|
PLATE VARIAX 2 METATR BRD Y 7H
|
Facility
|
IP
|
$9,983.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.82 |
| Max. Negotiated Rate |
$9,583.87 |
| Rate for Payer: Humana Commercial |
$8,485.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,367.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,994.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,996.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,094.79
|
| Rate for Payer: PHCS Commercial |
$9,583.87
|
| Rate for Payer: United Healthcare All Payer |
$8,785.22
|
| Rate for Payer: Aetna Commercial |
$7,687.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,786.90
|
| Rate for Payer: Cash Price |
$4,991.60
|
| Rate for Payer: Cigna Commercial |
$8,286.06
|
| Rate for Payer: First Health Commercial |
$9,484.04
|
|
|
PLATE VARIAX 2 METATR BRD Y 7H
|
Facility
|
OP
|
$9,983.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.82 |
| Max. Negotiated Rate |
$9,583.87 |
| Rate for Payer: Aetna Commercial |
$7,687.06
|
| Rate for Payer: Anthem Medicaid |
$3,433.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,786.90
|
| Rate for Payer: Cash Price |
$4,991.60
|
| Rate for Payer: Cigna Commercial |
$8,286.06
|
| Rate for Payer: First Health Commercial |
$9,484.04
|
| Rate for Payer: Humana Commercial |
$8,485.72
|
| Rate for Payer: Humana KY Medicaid |
$3,433.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,468.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,367.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,994.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,502.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,996.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,094.79
|
| Rate for Payer: PHCS Commercial |
$9,583.87
|
| Rate for Payer: United Healthcare All Payer |
$8,785.22
|
|
|
PLATE VARIAX 2 METATR SLM Y 2H
|
Facility
|
IP
|
$6,529.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$6,268.35 |
| Rate for Payer: Aetna Commercial |
$5,027.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,093.03
|
| Rate for Payer: Cash Price |
$3,264.77
|
| Rate for Payer: Cigna Commercial |
$5,419.51
|
| Rate for Payer: First Health Commercial |
$6,203.05
|
| Rate for Payer: Humana Commercial |
$5,550.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,354.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,818.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,958.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,745.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,897.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,024.15
|
| Rate for Payer: PHCS Commercial |
$6,268.35
|
| Rate for Payer: United Healthcare All Payer |
$5,745.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 2H
|
Facility
|
OP
|
$6,529.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$6,268.35 |
| Rate for Payer: Aetna Commercial |
$5,027.74
|
| Rate for Payer: Anthem Medicaid |
$2,245.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,093.03
|
| Rate for Payer: Cash Price |
$3,264.77
|
| Rate for Payer: Cigna Commercial |
$5,419.51
|
| Rate for Payer: First Health Commercial |
$6,203.05
|
| Rate for Payer: Humana Commercial |
$5,550.10
|
| Rate for Payer: Humana KY Medicaid |
$2,245.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,268.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,354.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,818.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,958.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,290.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,745.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,897.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,024.15
|
| Rate for Payer: PHCS Commercial |
$6,268.35
|
| Rate for Payer: United Healthcare All Payer |
$5,745.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 3H
|
Facility
|
OP
|
$6,529.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$6,268.35 |
| Rate for Payer: Aetna Commercial |
$5,027.74
|
| Rate for Payer: Anthem Medicaid |
$2,245.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,093.03
|
| Rate for Payer: Cash Price |
$3,264.77
|
| Rate for Payer: Cigna Commercial |
$5,419.51
|
| Rate for Payer: First Health Commercial |
$6,203.05
|
| Rate for Payer: Humana Commercial |
$5,550.10
|
| Rate for Payer: Humana KY Medicaid |
$2,245.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,268.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,354.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,818.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,958.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,290.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,745.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,897.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,024.15
|
| Rate for Payer: PHCS Commercial |
$6,268.35
|
| Rate for Payer: United Healthcare All Payer |
