|
VARIAX FIBULA PLATE 11 H
|
Facility
|
OP
|
$4,972.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.36 |
| Max. Negotiated Rate |
$4,773.12 |
| Rate for Payer: Aetna Commercial |
$3,828.44
|
| Rate for Payer: Anthem Medicaid |
$1,709.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,878.16
|
| Rate for Payer: Cash Price |
$2,486.00
|
| Rate for Payer: Cigna Commercial |
$4,126.76
|
| Rate for Payer: First Health Commercial |
$4,723.40
|
| Rate for Payer: Humana Commercial |
$4,226.20
|
| Rate for Payer: Humana KY Medicaid |
$1,709.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,727.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,077.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,669.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,744.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,375.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,729.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$994.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$646.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,541.32
|
| Rate for Payer: PHCS Commercial |
$4,773.12
|
| Rate for Payer: United Healthcare All Payer |
$4,375.36
|
|
|
VARIAX FIBULA PLATE 3 H
|
Facility
|
IP
|
$3,907.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$3,751.37 |
| Rate for Payer: Aetna Commercial |
$3,008.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.99
|
| Rate for Payer: Cash Price |
$1,953.84
|
| Rate for Payer: Cigna Commercial |
$3,243.37
|
| Rate for Payer: First Health Commercial |
$3,712.30
|
| Rate for Payer: Humana Commercial |
$3,321.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.38
|
| Rate for Payer: PHCS Commercial |
$3,751.37
|
| Rate for Payer: United Healthcare All Payer |
$3,438.76
|
|
|
VARIAX FIBULA PLATE 3 H
|
Facility
|
OP
|
$3,907.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$3,751.37 |
| Rate for Payer: Aetna Commercial |
$3,008.91
|
| Rate for Payer: Anthem Medicaid |
$1,343.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.99
|
| Rate for Payer: Cash Price |
$1,953.84
|
| Rate for Payer: Cigna Commercial |
$3,243.37
|
| Rate for Payer: First Health Commercial |
$3,712.30
|
| Rate for Payer: Humana Commercial |
$3,321.53
|
| Rate for Payer: Humana KY Medicaid |
$1,343.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.38
|
| Rate for Payer: PHCS Commercial |
$3,751.37
|
| Rate for Payer: United Healthcare All Payer |
$3,438.76
|
|
|
VARIAX FIBULA PLATE 4 H
|
Facility
|
OP
|
$3,907.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$3,751.37 |
| Rate for Payer: Aetna Commercial |
$3,008.91
|
| Rate for Payer: Anthem Medicaid |
$1,343.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.99
|
| Rate for Payer: Cash Price |
$1,953.84
|
| Rate for Payer: Cigna Commercial |
$3,243.37
|
| Rate for Payer: First Health Commercial |
$3,712.30
|
| Rate for Payer: Humana Commercial |
$3,321.53
|
| Rate for Payer: Humana KY Medicaid |
$1,343.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.38
|
| Rate for Payer: PHCS Commercial |
$3,751.37
|
| Rate for Payer: United Healthcare All Payer |
$3,438.76
|
|
|
VARIAX FIBULA PLATE 4 H
|
Facility
|
IP
|
$3,907.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$3,751.37 |
| Rate for Payer: Aetna Commercial |
$3,008.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.99
|
| Rate for Payer: Cash Price |
$1,953.84
|
| Rate for Payer: Cigna Commercial |
$3,243.37
|
| Rate for Payer: First Health Commercial |
$3,712.30
|
| Rate for Payer: Humana Commercial |
$3,321.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.38
|
| Rate for Payer: PHCS Commercial |
$3,751.37
|
| Rate for Payer: United Healthcare All Payer |
$3,438.76
|
|
|
VARIAX FIBULA PLATE 5 H
|
Facility
|
IP
|
$3,907.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$3,751.37 |
| Rate for Payer: Aetna Commercial |
$3,008.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.99
|
| Rate for Payer: Cash Price |
$1,953.84
|
| Rate for Payer: Cigna Commercial |
$3,243.37
|
| Rate for Payer: First Health Commercial |
$3,712.30
|
| Rate for Payer: Humana Commercial |
$3,321.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.38
|
| Rate for Payer: PHCS Commercial |
$3,751.37
|
| Rate for Payer: United Healthcare All Payer |
$3,438.76
|
|
|
VARIAX FIBULA PLATE 5 H
|
Facility
|
OP
|
$3,907.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.00 |
| Max. Negotiated Rate |
$3,751.37 |
| Rate for Payer: Aetna Commercial |
$3,008.91
|
| Rate for Payer: Anthem Medicaid |
$1,343.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.99
|
| Rate for Payer: Cash Price |
$1,953.84
|
