|
DX SWIVELOCK 3.5X8.5MM W/FORKT
|
Facility
|
IP
|
$3,593.75
|
|
| Hospital Charge Code |
27000242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.12 |
| Max. Negotiated Rate |
$3,450.00 |
| Rate for Payer: Aetna Commercial |
$2,767.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.12
|
| Rate for Payer: Cash Price |
$1,796.88
|
| Rate for Payer: Cigna Commercial |
$2,982.81
|
| Rate for Payer: First Health Commercial |
$3,414.06
|
| Rate for Payer: Humana Commercial |
$3,054.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,946.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,162.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,695.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,126.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,479.69
|
| Rate for Payer: PHCS Commercial |
$3,450.00
|
| Rate for Payer: United Healthcare All Payer |
$3,162.50
|
|
|
DYAZIDE(TRIAMTERENE/HCTZ) 1CAP
|
Facility
|
IP
|
$4.41
|
|
|
Service Code
|
NDC 72578009001
|
| Hospital Charge Code |
25000588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
DYAZIDE(TRIAMTERENE/HCTZ) 1CAP
|
Facility
|
OP
|
$4.41
|
|
|
Service Code
|
NDC 72578009001
|
| Hospital Charge Code |
25000588
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.23 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Anthem Medicaid |
$1.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3.44
|
| Rate for Payer: Cash Price |
$2.20
|
| Rate for Payer: Cigna Commercial |
$3.66
|
| Rate for Payer: First Health Commercial |
$4.19
|
| Rate for Payer: Humana Commercial |
$3.75
|
| Rate for Payer: Humana KY Medicaid |
$1.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3.88
|
| Rate for Payer: Ohio Health Group HMO |
$3.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3.04
|
| Rate for Payer: PHCS Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Payer |
$3.88
|
|
|
DYE LYMPHAZURIN
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
25003191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$7.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$11.00
|
| Rate for Payer: CareSource Just4Me Medicare |
$10.61
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Humana Medicare Advantage |
$7.86
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$9.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DYE LYMPHAZURIN
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
25003191
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
DYNACIRC (ISRADIPIN 2.5MG/1CAP
|
Facility
|
OP
|
$9.44
|
|
|
Service Code
|
NDC 16252053901
|
| Hospital Charge Code |
25003846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$7.27
|
| Rate for Payer: Anthem Medicaid |
$3.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.36
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cigna Commercial |
$7.84
|
| Rate for Payer: First Health Commercial |
$8.97
|
| Rate for Payer: Humana Commercial |
$8.02
|
| Rate for Payer: Humana KY Medicaid |
$3.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.31
|
| Rate for Payer: Ohio Health Group HMO |
$7.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.51
|
| Rate for Payer: PHCS Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Payer |
$8.31
|
|
|
DYNACIRC (ISRADIPIN 2.5MG/1CAP
|
Facility
|
IP
|
$9.44
|
|
|
Service Code
|
NDC 16252053901
|
| Hospital Charge Code |
25003846
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.83 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$7.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.36
|
| Rate for Payer: Cash Price |
$4.72
|
| Rate for Payer: Cigna Commercial |
$7.84
|
| Rate for Payer: First Health Commercial |
$8.97
|
| Rate for Payer: Humana Commercial |
$8.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.31
|
| Rate for Payer: Ohio Health Group HMO |
$7.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.51
|
| Rate for Payer: PHCS Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Payer |
$8.31
|
|
|
DYNACIRC (ISRADIPINE) 5MG CAP
|
Facility
|
OP
|
$10.11
|
|
|
Service Code
|
NDC 16252054001
|
| Hospital Charge Code |
25000589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: Anthem Medicaid |
$3.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.89
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Cigna Commercial |
$8.39
|
| Rate for Payer: First Health Commercial |
$9.60
|
| Rate for Payer: Humana Commercial |
$8.59
|