$5,745.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 3H
|
Facility
|
IP
|
$6,529.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$6,268.35 |
| Rate for Payer: Aetna Commercial |
$5,027.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,093.03
|
| Rate for Payer: Cash Price |
$3,264.77
|
| Rate for Payer: Cigna Commercial |
$5,419.51
|
| Rate for Payer: First Health Commercial |
$6,203.05
|
| Rate for Payer: Humana Commercial |
$5,550.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,354.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,818.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,958.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,745.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,897.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,024.15
|
| Rate for Payer: PHCS Commercial |
$6,268.35
|
| Rate for Payer: United Healthcare All Payer |
$5,745.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 4H
|
Facility
|
IP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.71 |
| Max. Negotiated Rate |
$4,672.32 |
| Rate for Payer: Aetna Commercial |
$3,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,796.26
|
| Rate for Payer: Cash Price |
$2,433.50
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: First Health Commercial |
$4,623.65
|
| Rate for Payer: Humana Commercial |
$4,136.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,990.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,591.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,460.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,282.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,650.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.77
|
| Rate for Payer: PHCS Commercial |
$4,672.32
|
| Rate for Payer: United Healthcare All Payer |
$4,282.96
|
|
|
PLATE VARIAX 2 METATR SLM Y 4H
|
Facility
|
OP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.71 |
| Max. Negotiated Rate |
$4,672.32 |
| Rate for Payer: Aetna Commercial |
$3,747.59
|
| Rate for Payer: Anthem Medicaid |
$1,673.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,796.26
|
| Rate for Payer: Cash Price |
$2,433.50
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: First Health Commercial |
$4,623.65
|
| Rate for Payer: Humana Commercial |
$4,136.95
|
| Rate for Payer: Humana KY Medicaid |
$1,673.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,690.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,990.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,591.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,460.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,707.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,282.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,650.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.77
|
| Rate for Payer: PHCS Commercial |
$4,672.32
|
| Rate for Payer: United Healthcare All Payer |
$4,282.96
|
|
|
PLATE VARIAX 2 METATR SLM Y 5H
|
Facility
|
OP
|
$6,529.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$6,268.35 |
| Rate for Payer: Humana Commercial |
$5,550.10
|
| Rate for Payer: Humana KY Medicaid |
$2,245.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,268.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,354.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,818.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,958.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,290.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,745.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,897.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,024.15
|
| Rate for Payer: PHCS Commercial |
$6,268.35
|
| Rate for Payer: United Healthcare All Payer |
$5,745.99
|
| Rate for Payer: Aetna Commercial |
$5,027.74
|
| Rate for Payer: Anthem Medicaid |
$2,245.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,093.03
|
| Rate for Payer: Cash Price |
$3,264.77
|
| Rate for Payer: Cigna Commercial |
$5,419.51
|
| Rate for Payer: First Health Commercial |
$6,203.05
|
|
|
PLATE VARIAX 2 METATR SLM Y 5H
|
Facility
|
IP
|
$6,529.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$848.84 |
| Max. Negotiated Rate |
$6,268.35 |
| Rate for Payer: Aetna Commercial |
$5,027.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,093.03
|
| Rate for Payer: Cash Price |
$3,264.77
|
| Rate for Payer: Cigna Commercial |
$5,419.51
|
| Rate for Payer: First Health Commercial |
$6,203.05
|
| Rate for Payer: Humana Commercial |
$5,550.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,354.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,818.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,958.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,745.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,897.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,305.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$848.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,024.15
|