| Rate for Payer: Cigna Commercial |
$3,243.37
|
| Rate for Payer: First Health Commercial |
$3,712.30
|
| Rate for Payer: Humana Commercial |
$3,321.53
|
| Rate for Payer: Humana KY Medicaid |
$1,343.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.38
|
| Rate for Payer: PHCS Commercial |
$3,751.37
|
| Rate for Payer: United Healthcare All Payer |
$3,438.76
|
|
|
VARIAX FIBULA PLATE 6 H
|
Facility
|
OP
|
$3,972.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.38 |
| Max. Negotiated Rate |
$3,813.30 |
| Rate for Payer: Aetna Commercial |
$3,058.59
|
| Rate for Payer: Anthem Medicaid |
$1,366.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.31
|
| Rate for Payer: Cash Price |
$1,986.10
|
| Rate for Payer: Cigna Commercial |
$3,296.92
|
| Rate for Payer: First Health Commercial |
$3,773.58
|
| Rate for Payer: Humana Commercial |
$3,376.36
|
| Rate for Payer: Humana KY Medicaid |
$1,366.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,379.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,931.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,495.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.38
|
| Rate for Payer: PHCS Commercial |
$3,813.30
|
| Rate for Payer: United Healthcare All Payer |
$3,495.53
|
|
|
VARIAX FIBULA PLATE 6 H
|
Facility
|
IP
|
$3,972.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.38 |
| Max. Negotiated Rate |
$3,813.30 |
| Rate for Payer: Aetna Commercial |
$3,058.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.31
|
| Rate for Payer: Cash Price |
$1,986.10
|
| Rate for Payer: Cigna Commercial |
$3,296.92
|
| Rate for Payer: First Health Commercial |
$3,773.58
|
| Rate for Payer: Humana Commercial |
$3,376.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,931.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,495.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.38
|
| Rate for Payer: PHCS Commercial |
$3,813.30
|
| Rate for Payer: United Healthcare All Payer |
$3,495.53
|
|
|
VARIAX FIBULA PLATE 7 H
|
Facility
|
IP
|
$4,124.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.24 |
| Max. Negotiated Rate |
$3,959.96 |
| Rate for Payer: Aetna Commercial |
$3,176.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.47
|
| Rate for Payer: Cash Price |
$2,062.48
|
| Rate for Payer: Cigna Commercial |
$3,423.72
|
| Rate for Payer: First Health Commercial |
$3,918.71
|
| Rate for Payer: Humana Commercial |
$3,506.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,629.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.74
|
| Rate for Payer: PHCS Commercial |
$3,959.96
|
| Rate for Payer: United Healthcare All Payer |
$3,629.96
|
|
|
VARIAX FIBULA PLATE 7 H
|
Facility
|
OP
|
$4,124.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.24 |
| Max. Negotiated Rate |
$3,959.96 |
| Rate for Payer: Aetna Commercial |
$3,176.22
|
| Rate for Payer: Anthem Medicaid |
$1,418.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.47
|
| Rate for Payer: Cash Price |
$2,062.48
|
| Rate for Payer: Cigna Commercial |
$3,423.72
|
| Rate for Payer: First Health Commercial |
$3,918.71
|
| Rate for Payer: Humana Commercial |
$3,506.22
|
| Rate for Payer: Humana KY Medicaid |
$1,418.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,629.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$824.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.74
|
| Rate for Payer: PHCS Commercial |
$3,959.96
|
| Rate for Payer: United Healthcare All Payer |
$3,629.96
|
|
|
VARIAX FIBULA PLATE 7H STR
|
Facility
|
OP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem Medicaid |
$1,608.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Humana KY Medicaid |
$1,608.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,625.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,641.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
VARIAX FIBULA PLATE 7H STR
|
Facility
|
IP
|
$4,678.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.14 |
| Max. Negotiated Rate |
$4,490.88 |
| Rate for Payer: Aetna Commercial |
$3,602.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,648.84
|
| Rate for Payer: Cash Price |
$2,339.00
|
| Rate for Payer: Cigna Commercial |
$3,882.74
|
| Rate for Payer: First Health Commercial |
$4,444.10
|
| Rate for Payer: Humana Commercial |
$3,976.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,835.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,452.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,403.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,116.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,508.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$935.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$608.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,450.18
