|
PLATE VOLAR MIDSHAFT RAD 8H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 8H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR RADIUS 47MM
|
Facility
|
IP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE VOLAR RADIUS 47MM
|
Facility
|
OP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem Medicaid |
$1,073.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Humana KY Medicaid |
$1,073.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE VOLAR RADIUS 60MM
|
Facility
|
IP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE VOLAR RADIUS 60MM
|
Facility
|
OP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem Medicaid |
$1,073.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Humana KY Medicaid |
$1,073.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE VOLAR SMARTLOCK NAR LONG
|
Facility
|
IP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK NAR LONG
|
Facility
|
OP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem Medicaid |
$2,410.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Humana KY Medicaid |
$2,410.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,434.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,458.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK NAR SHRT
|
Facility
|
OP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem Medicaid |
$2,410.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Humana KY Medicaid |
$2,410.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,434.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,458.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK NAR SHRT
|
Facility
|
IP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK STD LONG
|
Facility
|
IP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK STD LONG
|
Facility
|
OP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem Medicaid |
$2,410.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Humana KY Medicaid |
$2,410.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,434.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,458.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK STD SHRT
|
Facility
|
OP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem Medicaid |
$2,410.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Humana KY Medicaid |
$2,410.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,434.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,458.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK STD SHRT
|
Facility
|
IP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK WIDE LNG
|
Facility
|
IP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK WIDE LNG
|
Facility
|
OP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem Medicaid |
$2,410.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Humana KY Medicaid |
$2,410.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,434.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,458.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK WIDE SHT
|
Facility
|
IP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR SMARTLOCK WIDE SHT
|
Facility
|
OP
|
$7,009.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,102.75 |
| Max. Negotiated Rate |
$6,728.79 |
| Rate for Payer: Aetna Commercial |
$5,397.05
|
| Rate for Payer: Anthem Medicaid |
$2,410.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,467.14
|
| Rate for Payer: Cash Price |
$3,504.58
|
| Rate for Payer: Cigna Commercial |
$5,817.60
|
| Rate for Payer: First Health Commercial |
$6,658.70
|
| Rate for Payer: Humana Commercial |
$5,957.79
|
| Rate for Payer: Humana KY Medicaid |
$2,410.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,434.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,747.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,172.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,102.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,458.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,168.06
|
| Rate for Payer: Ohio Health Group HMO |
$5,256.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,607.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,097.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,836.32
|
| Rate for Payer: PHCS Commercial |
$6,728.79
|
| Rate for Payer: United Healthcare All Payer |
$6,168.06
|
|
|
PLATE VOLAR W/LIP LEFT 4H
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem Medicaid |
$1,683.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Humana KY Medicaid |
$1,683.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,700.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE VOLAR W/LIP LEFT 4H
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE VOLAR W/LIP LEFT 5H
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE VOLAR W/LIP LEFT 5H
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem Medicaid |
$1,683.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Humana KY Medicaid |
$1,683.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,700.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE VOLAR W/LIP LEFT 6H
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE VOLAR W/LIP LEFT 6H
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem Medicaid |
$1,683.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Humana KY Medicaid |
$1,683.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,700.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE VOLAR W/LIP LEFT 7H
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