| Rate for Payer: PHCS Commercial |
$6,268.35
|
| Rate for Payer: United Healthcare All Payer |
$5,745.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 6H
|
Facility
|
OP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.71 |
| Max. Negotiated Rate |
$4,672.32 |
| Rate for Payer: Aetna Commercial |
$3,747.59
|
| Rate for Payer: Anthem Medicaid |
$1,673.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,796.26
|
| Rate for Payer: Cash Price |
$2,433.50
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: First Health Commercial |
$4,623.65
|
| Rate for Payer: Humana Commercial |
$4,136.95
|
| Rate for Payer: Humana KY Medicaid |
$1,673.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,690.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,990.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,591.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,460.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,707.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,282.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,650.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.77
|
| Rate for Payer: PHCS Commercial |
$4,672.32
|
| Rate for Payer: United Healthcare All Payer |
$4,282.96
|
|
|
PLATE VARIAX 2 METATR SLM Y 6H
|
Facility
|
IP
|
$4,867.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.71 |
| Max. Negotiated Rate |
$4,672.32 |
| Rate for Payer: Aetna Commercial |
$3,747.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,796.26
|
| Rate for Payer: Cash Price |
$2,433.50
|
| Rate for Payer: Cigna Commercial |
$4,039.61
|
| Rate for Payer: First Health Commercial |
$4,623.65
|
| Rate for Payer: Humana Commercial |
$4,136.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,990.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,591.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,460.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,282.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,650.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$973.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,508.77
|
| Rate for Payer: PHCS Commercial |
$4,672.32
|
| Rate for Payer: United Healthcare All Payer |
$4,282.96
|
|
|
PLATE VARIAX 2 METATR SLM Y 7H
|
Facility
|
IP
|
$8,917.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,159.26 |
| Max. Negotiated Rate |
$8,560.70 |
| Rate for Payer: Aetna Commercial |
$6,866.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,955.57
|
| Rate for Payer: Cash Price |
$4,458.70
|
| Rate for Payer: Cigna Commercial |
$7,401.44
|
| Rate for Payer: First Health Commercial |
$8,471.53
|
| Rate for Payer: Humana Commercial |
$7,579.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,312.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,581.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,847.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,688.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,783.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,159.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,764.39
|
| Rate for Payer: PHCS Commercial |
$8,560.70
|
| Rate for Payer: United Healthcare All Payer |
$7,847.31
|
|
|
PLATE VARIAX 2 METATR SLM Y 7H
|
Facility
|
OP
|
$8,917.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,159.26 |
| Max. Negotiated Rate |
$8,560.70 |
| Rate for Payer: Aetna Commercial |
$6,866.40
|
| Rate for Payer: Anthem Medicaid |
$3,066.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,955.57
|
| Rate for Payer: Cash Price |
$4,458.70
|
| Rate for Payer: Cigna Commercial |
$7,401.44
|
| Rate for Payer: First Health Commercial |
$8,471.53
|
| Rate for Payer: Humana Commercial |
$7,579.79
|
| Rate for Payer: Humana KY Medicaid |
$3,066.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,097.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,312.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,581.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,128.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,847.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,688.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,783.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,159.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,764.39
|
| Rate for Payer: PHCS Commercial |
$8,560.70
|
| Rate for Payer: United Healthcare All Payer |
$7,847.31
|
|
|
PLATE VARIAX CLAVICL 7H 12MM R
|
Facility
|
OP
|
$11,034.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.47 |
| Max. Negotiated Rate |
$10,592.98 |
| Rate for Payer: Aetna Commercial |
$8,496.45
|
| Rate for Payer: Anthem Medicaid |
$3,794.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,606.79
|
| Rate for Payer: Cash Price |
$5,517.18
|
| Rate for Payer: Cigna Commercial |
$9,158.51
|
| Rate for Payer: First Health Commercial |
$10,482.63
|
| Rate for Payer: Humana Commercial |
$9,379.20
|
| Rate for Payer: Humana KY Medicaid |
