|
PLATE VARIAX 2 METATR SLM Y 6H
|
Facility
|
OP
|
$4,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,457.25 |
| Max. Negotiated Rate |
$4,663.20 |
| Rate for Payer: Aetna Commercial |
$3,740.28
|
| Rate for Payer: Anthem Medicaid |
$1,670.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,788.85
|
| Rate for Payer: Cash Price |
$2,428.75
|
| Rate for Payer: Cigna Commercial |
$4,031.72
|
| Rate for Payer: First Health Commercial |
$4,614.62
|
| Rate for Payer: Humana Commercial |
$4,128.88
|
| Rate for Payer: Humana KY Medicaid |
$1,670.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,687.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,983.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,584.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,274.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,643.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,226.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,351.68
|
| Rate for Payer: PHCS Commercial |
$4,663.20
|
| Rate for Payer: United Healthcare All Payer |
$4,274.60
|
|
|
PLATE VARIAX 2 METATR SLM Y 7H
|
Facility
|
OP
|
$9,117.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,735.22 |
| Max. Negotiated Rate |
$8,752.70 |
| Rate for Payer: Aetna Commercial |
$7,020.40
|
| Rate for Payer: Anthem Medicaid |
$3,135.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,111.57
|
| Rate for Payer: Cash Price |
$4,558.70
|
| Rate for Payer: Cigna Commercial |
$7,567.44
|
| Rate for Payer: First Health Commercial |
$8,661.53
|
| Rate for Payer: Humana Commercial |
$7,749.79
|
| Rate for Payer: Humana KY Medicaid |
$3,135.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,167.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,728.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,735.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,198.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,932.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,291.01
|
| Rate for Payer: PHCS Commercial |
$8,752.70
|
| Rate for Payer: United Healthcare All Payer |
$8,023.31
|
|
|
PLATE VARIAX 2 METATR SLM Y 7H
|
Facility
|
IP
|
$9,117.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,735.22 |
| Max. Negotiated Rate |
$8,752.70 |
| Rate for Payer: Aetna Commercial |
$7,020.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,111.57
|
| Rate for Payer: Cash Price |
$4,558.70
|
| Rate for Payer: Cigna Commercial |
$7,567.44
|
| Rate for Payer: First Health Commercial |
$8,661.53
|
| Rate for Payer: Humana Commercial |
$7,749.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,728.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,735.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.31
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,293.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,932.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,291.01
|
| Rate for Payer: PHCS Commercial |
$8,752.70
|
| Rate for Payer: United Healthcare All Payer |
$8,023.31
|
|
|
PLATE VARIAX CLAVICL 7H 12MM R
|
Facility
|
OP
|
$11,276.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,383.02 |
| Max. Negotiated Rate |
$10,825.66 |
| Rate for Payer: Aetna Commercial |
$8,683.08
|
| Rate for Payer: Anthem Medicaid |
$3,878.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,795.85
|
| Rate for Payer: Cash Price |
$5,638.36
|
| Rate for Payer: Cigna Commercial |
$9,359.69
|
| Rate for Payer: First Health Commercial |
$10,712.89
|
| Rate for Payer: Humana Commercial |
$9,585.22
|
| Rate for Payer: Humana KY Medicaid |
$3,878.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,917.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,246.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,322.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,383.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,955.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,923.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,021.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,810.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,780.94
|
| Rate for Payer: PHCS Commercial |
$10,825.66
|
| Rate for Payer: United Healthcare All Payer |
$9,923.52
|
|
|
PLATE VARIAX CLAVICL 7H 12MM R
|
Facility
|
IP
|
$11,276.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,383.02 |
| Max. Negotiated Rate |
$10,825.66 |
| Rate for Payer: Aetna Commercial |
$8,683.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,795.85
|
| Rate for Payer: Cash Price |
$5,638.36
|
| Rate for Payer: Cigna Commercial |
$9,359.69
|
| Rate for Payer: First Health Commercial |
$10,712.89
|
| Rate for Payer: Humana Commercial |
$9,585.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,246.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,322.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,383.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,923.52
|
| Rate for Payer: Ohio Health Group HMO |
$8,457.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,021.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,810.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,780.94
