Payer: Cash Price |
$6,901.62
|
| Rate for Payer: Cigna Commercial |
$11,456.69
|
| Rate for Payer: First Health Commercial |
$13,113.08
|
| Rate for Payer: Humana Commercial |
$11,732.75
|
| Rate for Payer: Humana KY Medicaid |
$4,746.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,795.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,318.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,186.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,140.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,842.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,146.85
|
| Rate for Payer: Ohio Health Group HMO |
$10,352.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,760.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,794.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,279.00
|
| Rate for Payer: PHCS Commercial |
$13,251.11
|
| Rate for Payer: United Healthcare All Payer |
$12,146.85
|
|
|
DYNANAIL MINI 8 MM X 100 MM
|
Facility
|
IP
|
$27,776.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,610.98 |
| Max. Negotiated Rate |
$26,665.68 |
| Rate for Payer: Aetna Commercial |
$21,388.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,665.86
|
| Rate for Payer: Cash Price |
$13,888.38
|
| Rate for Payer: Cigna Commercial |
$23,054.70
|
| Rate for Payer: First Health Commercial |
$26,387.91
|
| Rate for Payer: Humana Commercial |
$23,610.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,776.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,499.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,333.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,443.54
|
| Rate for Payer: Ohio Health Group HMO |
$20,832.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,555.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,610.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,610.79
|
| Rate for Payer: PHCS Commercial |
$26,665.68
|
| Rate for Payer: United Healthcare All Payer |
$24,443.54
|
|
|
DYNANAIL MINI 8 MM X 100 MM
|
Facility
|
OP
|
$27,776.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,610.98 |
| Max. Negotiated Rate |
$26,665.68 |
| Rate for Payer: Aetna Commercial |
$21,388.10
|
| Rate for Payer: Anthem Medicaid |
$9,552.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,665.86
|
| Rate for Payer: Cash Price |
$13,888.38
|
| Rate for Payer: Cigna Commercial |
$23,054.70
|
| Rate for Payer: First Health Commercial |
$26,387.91
|
| Rate for Payer: Humana Commercial |
$23,610.24
|
| Rate for Payer: Humana KY Medicaid |
$9,552.42
|
| Rate for Payer: Kentucky WC Medicaid |
$9,649.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,776.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,499.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,333.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,744.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,443.54
|
| Rate for Payer: Ohio Health Group HMO |
$20,832.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,555.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,610.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,610.79
|
| Rate for Payer: PHCS Commercial |
$26,665.68
|
| Rate for Payer: United Healthcare All Payer |
$24,443.54
|
|
|
DYNANAIL MINI 8 MM X 60 MM
|
Facility
|
IP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 8 MM X 60 MM
|
Facility
|
OP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem Medicaid |
$7,575.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Humana KY Medicaid |
$7,575.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,652.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,727.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 8 MM X 70 MM
|
Facility
|
OP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem Medicaid |
$7,575.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Humana KY Medicaid |
$7,575.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,652.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,727.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 8 MM X 70 MM
|
Facility
|
IP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 8 MM X 80 MM
|
Facility
|
OP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem Medicaid |
$7,575.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Humana KY Medicaid |
$7,575.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,652.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,727.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 8 MM X 80 MM
|
Facility
|
IP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 8 MM X 90 MM
|
Facility
|
OP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem Medicaid |
$7,575.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Humana KY Medicaid |
$7,575.43
|
| Rate for Payer: Kentucky WC Medicaid |
$7,652.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,727.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANAIL MINI 8 MM X 90 MM
|
Facility
|
IP
|
$22,028.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,863.64 |
| Max. Negotiated Rate |
$21,146.88 |
| Rate for Payer: Aetna Commercial |
$16,961.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,181.84
|
| Rate for Payer: Cash Price |
$11,014.00
|
| Rate for Payer: Cigna Commercial |
$18,283.24
|
| Rate for Payer: First Health Commercial |
$20,926.60
|
| Rate for Payer: Humana Commercial |
$18,723.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,062.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,256.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,608.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,384.64
|
| Rate for Payer: Ohio Health Group HMO |
$16,521.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,828.68
|
| Rate for Payer: PHCS Commercial |
$21,146.88
|
| Rate for Payer: United Healthcare All Payer |
$19,384.64
|
|
|
DYNANITE PIP BENT 12MM
|
Facility
|
OP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem Medicaid |
$3,341.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Humana KY Medicaid |
$3,341.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
|
DYNANITE PIP BENT 12MM
|
Facility
|
IP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
|
DYNANITE PIP - BENT 14MM
|
Facility
|
IP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
|
DYNANITE PIP - BENT 14MM
|
Facility
|
OP
|
$9,716.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.18 |
| Max. Negotiated Rate |
$9,328.08 |
| Rate for Payer: Aetna Commercial |
$7,481.90
|
| Rate for Payer: Anthem Medicaid |
$3,341.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,579.06
|
| Rate for Payer: Cash Price |
$4,858.38
|
| Rate for Payer: Cigna Commercial |
$8,064.90
|
| Rate for Payer: First Health Commercial |
$9,230.91
|
| Rate for Payer: Humana Commercial |
$8,259.24
|
| Rate for Payer: Humana KY Medicaid |
$3,341.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,915.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,943.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.19
|
| Rate for Payer: PHCS Commercial |
$9,328.08
|
| Rate for Payer: United Healthcare All Payer |
$8,550.74
|
|
|
DYNASTY A-CL 15DG 36M DLXPLJ36
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
DYNASTY A-CL 15DG 36M DLXPLJ36
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
DYNASTY A-CL 15DG 36M DLXPLK36
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
