|
PLATE VOLAR LUNATE SUTURE
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE VOLAR MIDSHAFT RAD 10H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 10H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 12H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 12H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
|
|
PLATE VOLAR MIDSHAFT RAD 14H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 14H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 16H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 16H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 6H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 6H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 8H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR MIDSHAFT RAD 8H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE VOLAR RADIUS 47MM
|
Facility
|
IP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE VOLAR RADIUS 47MM
|
Facility
|
OP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Anthem Medicaid |
$1,116.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Humana KY Medicaid |
$1,116.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE VOLAR RADIUS 60MM
|
Facility
|
IP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE VOLAR RADIUS 60MM
|
Facility
|
OP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Anthem Medicaid |
$1,116.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Humana KY Medicaid |
$1,116.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE VOLAR SMARTLOCK NAR LONG
|
Facility
|
IP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Aetna Commercial |
$5,243.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
|
|
PLATE VOLAR SMARTLOCK NAR LONG
|
Facility
|
OP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Aetna Commercial |
$5,243.05
|
| Rate for Payer: Anthem Medicaid |
$2,341.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Humana KY Medicaid |
$2,341.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,388.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
|
|
PLATE VOLAR SMARTLOCK NAR SHRT
|
Facility
|
OP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Aetna Commercial |
$5,243.05
|
| Rate for Payer: Anthem Medicaid |
$2,341.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Humana KY Medicaid |
$2,341.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,388.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
|
|
PLATE VOLAR SMARTLOCK NAR SHRT
|
Facility
|
IP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Aetna Commercial |
$5,243.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
|
|
PLATE VOLAR SMARTLOCK STD LONG
|
Facility
|
IP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Aetna Commercial |
$5,243.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
|
|
PLATE VOLAR SMARTLOCK STD LONG
|
Facility
|
OP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Anthem Medicaid |
$2,341.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Humana KY Medicaid |
$2,341.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,388.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
| Rate for Payer: Aetna Commercial |
$5,243.05
|
|
|
PLATE VOLAR SMARTLOCK STD SHRT
|
Facility
|
OP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Aetna Commercial |
$5,243.05
|
| Rate for Payer: Anthem Medicaid |
$2,341.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Humana KY Medicaid |
$2,341.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,365.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,388.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
|
|
PLATE VOLAR SMARTLOCK STD SHRT
|
Facility
|
IP
|
$6,809.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.19 |
| Max. Negotiated Rate |
$6,536.79 |
| Rate for Payer: Aetna Commercial |
$5,243.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,311.14
|
| Rate for Payer: Cash Price |
$3,404.58
|
| Rate for Payer: Cigna Commercial |
$5,651.60
|
| Rate for Payer: First Health Commercial |
$6,468.70
|
| Rate for Payer: Humana Commercial |
$5,787.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,583.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,025.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,042.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,992.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,106.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,110.84
|
| Rate for Payer: PHCS Commercial |
$6,536.79
|
| Rate for Payer: United Healthcare All Payer |
$5,992.06
|
|