|
| Rate for Payer: PHCS Commercial |
$10,825.66
|
| Rate for Payer: United Healthcare All Payer |
$9,923.52
|
|
|
PLATE VARIAX CLAVICLE 6H 12MM
|
Facility
|
IP
|
$8,185.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.69 |
| Max. Negotiated Rate |
$7,858.20 |
| Rate for Payer: Aetna Commercial |
$6,302.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,384.79
|
| Rate for Payer: Cash Price |
$4,092.81
|
| Rate for Payer: Cigna Commercial |
$6,794.07
|
| Rate for Payer: First Health Commercial |
$7,776.35
|
| Rate for Payer: Humana Commercial |
$6,957.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,040.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.35
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,121.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,648.08
|
| Rate for Payer: PHCS Commercial |
$7,858.20
|
| Rate for Payer: United Healthcare All Payer |
$7,203.35
|
|
|
PLATE VARIAX CLAVICLE 6H 12MM
|
Facility
|
OP
|
$8,185.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,455.69 |
| Max. Negotiated Rate |
$7,858.20 |
| Rate for Payer: Aetna Commercial |
$6,302.94
|
| Rate for Payer: Anthem Medicaid |
$2,815.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,384.79
|
| Rate for Payer: Cash Price |
$4,092.81
|
| Rate for Payer: Cigna Commercial |
$6,794.07
|
| Rate for Payer: First Health Commercial |
$7,776.35
|
| Rate for Payer: Humana Commercial |
$6,957.79
|
| Rate for Payer: Humana KY Medicaid |
$2,815.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,843.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,712.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,040.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,455.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,871.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,203.35
|
| Rate for Payer: Ohio Health Group HMO |
$6,139.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,548.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,121.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,648.08
|
| Rate for Payer: PHCS Commercial |
$7,858.20
|
| Rate for Payer: United Healthcare All Payer |
$7,203.35
|
|
|
PLATE VARIAX COMP BROAD 6H
|
Facility
|
IP
|
$3,213.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.13 |
| Max. Negotiated Rate |
$3,085.21 |
| Rate for Payer: Aetna Commercial |
$2,474.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,506.73
|
| Rate for Payer: Cash Price |
$1,606.88
|
| Rate for Payer: Cigna Commercial |
$2,667.42
|
| Rate for Payer: First Health Commercial |
$3,053.07
|
| Rate for Payer: Humana Commercial |
$2,731.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,371.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,571.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,217.49
|
| Rate for Payer: PHCS Commercial |
$3,085.21
|
| Rate for Payer: United Healthcare All Payer |
$2,828.11
|
|
|
PLATE VARIAX COMP BROAD 6H
|
Facility
|
OP
|
$3,213.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.13 |
| Max. Negotiated Rate |
$3,085.21 |
| Rate for Payer: Aetna Commercial |
$2,474.60
|
| Rate for Payer: Anthem Medicaid |
$1,105.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,506.73
|
| Rate for Payer: Cash Price |
$1,606.88
|
| Rate for Payer: Cigna Commercial |
$2,667.42
|
| Rate for Payer: First Health Commercial |
$3,053.07
|
| Rate for Payer: Humana Commercial |
$2,731.70
|
| Rate for Payer: Humana KY Medicaid |
$1,105.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,371.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,571.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,795.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,217.49
|
| Rate for Payer: PHCS Commercial |
$3,085.21
|
| Rate for Payer: United Healthcare All Payer |
$2,828.11
|
|
|
PLATE VARIAX COMP BROAD 7H
|
Facility
|
OP
|
$3,432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.75 |
| Max. Negotiated Rate |
$3,295.20 |
| Rate for Payer: Aetna Commercial |
$2,643.03
|
| Rate for Payer: Anthem Medicaid |
$1,180.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,677.35
|
| Rate for Payer: Cash Price |
$1,716.25
|
| Rate for Payer: Cigna Commercial |
$2,848.97
|
| Rate for Payer: First Health Commercial |
$3,260.88
|
| Rate for Payer: Humana Commercial |
$2,917.62
|
| Rate for Payer: Humana KY Medicaid |
$1,180.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,986.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.43
|
| Rate for Payer: PHCS Commercial |
$3,295.20
|
| Rate for Payer: United Healthcare All Payer |
$3,020.60
|
|
|
PLATE VARIAX COMP BROAD 7H
|
Facility
|
IP
|
$3,432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.75 |
| Max. Negotiated Rate |
$3,295.20 |
| Rate for Payer: Aetna Commercial |
$2,643.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,677.35
|
| Rate for Payer: Cash Price |
$1,716.25
|
| Rate for Payer: Cigna Commercial |
$2,848.97
|
| Rate for Payer: First Health Commercial |
$3,260.88
|
