|
DYNANAIL MINI 7MM*80MM
|
Facility
|
OP
|
$14,060.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$13,498.36 |
| Rate for Payer: Aetna Commercial |
$10,826.81
|
| Rate for Payer: Anthem Medicaid |
$4,835.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,967.42
|
| Rate for Payer: Cash Price |
$7,030.40
|
| Rate for Payer: Cigna Commercial |
$11,670.46
|
| Rate for Payer: First Health Commercial |
$13,357.75
|
| Rate for Payer: Humana Commercial |
$11,951.67
|
| Rate for Payer: Humana KY Medicaid |
$4,835.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,884.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,529.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,376.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,932.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,373.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,545.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,248.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,232.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,701.95
|
| Rate for Payer: PHCS Commercial |
$13,498.36
|
| Rate for Payer: United Healthcare All Payer |
$12,373.50
|
|
|
DYNANAIL MINI 7MM*80MM
|
Facility
|
IP
|
$14,060.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$13,498.36 |
| Rate for Payer: Aetna Commercial |
$10,826.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,967.42
|
| Rate for Payer: Cash Price |
$7,030.40
|
| Rate for Payer: Cigna Commercial |
$11,670.46
|
| Rate for Payer: First Health Commercial |
$13,357.75
|
| Rate for Payer: Humana Commercial |
$11,951.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,529.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,376.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,373.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,545.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,248.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,232.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,701.95
|
| Rate for Payer: PHCS Commercial |
$13,498.36
|
| Rate for Payer: United Healthcare All Payer |
$12,373.50
|
|
|
DYNANAIL MINI 7MM*90MM
|
Facility
|
OP
|
$14,060.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$13,498.36 |
| Rate for Payer: Aetna Commercial |
$10,826.81
|
| Rate for Payer: Anthem Medicaid |
$4,835.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,967.42
|
| Rate for Payer: Cash Price |
$7,030.40
|
| Rate for Payer: Cigna Commercial |
$11,670.46
|
| Rate for Payer: First Health Commercial |
$13,357.75
|
| Rate for Payer: Humana Commercial |
$11,951.67
|
| Rate for Payer: Humana KY Medicaid |
$4,835.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,884.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,529.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,376.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,932.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,373.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,545.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,248.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,232.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,701.95
|
| Rate for Payer: PHCS Commercial |
$13,498.36
|
| Rate for Payer: United Healthcare All Payer |
$12,373.50
|
|
|
DYNANAIL MINI 7MM*90MM
|
Facility
|
IP
|
$14,060.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,218.24 |
| Max. Negotiated Rate |
$13,498.36 |
| Rate for Payer: Aetna Commercial |
$10,826.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,967.42
|
| Rate for Payer: Cash Price |
$7,030.40
|
| Rate for Payer: Cigna Commercial |
$11,670.46
|
| Rate for Payer: First Health Commercial |
$13,357.75
|
| Rate for Payer: Humana Commercial |
$11,951.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,529.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,376.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,218.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,373.50
|
| Rate for Payer: Ohio Health Group HMO |
$10,545.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,248.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,232.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,701.95
|
| Rate for Payer: PHCS Commercial |
$13,498.36
|
| Rate for Payer: United Healthcare All Payer |
$12,373.50
|
|
|
DYNANAIL MINI 8 MM X 100 MM
|
Facility
|
OP
|
$28,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,581.88 |
| Max. Negotiated Rate |
$27,462.00 |
| Rate for Payer: Aetna Commercial |
$22,026.81
|
| Rate for Payer: Anthem Medicaid |
$9,837.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,312.88
|
| Rate for Payer: Cash Price |
$14,303.12
|
| Rate for Payer: Cigna Commercial |
$23,743.19
|
| Rate for Payer: First Health Commercial |
$27,175.94
|
| Rate for Payer: Humana Commercial |
$24,315.31
|
| Rate for Payer: Humana KY Medicaid |
$9,837.69
|
| Rate for Payer: Kentucky WC Medicaid |
$9,937.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,457.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,111.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,581.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,035.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,173.50
|
| Rate for Payer: Ohio Health Group HMO |
$21,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,885.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,887.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,738.31
|
| Rate for Payer: PHCS Commercial |
$27,462.00
|
| Rate for Payer: United Healthcare All Payer |
$25,173.50
|
|
|
DYNANAIL MINI 8 MM X 100 MM
|
Facility
|
IP
|
$28,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,581.88 |
| Max. Negotiated Rate |
$27,462.00 |
| Rate for Payer: Aetna Commercial |
$22,026.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$22,312.88
|
| Rate for Payer: Cash Price |
$14,303.12
|
| Rate for Payer: Cigna Commercial |
$23,743.19
|
| Rate for Payer: First Health Commercial |
$27,175.94
|
| Rate for Payer: Humana Commercial |
$24,315.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$23,457.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$21,111.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,581.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$25,173.50
|
| Rate for Payer: Ohio Health Group HMO |
$21,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$22,885.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$24,887.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$19,738.31
|
| Rate for Payer: PHCS Commercial |
$27,462.00
|
| Rate for Payer: United Healthcare All Payer |
$25,173.50
|
|
|
DYNANAIL MINI 8 MM X 60 MM
|
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 8 MM X 60 MM
|
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 8 MM X 70 MM
|
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 8 MM X 70 MM
|
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 8 MM X 80 MM
|
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 8 MM X 80 MM
|
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 8 MM X 90 MM
|
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 8 MM X 90 MM
|
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
|
|
|
DYNANITE PIP BENT 12MM
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
DYNANITE PIP BENT 12MM
|
Facility
|
IP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
DYNANITE PIP - BENT 14MM
|
Facility
|
OP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem Medicaid |
$3,410.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Humana KY Medicaid |
$3,410.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,478.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
DYNANITE PIP - BENT 14MM
|
Facility
|
IP
|
$9,916.75
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.03 |
| Max. Negotiated Rate |
$9,520.08 |
| Rate for Payer: Aetna Commercial |
$7,635.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,735.06
|
| Rate for Payer: Cash Price |
$4,958.38
|
| Rate for Payer: Cigna Commercial |
$8,230.90
|
| Rate for Payer: First Health Commercial |
$9,420.91
|
| Rate for Payer: Humana Commercial |
$8,429.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,131.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,318.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,726.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,437.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,627.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,842.56
|
| Rate for Payer: PHCS Commercial |
$9,520.08
|
| Rate for Payer: United Healthcare All Payer |
$8,726.74
|
|
|
DYNASTY A-CL 15DG 36M DLXPLJ36
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DYNASTY A-CL 15DG 36M DLXPLJ36
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DYNASTY A-CL 15DG 36M DLXPLK36
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DYNASTY A-CL 15DG 36M DLXPLK36
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DYNASTY A-CL 15DG LNR 28M GRPB
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DYNASTY A-CL 15DG LNR 28M GRPB
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
DYNASTY A-CL 15DG LNR 32M GRPC
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