$3,794.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,833.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,048.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,143.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,310.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,870.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,710.23
|
| Rate for Payer: Ohio Health Group HMO |
$8,275.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,206.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,434.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,420.65
|
| Rate for Payer: PHCS Commercial |
$10,592.98
|
| Rate for Payer: United Healthcare All Payer |
$9,710.23
|
|
|
PLATE VARIAX CLAVICL 7H 12MM R
|
Facility
|
IP
|
$11,034.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,434.47 |
| Max. Negotiated Rate |
$10,592.98 |
| Rate for Payer: Aetna Commercial |
$8,496.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,606.79
|
| Rate for Payer: Cash Price |
$5,517.18
|
| Rate for Payer: Cigna Commercial |
$9,158.51
|
| Rate for Payer: First Health Commercial |
$10,482.63
|
| Rate for Payer: Humana Commercial |
$9,379.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,048.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,143.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,310.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,710.23
|
| Rate for Payer: Ohio Health Group HMO |
$8,275.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,206.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,434.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,420.65
|
| Rate for Payer: PHCS Commercial |
$10,592.98
|
| Rate for Payer: United Healthcare All Payer |
$9,710.23
|
|
|
PLATE VARIAX CLAVICLE 6H 12MM
|
Facility
|
OP
|
$7,985.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.13 |
| Max. Negotiated Rate |
$7,666.20 |
| Rate for Payer: Aetna Commercial |
$6,148.94
|
| Rate for Payer: Anthem Medicaid |
$2,746.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,228.79
|
| Rate for Payer: Cash Price |
$3,992.81
|
| Rate for Payer: Cigna Commercial |
$6,628.07
|
| Rate for Payer: First Health Commercial |
$7,586.35
|
| Rate for Payer: Humana Commercial |
$6,787.79
|
| Rate for Payer: Humana KY Medicaid |
$2,746.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,774.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,548.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,893.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,395.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,801.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,027.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,989.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.55
|
| Rate for Payer: PHCS Commercial |
$7,666.20
|
| Rate for Payer: United Healthcare All Payer |
$7,027.35
|
|
|
PLATE VARIAX CLAVICLE 6H 12MM
|
Facility
|
IP
|
$7,985.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.13 |
| Max. Negotiated Rate |
$7,666.20 |
| Rate for Payer: Aetna Commercial |
$6,148.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,228.79
|
| Rate for Payer: Cash Price |
$3,992.81
|
| Rate for Payer: Cigna Commercial |
$6,628.07
|
| Rate for Payer: First Health Commercial |
$7,586.35
|
| Rate for Payer: Humana Commercial |
$6,787.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,548.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,893.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,395.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,027.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,989.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,475.55
|
| Rate for Payer: PHCS Commercial |
$7,666.20
|
| Rate for Payer: United Healthcare All Payer |
$7,027.35
|
|
|
PLATE VARIAX COMP BROAD 6H
|
Facility
|
IP
|
$3,367.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.82 |
| Max. Negotiated Rate |
$3,233.16 |
| Rate for Payer: Aetna Commercial |
$2,593.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
| Rate for Payer: Cash Price |
$1,683.94
|
| Rate for Payer: Cigna Commercial |
$2,795.34
|
| Rate for Payer: First Health Commercial |
$3,199.49
|
| Rate for Payer: Humana Commercial |
$2,862.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
| Rate for Payer: PHCS Commercial |
$3,233.16
|
| Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
|
PLATE VARIAX COMP BROAD 6H
|
Facility
|
OP
|
$3,367.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.82 |
| Max. Negotiated Rate |
$3,233.16 |
| Rate for Payer: Aetna Commercial |
$2,593.27
|
| Rate for Payer: Anthem Medicaid |
$1,158.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
| Rate for Payer: Cash Price |
$1,683.94
|
| Rate for Payer: Cigna Commercial |
$2,795.34
|
| Rate for Payer: First Health Commercial |
$3,199.49
|
| Rate for Payer: Humana Commercial |
$2,862.70
|
| Rate for Payer: Humana KY Medicaid |
$1,158.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