| Rate for Payer: Humana Commercial |
$2,917.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,986.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.43
|
| Rate for Payer: PHCS Commercial |
$3,295.20
|
| Rate for Payer: United Healthcare All Payer |
$3,020.60
|
|
|
PLATE VARIAX COMP BROAD STR 8H
|
Facility
|
OP
|
$7,182.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.87 |
| Max. Negotiated Rate |
$6,895.58 |
| Rate for Payer: Aetna Commercial |
$5,530.83
|
| Rate for Payer: Anthem Medicaid |
$2,470.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,602.66
|
| Rate for Payer: Cash Price |
$3,591.45
|
| Rate for Payer: Cigna Commercial |
$5,961.81
|
| Rate for Payer: First Health Commercial |
$6,823.76
|
| Rate for Payer: Humana Commercial |
$6,105.47
|
| Rate for Payer: Humana KY Medicaid |
$2,470.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,495.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,519.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,746.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,249.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,956.20
|
| Rate for Payer: PHCS Commercial |
$6,895.58
|
| Rate for Payer: United Healthcare All Payer |
$6,320.95
|
|
|
PLATE VARIAX COMP BROAD STR 8H
|
Facility
|
IP
|
$7,182.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.87 |
| Max. Negotiated Rate |
$6,895.58 |
| Rate for Payer: Aetna Commercial |
$5,530.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,602.66
|
| Rate for Payer: Cash Price |
$3,591.45
|
| Rate for Payer: Cigna Commercial |
$5,961.81
|
| Rate for Payer: First Health Commercial |
$6,823.76
|
| Rate for Payer: Humana Commercial |
$6,105.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,746.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,249.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,956.20
|
| Rate for Payer: PHCS Commercial |
$6,895.58
|
| Rate for Payer: United Healthcare All Payer |
$6,320.95
|
|
|
PLATE VARIAX COMP NAR STR 6H
|
Facility
|
OP
|
$3,432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.75 |
| Max. Negotiated Rate |
$3,295.20 |
| Rate for Payer: Aetna Commercial |
$2,643.03
|
| Rate for Payer: Anthem Medicaid |
$1,180.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,677.35
|
| Rate for Payer: Cash Price |
$1,716.25
|
| Rate for Payer: Cigna Commercial |
$2,848.97
|
| Rate for Payer: First Health Commercial |
$3,260.88
|
| Rate for Payer: Humana Commercial |
$2,917.62
|
| Rate for Payer: Humana KY Medicaid |
$1,180.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,986.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.43
|
| Rate for Payer: PHCS Commercial |
$3,295.20
|
| Rate for Payer: United Healthcare All Payer |
$3,020.60
|
|
|
PLATE VARIAX COMP NAR STR 6H
|
Facility
|
IP
|
$3,432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.75 |
| Max. Negotiated Rate |
$3,295.20 |
| Rate for Payer: Aetna Commercial |
$2,643.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,677.35
|
| Rate for Payer: Cash Price |
$1,716.25
|
| Rate for Payer: Cigna Commercial |
$2,848.97
|
| Rate for Payer: First Health Commercial |
$3,260.88
|
| Rate for Payer: Humana Commercial |
$2,917.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,986.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.43
|
| Rate for Payer: PHCS Commercial |
$3,295.20
|
| Rate for Payer: United Healthcare All Payer |
$3,020.60
|
|
|
PLATE VARIAX COMP NAR STR 8H
|
Facility
|
IP
|
$3,833.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.99 |
| Max. Negotiated Rate |
$3,679.97 |
| Rate for Payer: Aetna Commercial |
$2,951.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,989.97
|
| Rate for Payer: Cash Price |
$1,916.65
|
| Rate for Payer: Cigna Commercial |
$3,181.64
|
| Rate for Payer: First Health Commercial |
$3,641.64
|
| Rate for Payer: Humana Commercial |
$3,258.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,143.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,828.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,149.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,373.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,874.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,066.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,334.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.98
|
| Rate for Payer: PHCS Commercial |
$3,679.97
|
| Rate for Payer: United Healthcare All Payer |
$3,373.30
|
|
|
PLATE VARIAX COMP NAR STR 8H
|
Facility
|
OP
|
$3,833.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.99 |
| Max. Negotiated Rate |
$3,679.97 |
| Rate for Payer: Aetna Commercial |
$2,951.64
|
| Rate for Payer: Anthem Medicaid |
$1,318.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,989.97
|
| Rate for Payer: Cash Price |
$1,916.65
|
| Rate for Payer: Cigna Commercial |
$3,181.64
|
| Rate for Payer: First Health Commercial |
$3,641.64
|
| Rate for Payer: Humana Commercial |
$3,258.30
|
| Rate for Payer: Humana KY Medicaid |