|
| Rate for Payer: PHCS Commercial |
$4,490.88
|
| Rate for Payer: United Healthcare All Payer |
$4,116.64
|
|
|
VARIAX FIBULA PLATE 8 H
|
Facility
|
IP
|
$6,560.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.92 |
| Max. Negotiated Rate |
$6,298.52 |
| Rate for Payer: Aetna Commercial |
$5,051.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,117.55
|
| Rate for Payer: Cash Price |
$3,280.48
|
| Rate for Payer: Cigna Commercial |
$5,445.60
|
| Rate for Payer: First Health Commercial |
$6,232.91
|
| Rate for Payer: Humana Commercial |
$5,576.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,379.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,841.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,773.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,920.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,033.90
|
| Rate for Payer: PHCS Commercial |
$6,298.52
|
| Rate for Payer: United Healthcare All Payer |
$5,773.64
|
|
|
VARIAX FIBULA PLATE 8 H
|
Facility
|
OP
|
$6,560.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.92 |
| Max. Negotiated Rate |
$6,298.52 |
| Rate for Payer: Aetna Commercial |
$5,051.94
|
| Rate for Payer: Anthem Medicaid |
$2,256.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,117.55
|
| Rate for Payer: Cash Price |
$3,280.48
|
| Rate for Payer: Cigna Commercial |
$5,445.60
|
| Rate for Payer: First Health Commercial |
$6,232.91
|
| Rate for Payer: Humana Commercial |
$5,576.82
|
| Rate for Payer: Humana KY Medicaid |
$2,256.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,279.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,379.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,841.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,301.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,773.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,920.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,033.90
|
| Rate for Payer: PHCS Commercial |
$6,298.52
|
| Rate for Payer: United Healthcare All Payer |
$5,773.64
|
|
|
VARIAX FIBULA PLATE 9 H
|
Facility
|
OP
|
$5,222.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.92 |
| Max. Negotiated Rate |
$5,013.56 |
| Rate for Payer: Aetna Commercial |
$4,021.29
|
| Rate for Payer: Anthem Medicaid |
$1,796.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,073.52
|
| Rate for Payer: Cash Price |
$2,611.23
|
| Rate for Payer: Cigna Commercial |
$4,334.64
|
| Rate for Payer: First Health Commercial |
$4,961.34
|
| Rate for Payer: Humana Commercial |
$4,439.09
|
| Rate for Payer: Humana KY Medicaid |
$1,796.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,814.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,282.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,854.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,566.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,595.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,916.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.96
|
| Rate for Payer: PHCS Commercial |
$5,013.56
|
| Rate for Payer: United Healthcare All Payer |
$4,595.76
|
|
|
VARIAX FIBULA PLATE 9 H
|
Facility
|
IP
|
$5,222.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.92 |
| Max. Negotiated Rate |
$5,013.56 |
| Rate for Payer: Aetna Commercial |
$4,021.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,073.52
|
| Rate for Payer: Cash Price |
$2,611.23
|
| Rate for Payer: Cigna Commercial |
$4,334.64
|
| Rate for Payer: First Health Commercial |
$4,961.34
|
| Rate for Payer: Humana Commercial |
$4,439.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,282.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,854.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,566.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,595.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,916.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.96
|
| Rate for Payer: PHCS Commercial |
$5,013.56
|
| Rate for Payer: United Healthcare All Payer |
$4,595.76
|
|
|
VARICELLA VACCINE LIVE
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
77000044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA VACCINE LIVE
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
77000044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.68 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Buckeye Medicare Advantage |
$372.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Healthspan PPO |
$101.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO/POS/PPO/Workers Compensation |