| Rate for Payer: PHCS Commercial |
$3,233.16
|
| Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
|
PLATE VARIAX COMP BROAD 7H
|
Facility
|
OP
|
$4,933.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.36 |
| Max. Negotiated Rate |
$4,736.16 |
| Rate for Payer: Aetna Commercial |
$3,798.80
|
| Rate for Payer: Anthem Medicaid |
$1,696.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,848.13
|
| Rate for Payer: Cash Price |
$2,466.75
|
| Rate for Payer: Cigna Commercial |
$4,094.80
|
| Rate for Payer: First Health Commercial |
$4,686.82
|
| Rate for Payer: Humana Commercial |
$4,193.48
|
| Rate for Payer: Humana KY Medicaid |
$1,696.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,713.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,045.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,640.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,480.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,730.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,341.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,700.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.38
|
| Rate for Payer: PHCS Commercial |
$4,736.16
|
| Rate for Payer: United Healthcare All Payer |
$4,341.48
|
|
|
PLATE VARIAX COMP BROAD 7H
|
Facility
|
IP
|
$4,933.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.36 |
| Max. Negotiated Rate |
$4,736.16 |
| Rate for Payer: Aetna Commercial |
$3,798.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,848.13
|
| Rate for Payer: Cash Price |
$2,466.75
|
| Rate for Payer: Cigna Commercial |
$4,094.80
|
| Rate for Payer: First Health Commercial |
$4,686.82
|
| Rate for Payer: Humana Commercial |
$4,193.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,045.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,640.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,480.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,341.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,700.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$641.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.38
|
| Rate for Payer: PHCS Commercial |
$4,736.16
|
| Rate for Payer: United Healthcare All Payer |
$4,341.48
|
|
|
PLATE VARIAX COMP BROAD STR 8H
|
Facility
|
OP
|
$6,982.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.78 |
| Max. Negotiated Rate |
$6,703.58 |
| Rate for Payer: Aetna Commercial |
$5,376.83
|
| Rate for Payer: Anthem Medicaid |
$2,401.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,446.66
|
| Rate for Payer: Cash Price |
$3,491.45
|
| Rate for Payer: Cigna Commercial |
$5,795.81
|
| Rate for Payer: First Health Commercial |
$6,633.76
|
| Rate for Payer: Humana Commercial |
$5,935.46
|
| Rate for Payer: Humana KY Medicaid |
$2,401.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,425.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,725.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,153.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,094.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,449.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,144.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,237.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,164.70
|
| Rate for Payer: PHCS Commercial |
$6,703.58
|
| Rate for Payer: United Healthcare All Payer |
$6,144.95
|
|
|
PLATE VARIAX COMP BROAD STR 8H
|
Facility
|
IP
|
$6,982.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.78 |
| Max. Negotiated Rate |
$6,703.58 |
| Rate for Payer: Aetna Commercial |
$5,376.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,446.66
|
| Rate for Payer: Cash Price |
$3,491.45
|
| Rate for Payer: Cigna Commercial |
$5,795.81
|
| Rate for Payer: First Health Commercial |
$6,633.76
|
| Rate for Payer: Humana Commercial |
$5,935.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,725.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,153.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,094.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,144.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,237.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,164.70
|
| Rate for Payer: PHCS Commercial |
$6,703.58
|
| Rate for Payer: United Healthcare All Payer |
$6,144.95
|
|
|
PLATE VARIAX COMP NAR STR 6H
|
Facility
|
OP
|
$3,367.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.82 |
| Max. Negotiated Rate |
$3,233.16 |
| Rate for Payer: Aetna Commercial |
$2,593.27
|
| Rate for Payer: Anthem Medicaid |
$1,158.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
| Rate for Payer: Cash Price |
$1,683.94
|
| Rate for Payer: Cigna Commercial |
$2,795.34
|
| Rate for Payer: First Health Commercial |
$3,199.49
|
| Rate for Payer: Humana Commercial |
$2,862.70
|
| Rate for Payer: Humana KY Medicaid |
$1,158.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
| Rate for Payer: PHCS Commercial |
$3,233.16
|
| Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