$1,318.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,331.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,143.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,828.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,149.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,344.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,373.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,874.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,066.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,334.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,644.98
|
| Rate for Payer: PHCS Commercial |
$3,679.97
|
| Rate for Payer: United Healthcare All Payer |
$3,373.30
|
|
|
PLATE VARIAX COMP NAR STR 9H
|
Facility
|
IP
|
$4,881.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.40 |
| Max. Negotiated Rate |
$4,686.10 |
| Rate for Payer: Aetna Commercial |
$3,758.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.45
|
| Rate for Payer: Cash Price |
$2,440.68
|
| Rate for Payer: Cigna Commercial |
$4,051.52
|
| Rate for Payer: First Health Commercial |
$4,637.28
|
| Rate for Payer: Humana Commercial |
$4,149.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,002.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,295.59
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,246.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.13
|
| Rate for Payer: PHCS Commercial |
$4,686.10
|
| Rate for Payer: United Healthcare All Payer |
$4,295.59
|
|
|
PLATE VARIAX COMP NAR STR 9H
|
Facility
|
OP
|
$4,881.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.40 |
| Max. Negotiated Rate |
$4,686.10 |
| Rate for Payer: Aetna Commercial |
$3,758.64
|
| Rate for Payer: Anthem Medicaid |
$1,678.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,807.45
|
| Rate for Payer: Cash Price |
$2,440.68
|
| Rate for Payer: Cigna Commercial |
$4,051.52
|
| Rate for Payer: First Health Commercial |
$4,637.28
|
| Rate for Payer: Humana Commercial |
$4,149.15
|
| Rate for Payer: Humana KY Medicaid |
$1,678.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,695.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,002.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,602.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,295.59
|
| Rate for Payer: Ohio Health Group HMO |
$3,661.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,905.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,246.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,368.13
|
| Rate for Payer: PHCS Commercial |
$4,686.10
|
| Rate for Payer: United Healthcare All Payer |
$4,295.59
|
|
|
PLATE VARIAX FIBULA 6H STR
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE VARIAX FIBULA 6H STR
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE VLP MINI-MOD 1.5MM Y 6H
|
Facility
|
IP
|
$5,090.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.11 |
| Max. Negotiated Rate |
$4,886.76 |
| Rate for Payer: Aetna Commercial |
$3,919.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.50
|
| Rate for Payer: Cash Price |
$2,545.19
|
| Rate for Payer: Cigna Commercial |
$4,225.02
|
| Rate for Payer: First Health Commercial |
$4,835.86
|
| Rate for Payer: Humana Commercial |
$4,326.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,174.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.36
|
| Rate for Payer: PHCS Commercial |
$4,886.76
|
| Rate for Payer: United Healthcare All Payer |
$4,479.53
|
|
|
PLATE VLP MINI-MOD 1.5MM Y 6H
|
Facility
|
OP
|
$5,090.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,527.11 |
| Max. Negotiated Rate |
$4,886.76 |
| Rate for Payer: Aetna Commercial |
$3,919.59
|
| Rate for Payer: Anthem Medicaid |
$1,750.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,970.50
|
| Rate for Payer: Cash Price |
$2,545.19
|
| Rate for Payer: Cigna Commercial |
$4,225.02
|
| Rate for Payer: First Health Commercial |
$4,835.86
|
| Rate for Payer: Humana Commercial |
$4,326.82
|
| Rate for Payer: Humana KY Medicaid |
$1,750.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,768.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,174.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,756.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,527.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,785.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,479.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,817.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,072.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,428.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,512.36
|
| Rate for Payer: PHCS Commercial |
$4,886.76
|
| Rate for Payer: United Healthcare All Payer |
$4,479.53
|
|
|
PLATE VLP MINI-MOD 1.5MM Y 8H
|
Facility
|
IP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
|
PLATE VLP MINI-MOD 1.5MM Y 8H
|
Facility
|
OP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem Medicaid |
$1,957.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Humana KY Medicaid |
$1,957.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,977.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