$242.24
|
| Rate for Payer: Multiplan PHCS |
$223.20
|
| Rate for Payer: Ohio Health Choice Preferred Health Choice |
$260.40
|
| Rate for Payer: UHCCP Medicaid |
$130.20
|
|
|
VARICELLA VACCINE LIVE
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
77000044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA VACCINE LIVE(T
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
770T0044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA VACCINE LIVE(T
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
HCPCS 90716
|
| Hospital Charge Code |
770T0044
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.36 |
| Max. Negotiated Rate |
$357.12 |
| Rate for Payer: Aetna Commercial |
$286.44
|
| Rate for Payer: Anthem Medicaid |
$127.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$290.16
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$308.76
|
| Rate for Payer: First Health Commercial |
$353.40
|
| Rate for Payer: Humana Commercial |
$316.20
|
| Rate for Payer: Humana KY Medicaid |
$127.93
|
| Rate for Payer: Kentucky WC Medicaid |
$129.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$305.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$274.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$111.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$130.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$327.36
|
| Rate for Payer: Ohio Health Group HMO |
$279.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$74.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$48.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$115.32
|
| Rate for Payer: PHCS Commercial |
$357.12
|
| Rate for Payer: United Healthcare All Payer |
$327.36
|
|
|
VARICELLA ZOSTER AB SCREEN
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
30001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem Medicaid |
$57.43
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$12.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.10
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$18.03
|
| Rate for Payer: CareSource Just4Me Medicare |
$12.88
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Humana KY Medicaid |
$57.43
|
| Rate for Payer: Humana Medicare Advantage |
$12.88
|
| Rate for Payer: Kentucky WC Medicaid |
$58.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$15.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$58.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
VARICELLA ZOSTER AB SCREEN
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
HCPCS 86787
|
| Hospital Charge Code |
30001217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.71 |
| Max. Negotiated Rate |
$160.32 |
| Rate for Payer: Aetna Commercial |
$128.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$134.10
|
| Rate for Payer: Cash Price |
$83.50
|
| Rate for Payer: Cigna Commercial |
$138.61
|
| Rate for Payer: First Health Commercial |
$158.65
|
| Rate for Payer: Humana Commercial |
$141.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$136.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$123.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$50.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$146.96
|
| Rate for Payer: Ohio Health Group HMO |
$125.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$21.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$51.77
|
| Rate for Payer: PHCS Commercial |
$160.32
|
| Rate for Payer: United Healthcare All Payer |
$146.96
|
|
|
VARIZIG 125 UNIT/1.2 ML VL
|
Facility
|
OP
|
$3,932.57
|
|
|
Service Code
|
HCPCS 90396
|
| Hospital Charge Code |
25003878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$511.23 |
| Max. Negotiated Rate |
$3,775.27 |
| Rate for Payer: Aetna Commercial |
$3,028.08
|
| Rate for Payer: Anthem Medicaid |
$1,352.41
|
| Rate for Payer: Anthem Medicare Advantage/PPO |
$2,255.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.40
|
| Rate for Payer: Buckeye Individual/Medicaid/Medicare Advantage |
$3,158.33
|
| Rate for Payer: CareSource Just4Me Medicare |
$3,045.53
|
| Rate for Payer: Cash Price |
$1,966.29
|
| Rate for Payer: Cash Price |
$1,966.29
|
| Rate for Payer: Cigna Commercial |
$3,264.03
|
| Rate for Payer: First Health Commercial |
$3,735.94
|
| Rate for Payer: Humana Commercial |
$3,342.68
|
| Rate for Payer: Humana KY Medicaid |
$1,352.41
|
| Rate for Payer: Humana Medicare Advantage |
$2,255.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,707.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.10
|
| Rate for Payer: PHCS Commercial |
$3,775.27
|
| Rate for Payer: United Healthcare All Payer |
$3,460.66
|
|
