|
VANGUARD VNGD CR TIB BRG 59X13
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD VNGD CR TIB BRG 59X13
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD VNGD CR TIB BRG 59X14
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD VNGD CR TIB BRG 59X14
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD VNGD CR TIB BRG 59X16
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD VNGD CR TIB BRG 59X16
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD VNGD CR TIB BRG 59X18
|
Facility
|
IP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VANGUARD VNGD CR TIB BRG 59X18
|
Facility
|
OP
|
$15,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$14,880.00 |
| Rate for Payer: Aetna Commercial |
$11,935.00
|
| Rate for Payer: Anthem Medicaid |
$5,330.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,090.00
|
| Rate for Payer: Cash Price |
$7,750.00
|
| Rate for Payer: Cigna Commercial |
$12,865.00
|
| Rate for Payer: First Health Commercial |
$14,725.00
|
| Rate for Payer: Humana Commercial |
$13,175.00
|
| Rate for Payer: Humana KY Medicaid |
$5,330.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,384.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,710.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,439.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,650.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,437.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,640.00
|
| Rate for Payer: Ohio Health Group HMO |
$11,625.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,485.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,695.00
|
| Rate for Payer: PHCS Commercial |
$14,880.00
|
| Rate for Payer: United Healthcare All Payer |
$13,640.00
|
|
|
VAPRISOL 20MG AMP
|
Facility
|
IP
|
$1,833.32
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003557
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$550.00 |
| Max. Negotiated Rate |
$1,759.99 |
| Rate for Payer: Aetna Commercial |
$1,411.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.99
|
| Rate for Payer: Cash Price |
$916.66
|
| Rate for Payer: Cigna Commercial |
$1,521.66
|
| Rate for Payer: First Health Commercial |
$1,741.65
|
| Rate for Payer: Humana Commercial |
$1,558.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,613.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,466.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,594.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.99
|
| Rate for Payer: PHCS Commercial |
$1,759.99
|
| Rate for Payer: United Healthcare All Payer |
$1,613.32
|
|
|
VAPRISOL 20MG AMP
|
Facility
|
OP
|
$1,833.32
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
25003557
|
|
Hospital Revenue Code
|
890
|
| Min. Negotiated Rate |
$550.00 |
| Max. Negotiated Rate |
$1,759.99 |
| Rate for Payer: Aetna Commercial |
$1,411.66
|
| Rate for Payer: Anthem Medicaid |
$630.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,429.99
|
| Rate for Payer: Cash Price |
$916.66
|
| Rate for Payer: Cigna Commercial |
$1,521.66
|
| Rate for Payer: First Health Commercial |
$1,741.65
|
| Rate for Payer: Humana Commercial |
$1,558.32
|
| Rate for Payer: Humana KY Medicaid |
$630.48
|
| Rate for Payer: Kentucky WC Medicaid |
$636.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,503.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$643.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,613.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,466.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,594.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.99
|
| Rate for Payer: PHCS Commercial |
$1,759.99
|
| Rate for Payer: United Healthcare All Payer |
$1,613.32
|
|
|
VAQTA 50U/1ML (HEP A ADULT)
|
Facility
|
IP
|
$349.57
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
25000011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$335.59 |
| Rate for Payer: Aetna Commercial |
$269.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.66
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cigna Commercial |
$290.14
|
| Rate for Payer: First Health Commercial |
$332.09
|
| Rate for Payer: Humana Commercial |
$297.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.62
|
| Rate for Payer: Ohio Health Group HMO |
$262.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.20
|
| Rate for Payer: PHCS Commercial |
$335.59
|
| Rate for Payer: United Healthcare All Payer |
$307.62
|
|
|
VAQTA 50U/1ML (HEP A ADULT)
|
Facility
|
OP
|
$349.57
|
|
|
Service Code
|
HCPCS 90632
|
| Hospital Charge Code |
25000011
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.87 |
| Max. Negotiated Rate |
$335.59 |
| Rate for Payer: Aetna Commercial |
$269.17
|
| Rate for Payer: Anthem Medicaid |
$120.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$272.66
|
| Rate for Payer: Cash Price |
$174.78
|
| Rate for Payer: Cigna Commercial |
$290.14
|
| Rate for Payer: First Health Commercial |
$332.09
|
| Rate for Payer: Humana Commercial |
$297.13
|
| Rate for Payer: Humana KY Medicaid |
$120.22
|
| Rate for Payer: Kentucky WC Medicaid |
$121.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$286.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$257.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$104.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$122.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$307.62
|
| Rate for Payer: Ohio Health Group HMO |
$262.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$279.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$304.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$241.20
|
| Rate for Payer: PHCS Commercial |
$335.59
|
| Rate for Payer: United Healthcare All Payer |
$307.62
|
|
|
VARIAN CRYO PROBE 17.MM 16.5G
|
Facility
|
IP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
VARIAN CRYO PROBE 17.MM 16.5G
|
Facility
|
OP
|
$8,821.75
|
|
|
Service Code
|
HCPCS C2618
|
| Hospital Charge Code |
27000207
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.53 |
| Max. Negotiated Rate |
$8,468.88 |
| Rate for Payer: Aetna Commercial |
$6,792.75
|
| Rate for Payer: Anthem Medicaid |
$3,033.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.97
|
| Rate for Payer: Cash Price |
$4,410.88
|
