|
PLATE VOLAR W/O LIP NAR R 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/O LIP NAR R 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/O LIP NAR R 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/O LIP NAR R 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/O LIP NAR R 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/O LIP NAR R 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/O LIP NAR R 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
|
|
|
PLATE VOLAR W/O LIP NAR R 7H
|
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 WO LIP RT 4H SHAFT
|
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 WO LIP RT 4H SHAFT
|
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 WO LIP RT 5H SHAFT
|
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 WO LIP RT 5H SHAFT
|
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 WO LIP RT 6H SHAFT
|
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 WO LIP RT 6H SHAFT
|
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 WO LIP RT 7H SHAFT
|
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 WO LIP RT 7H SHAFT
|
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 VOL DIS RAD 6H 2.4*54 L
|
Facility
|
OP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem Medicaid |
$2,421.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Humana KY Medicaid |
$2,421.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 6H 2.4*54 L
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
|
PLATE VOL DIS RAD 6H 2.4*66 L
|
Facility
|
IP
|
$5,615.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.67 |
| Max. Negotiated Rate |
$5,390.94 |
| Rate for Payer: Aetna Commercial |
$4,323.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,380.14
|
| Rate for Payer: Cash Price |
$2,807.78
|
| Rate for Payer: Cigna Commercial |
$4,660.91
|
| Rate for Payer: First Health Commercial |
$5,334.78
|
| Rate for Payer: Humana Commercial |
$4,773.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,604.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,144.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,941.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,211.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,492.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,885.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.74
|
| Rate for Payer: PHCS Commercial |
$5,390.94
|
| Rate for Payer: United Healthcare All Payer |
$4,941.69
|
|
|
PLATE VOL DIS RAD 6H 2.4*66 L
|
Facility
|
OP
|
$5,615.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.67 |
| Max. Negotiated Rate |
$5,390.94 |
| Rate for Payer: Aetna Commercial |
$4,323.98
|
| Rate for Payer: Anthem Medicaid |
$1,931.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,380.14
|
| Rate for Payer: Cash Price |
$2,807.78
|
| Rate for Payer: Cigna Commercial |
$4,660.91
|
| Rate for Payer: First Health Commercial |
$5,334.78
|
| Rate for Payer: Humana Commercial |
$4,773.23
|
| Rate for Payer: Humana KY Medicaid |
$1,931.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,604.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,144.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,941.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,211.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,492.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,885.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.74
|
| Rate for Payer: PHCS Commercial |
$5,390.94
|
| Rate for Payer: United Healthcare All Payer |
$4,941.69
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 L
|
Facility
|
IP
|
$5,748.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.47 |
| Max. Negotiated Rate |
$5,518.31 |
| Rate for Payer: Aetna Commercial |
$4,426.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,483.63
|
| Rate for Payer: Cash Price |
$2,874.12
|
| Rate for Payer: Cigna Commercial |
$4,771.04
|
| Rate for Payer: First Health Commercial |
$5,460.83
|
| Rate for Payer: Humana Commercial |
$4,886.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,713.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,242.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,724.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,058.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,311.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,598.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,000.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,966.29
|
| Rate for Payer: PHCS Commercial |
$5,518.31
|
| Rate for Payer: United Healthcare All Payer |
$5,058.45
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 L
|
Facility
|
OP
|
$5,748.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.47 |
| Max. Negotiated Rate |
$5,518.31 |
| Rate for Payer: Aetna Commercial |
$4,426.14
|
| Rate for Payer: Anthem Medicaid |
$1,976.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,483.63
|
| Rate for Payer: Cash Price |
$2,874.12
|
| Rate for Payer: Cigna Commercial |
$4,771.04
|
| Rate for Payer: First Health Commercial |
$5,460.83
|
| Rate for Payer: Humana Commercial |
$4,886.00
|
| Rate for Payer: Humana KY Medicaid |
$1,976.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,996.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,713.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,242.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,724.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,016.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,058.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,311.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,598.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,000.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,966.29
|
| Rate for Payer: PHCS Commercial |
$5,518.31
|
| Rate for Payer: United Healthcare All Payer |
$5,058.45
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 R
|
Facility
|
OP
|
$5,748.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.47 |
| Max. Negotiated Rate |
$5,518.31 |
| Rate for Payer: Aetna Commercial |
$4,426.14
|
| Rate for Payer: Anthem Medicaid |
$1,976.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,483.63
|
| Rate for Payer: Cash Price |
$2,874.12
|
| Rate for Payer: Cigna Commercial |
$4,771.04
|
| Rate for Payer: First Health Commercial |
$5,460.83
|
| Rate for Payer: Humana Commercial |
$4,886.00
|
| Rate for Payer: Humana KY Medicaid |
$1,976.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,996.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,713.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,242.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,724.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,016.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,058.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,311.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,598.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,000.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,966.29
|
| Rate for Payer: PHCS Commercial |
$5,518.31
|
| Rate for Payer: United Healthcare All Payer |
$5,058.45
|
|
|
PLATE VOL DIS RAD 6H 2.4*75 R
|
Facility
|
IP
|
$5,748.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,724.47 |
| Max. Negotiated Rate |
$5,518.31 |
| Rate for Payer: Aetna Commercial |
$4,426.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,483.63
|
| Rate for Payer: Cash Price |
$2,874.12
|
| Rate for Payer: Cigna Commercial |
$4,771.04
|
| Rate for Payer: First Health Commercial |
$5,460.83
|
| Rate for Payer: Humana Commercial |
$4,886.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,713.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,242.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,724.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,058.45
|
| Rate for Payer: Ohio Health Group HMO |
$4,311.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,598.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,000.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,966.29
|
| Rate for Payer: PHCS Commercial |
$5,518.31
|
| Rate for Payer: United Healthcare All Payer |
$5,058.45
|
|
|
PLATE VOL DIS RAD 7H 2.4*47 L
|
Facility
|
IP
|
$7,042.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,112.77 |
| Max. Negotiated Rate |
$6,760.86 |
| Rate for Payer: Aetna Commercial |
$5,422.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.20
|
| Rate for Payer: Cash Price |
$3,521.28
|
| Rate for Payer: Cigna Commercial |
$5,845.32
|
| Rate for Payer: First Health Commercial |
$6,690.43
|
| Rate for Payer: Humana Commercial |
$5,986.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,774.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,281.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,634.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,127.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,859.37
|
| Rate for Payer: PHCS Commercial |
$6,760.86
|
| Rate for Payer: United Healthcare All Payer |
$6,197.45
|
|