| Rate for Payer: Humana KY Medicaid |
$3.48
|
| Rate for Payer: Kentucky WC Medicaid |
$3.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.90
|
| Rate for Payer: Ohio Health Group HMO |
$7.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.98
|
| Rate for Payer: PHCS Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Payer |
$8.90
|
|
|
DYNACIRC (ISRADIPINE) 5MG CAP
|
Facility
|
IP
|
$10.11
|
|
|
Service Code
|
NDC 16252054001
|
| Hospital Charge Code |
25000589
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$9.71 |
| Rate for Payer: Aetna Commercial |
$7.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7.89
|
| Rate for Payer: Cash Price |
$5.06
|
| Rate for Payer: Cigna Commercial |
$8.39
|
| Rate for Payer: First Health Commercial |
$9.60
|
| Rate for Payer: Humana Commercial |
$8.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8.90
|
| Rate for Payer: Ohio Health Group HMO |
$7.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6.98
|
| Rate for Payer: PHCS Commercial |
$9.71
|
| Rate for Payer: United Healthcare All Payer |
$8.90
|
|
|
DYNAFORCE MTP LNG PLATE 5*X0*
|
Facility
|
OP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem Medicaid |
$1,880.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Humana KY Medicaid |
$1,880.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP LNG PLATE 5*X0*
|
Facility
|
IP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP PLATE 5*X0*
|
Facility
|
OP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem Medicaid |
$1,880.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Humana KY Medicaid |
$1,880.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP PLATE 5*X0*
|
Facility
|
IP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP STD PLATE 0* R/L
|
Facility
|
OP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem Medicaid |
$1,880.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Humana KY Medicaid |
$1,880.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP STD PLATE 0* R/L
|
Facility
|
IP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP STD PLATE 10*R/L
|
Facility
|
IP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP STD PLATE 10*R/L
|
Facility
|
OP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem Medicaid |
$1,880.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Humana KY Medicaid |
$1,880.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP STD PLATE 5*R/L
|
Facility
|
IP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNAFORCE MTP STD PLATE 5*R/L
|
Facility
|
OP
|
$5,468.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,640.62 |
| Max. Negotiated Rate |
$5,250.00 |
| Rate for Payer: Aetna Commercial |
$4,210.94
|
| Rate for Payer: Anthem Medicaid |
$1,880.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.62
|
| Rate for Payer: Cash Price |
$2,734.38
|
| Rate for Payer: Cigna Commercial |
$4,539.06
|
| Rate for Payer: First Health Commercial |
$5,195.31
|
| Rate for Payer: Humana Commercial |
$4,648.44
|
| Rate for Payer: Humana KY Medicaid |
$1,880.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,035.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,375.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,757.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,773.44
|
| Rate for Payer: PHCS Commercial |
$5,250.00
|
| Rate for Payer: United Healthcare All Payer |
$4,812.50
|
|
|
DYNANAIL MINI 7MM*100MM
|
Facility
|
OP
|
$22,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,810.00 |
| Max. Negotiated Rate |
$21,792.00 |
| Rate for Payer: Aetna Commercial |
$17,479.00
|
| Rate for Payer: Anthem Medicaid |
$7,806.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,706.00
|
| Rate for Payer: Cash Price |
$11,350.00
|
| Rate for Payer: Cigna Commercial |
$18,841.00
|
| Rate for Payer: First Health Commercial |
$21,565.00
|
| Rate for Payer: Humana Commercial |
$19,295.00
|
| Rate for Payer: Humana KY Medicaid |
$7,806.53
|
| Rate for Payer: Kentucky WC Medicaid |
$7,885.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,752.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,963.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,749.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,663.00
|
| Rate for Payer: PHCS Commercial |
$21,792.00
|
| Rate for Payer: United Healthcare All Payer |
$19,976.00
|
|
|
DYNANAIL MINI 7MM*100MM
|
Facility
|
IP
|
$22,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,810.00 |