| Rate for Payer: Cigna Commercial |
$7,322.05
|
| Rate for Payer: First Health Commercial |
$8,380.66
|
| Rate for Payer: Humana Commercial |
$7,498.49
|
| Rate for Payer: Humana KY Medicaid |
$3,033.80
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,057.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,674.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,087.01
|
| Rate for Payer: PHCS Commercial |
$8,468.88
|
| Rate for Payer: United Healthcare All Payer |
$7,763.14
|
|
|
VARIAX FIBULA PLATE 10 H
|
Facility
|
IP
|
$4,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$4,771.20 |
| Rate for Payer: Aetna Commercial |
$3,826.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,876.60
|
| Rate for Payer: Cash Price |
$2,485.00
|
| Rate for Payer: Cigna Commercial |
$4,125.10
|
| Rate for Payer: First Health Commercial |
$4,721.50
|
| Rate for Payer: Humana Commercial |
$4,224.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,667.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,373.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,323.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,429.30
|
| Rate for Payer: PHCS Commercial |
$4,771.20
|
| Rate for Payer: United Healthcare All Payer |
$4,373.60
|
|
|
VARIAX FIBULA PLATE 10 H
|
Facility
|
OP
|
$4,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$4,771.20 |
| Rate for Payer: Aetna Commercial |
$3,826.90
|
| Rate for Payer: Anthem Medicaid |
$1,709.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,876.60
|
| Rate for Payer: Cash Price |
$2,485.00
|
| Rate for Payer: Cigna Commercial |
$4,125.10
|
| Rate for Payer: First Health Commercial |
$4,721.50
|
| Rate for Payer: Humana Commercial |
$4,224.50
|
| Rate for Payer: Humana KY Medicaid |
$1,709.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,726.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,667.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,743.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,373.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,323.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,429.30
|
| Rate for Payer: PHCS Commercial |
$4,771.20
|
| Rate for Payer: United Healthcare All Payer |
$4,373.60
|
|
|
VARIAX FIBULA PLATE 11 H
|
Facility
|
IP
|
$4,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$4,771.20 |
| Rate for Payer: Aetna Commercial |
$3,826.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,876.60
|
| Rate for Payer: Cash Price |
$2,485.00
|
| Rate for Payer: Cigna Commercial |
$4,125.10
|
| Rate for Payer: First Health Commercial |
$4,721.50
|
| Rate for Payer: Humana Commercial |
$4,224.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,667.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,373.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,323.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,429.30
|
| Rate for Payer: PHCS Commercial |
$4,771.20
|
| Rate for Payer: United Healthcare All Payer |
$4,373.60
|
|
|
VARIAX FIBULA PLATE 11 H
|
Facility
|
OP
|
$4,970.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,491.00 |
| Max. Negotiated Rate |
$4,771.20 |
| Rate for Payer: Aetna Commercial |
$3,826.90
|
| Rate for Payer: Anthem Medicaid |
$1,709.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,876.60
|
| Rate for Payer: Cash Price |
$2,485.00
|
| Rate for Payer: Cigna Commercial |
$4,125.10
|
| Rate for Payer: First Health Commercial |
$4,721.50
|
| Rate for Payer: Humana Commercial |
$4,224.50
|
| Rate for Payer: Humana KY Medicaid |
$1,709.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,726.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,075.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,667.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,491.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,743.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,373.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,727.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,323.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,429.30
|
| Rate for Payer: PHCS Commercial |
$4,771.20
|
| Rate for Payer: United Healthcare All Payer |
$4,373.60
|
|
|
VARIAX FIBULA PLATE 3 H
|
Facility
|
IP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
VARIAX FIBULA PLATE 3 H
|
Facility
|
OP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem Medicaid |
$1,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Humana KY Medicaid |
$1,346.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
VARIAX FIBULA PLATE 4 H
|
Facility
|
IP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
VARIAX FIBULA PLATE 4 H
|
Facility
|
OP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem Medicaid |
$1,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Humana KY Medicaid |
$1,346.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
VARIAX FIBULA PLATE 5 H
|
Facility
|
IP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
VARIAX FIBULA PLATE 5 H
|
Facility
|
OP
|
$3,916.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.88 |
| Max. Negotiated Rate |
$3,759.60 |
| Rate for Payer: Aetna Commercial |
$3,015.51
|
| Rate for Payer: Anthem Medicaid |
$1,346.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,054.68
|
| Rate for Payer: Cash Price |
$1,958.12
|
| Rate for Payer: Cigna Commercial |
$3,250.49
|
| Rate for Payer: First Health Commercial |
$3,720.44
|
| Rate for Payer: Humana Commercial |
$3,328.81
|
| Rate for Payer: Humana KY Medicaid |
$1,346.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,211.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,890.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,446.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,937.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,133.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,407.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,702.21
|
| Rate for Payer: PHCS Commercial |
$3,759.60
|
| Rate for Payer: United Healthcare All Payer |
$3,446.30
|
|
|
VARIAX FIBULA PLATE 6 H
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem Medicaid |
$1,371.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Humana KY Medicaid |
$1,371.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