| Max. Negotiated Rate |
$21,792.00 |
| Rate for Payer: Aetna Commercial |
$17,479.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,706.00
|
| Rate for Payer: Cash Price |
$11,350.00
|
| Rate for Payer: Cigna Commercial |
$18,841.00
|
| Rate for Payer: First Health Commercial |
$21,565.00
|
| Rate for Payer: Humana Commercial |
$19,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,752.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,749.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,663.00
|
| Rate for Payer: PHCS Commercial |
$21,792.00
|
| Rate for Payer: United Healthcare All Payer |
$19,976.00
|
|
|
DYNANAIL MINI 7MM*60MM
|
Facility
|
IP
|
$22,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,810.00 |
| Max. Negotiated Rate |
$21,792.00 |
| Rate for Payer: Aetna Commercial |
$17,479.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,706.00
|
| Rate for Payer: Cash Price |
$11,350.00
|
| Rate for Payer: Cigna Commercial |
$18,841.00
|
| Rate for Payer: First Health Commercial |
$21,565.00
|
| Rate for Payer: Humana Commercial |
$19,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,752.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,749.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,663.00
|
| Rate for Payer: PHCS Commercial |
$21,792.00
|
| Rate for Payer: United Healthcare All Payer |
$19,976.00
|
|
|
DYNANAIL MINI 7MM*60MM
|
Facility
|
OP
|
$22,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,810.00 |
| Max. Negotiated Rate |
$21,792.00 |
| Rate for Payer: Aetna Commercial |
$17,479.00
|
| Rate for Payer: Anthem Medicaid |
$7,806.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,706.00
|
| Rate for Payer: Cash Price |
$11,350.00
|
| Rate for Payer: Cigna Commercial |
$18,841.00
|
| Rate for Payer: First Health Commercial |
$21,565.00
|
| Rate for Payer: Humana Commercial |
$19,295.00
|
| Rate for Payer: Humana KY Medicaid |
$7,806.53
|
| Rate for Payer: Kentucky WC Medicaid |
$7,885.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,752.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,963.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,749.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,663.00
|
| Rate for Payer: PHCS Commercial |
$21,792.00
|
| Rate for Payer: United Healthcare All Payer |
$19,976.00
|
|
|
DYNANAIL MINI 7MM*70MM
|
Facility
|
IP
|
$22,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,810.00 |
| Max. Negotiated Rate |
$21,792.00 |
| Rate for Payer: Aetna Commercial |
$17,479.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,706.00
|
| Rate for Payer: Cash Price |
$11,350.00
|
| Rate for Payer: Cigna Commercial |
$18,841.00
|
| Rate for Payer: First Health Commercial |
$21,565.00
|
| Rate for Payer: Humana Commercial |
$19,295.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,752.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,810.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,749.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,663.00
|
| Rate for Payer: PHCS Commercial |
$21,792.00
|
| Rate for Payer: United Healthcare All Payer |
$19,976.00
|
|
|
DYNANAIL MINI 7MM*70MM
|
Facility
|
OP
|
$22,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,810.00 |
| Max. Negotiated Rate |
$21,792.00 |
| Rate for Payer: Aetna Commercial |
$17,479.00
|
| Rate for Payer: Anthem Medicaid |
$7,806.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17,706.00
|
| Rate for Payer: Cash Price |
$11,350.00
|
| Rate for Payer: Cigna Commercial |
$18,841.00
|
| Rate for Payer: First Health Commercial |
$21,565.00
|
| Rate for Payer: Humana Commercial |
$19,295.00
|
| Rate for Payer: Humana KY Medicaid |
$7,806.53
|
| Rate for Payer: Kentucky WC Medicaid |
$7,885.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18,614.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16,752.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,810.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,963.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$19,976.00
|
| Rate for Payer: Ohio Health Group HMO |
$17,025.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18,160.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19,749.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15,663.00
|
| Rate for Payer: PHCS Commercial |
$21,792.00
|
| Rate for Payer: United Healthcare All Payer |
$19,976.00
|
|
