|
PLATE ANTERIOR CLAVICLE 10H
|
Facility
|
OP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem Medicaid |
$1,653.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Humana KY Medicaid |
$1,653.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,670.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
|
PLATE ANTERIOR MALLEOLAR
|
Facility
|
IP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE ANTERIOR MALLEOLAR
|
Facility
|
OP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem Medicaid |
$1,171.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Humana KY Medicaid |
$1,171.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE ANTMC VOL DR LT NAR
|
Facility
|
OP
|
$4,627.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$601.56 |
| Max. Negotiated Rate |
$4,442.32 |
| Rate for Payer: Aetna Commercial |
$3,563.11
|
| Rate for Payer: Anthem Medicaid |
$1,591.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,609.39
|
| Rate for Payer: Cash Price |
$2,313.71
|
| Rate for Payer: Cigna Commercial |
$3,840.76
|
| Rate for Payer: First Health Commercial |
$4,396.05
|
| Rate for Payer: Humana Commercial |
$3,933.31
|
| Rate for Payer: Humana KY Medicaid |
$1,591.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,607.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,794.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,415.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,388.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,623.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,072.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,470.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$925.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$601.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.50
|
| Rate for Payer: PHCS Commercial |
$4,442.32
|
| Rate for Payer: United Healthcare All Payer |
$4,072.13
|
|
|
PLATE ANTMC VOL DR LT NAR
|
Facility
|
IP
|
$4,627.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$601.56 |
| Max. Negotiated Rate |
$4,442.32 |
| Rate for Payer: Aetna Commercial |
$3,563.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,609.39
|
| Rate for Payer: Cash Price |
$2,313.71
|
| Rate for Payer: Cigna Commercial |
$3,840.76
|
| Rate for Payer: First Health Commercial |
$4,396.05
|
| Rate for Payer: Humana Commercial |
$3,933.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,794.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,415.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,388.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,072.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,470.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$925.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$601.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.50
|
| Rate for Payer: PHCS Commercial |
$4,442.32
|
| Rate for Payer: United Healthcare All Payer |
$4,072.13
|
|
|
PLATE ANTMC VOL DR LT NAR LG
|
Facility
|
OP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem Medicaid |
$1,796.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Humana KY Medicaid |
$1,796.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,814.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
PLATE ANTMC VOL DR LT NAR LG
|
Facility
|
IP
|
$5,224.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$679.12 |
| Max. Negotiated Rate |
$5,015.04 |
| Rate for Payer: Aetna Commercial |
$4,022.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,074.72
|
| Rate for Payer: Cash Price |
$2,612.00
|
| Rate for Payer: Cigna Commercial |
$4,335.92
|
| Rate for Payer: First Health Commercial |
$4,962.80
|
| Rate for Payer: Humana Commercial |
$4,440.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,283.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,855.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,597.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$679.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,619.44
|
| Rate for Payer: PHCS Commercial |
$5,015.04
|
| Rate for Payer: United Healthcare All Payer |
$4,597.12
|
|
|
PLATE ANTMC VOL DR LT STD
|
Facility
|
OP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem Medicaid |
$2,594.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Humana KY Medicaid |
$2,594.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
PLATE ANTMC VOL DR LT STD
|
Facility
|
IP
|
$7,545.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$980.85 |
| Max. Negotiated Rate |
$7,243.20 |
| Rate for Payer: Aetna Commercial |
$5,809.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,885.10
|
| Rate for Payer: Cash Price |
$3,772.50
|
| Rate for Payer: Cigna Commercial |
$6,262.35
|
| Rate for Payer: First Health Commercial |
$7,167.75
|
| Rate for Payer: Humana Commercial |
$6,413.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,568.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,639.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,338.95
|
| Rate for Payer: PHCS Commercial |
$7,243.20
|
| Rate for Payer: United Healthcare All Payer |
$6,639.60
|
|
|
PLATE ANTMC VOL DR RT NAR
|
Facility
|
IP
|
$5,671.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.26 |
| Max. Negotiated Rate |
$5,444.41 |
| Rate for Payer: Humana Commercial |
$4,820.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,650.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,185.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,701.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,990.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,253.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,134.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,758.09
|
| Rate for Payer: PHCS Commercial |
$5,444.41
|
| Rate for Payer: United Healthcare All Payer |
$4,990.71
|
| Rate for Payer: Aetna Commercial |
$4,366.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,423.58
|
| Rate for Payer: Cash Price |
$2,835.63
|
| Rate for Payer: Cigna Commercial |
$4,707.15
|
| Rate for Payer: First Health Commercial |
$5,387.70
|
|
|
PLATE ANTMC VOL DR RT NAR
|
Facility
|
OP
|
$5,671.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$737.26 |
| Max. Negotiated Rate |
$5,444.41 |
| Rate for Payer: Aetna Commercial |
$4,366.87
|
| Rate for Payer: Anthem Medicaid |
$1,950.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,423.58
|
| Rate for Payer: Cash Price |
$2,835.63
|
| Rate for Payer: Cigna Commercial |
$4,707.15
|
| Rate for Payer: First Health Commercial |
$5,387.70
|
| Rate for Payer: Humana Commercial |
$4,820.57
|
| Rate for Payer: Humana KY Medicaid |
$1,950.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,970.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,650.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,185.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,701.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,989.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,990.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,253.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,134.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$737.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,758.09
|
| Rate for Payer: PHCS Commercial |
$5,444.41
|
| Rate for Payer: United Healthcare All Payer |
$4,990.71
|
|
|
PLATE ANTMC VOL DR RT NAR LG
|
Facility
|
OP
|
$5,004.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.56 |
| Max. Negotiated Rate |
$4,804.10 |
| Rate for Payer: Aetna Commercial |
$3,853.29
|
| Rate for Payer: Anthem Medicaid |
$1,720.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,903.33
|
| Rate for Payer: Cash Price |
$2,502.14
|
| Rate for Payer: Cigna Commercial |
$4,153.54
|
| Rate for Payer: First Health Commercial |
$4,754.06
|
| Rate for Payer: Humana Commercial |
$4,253.63
|
| Rate for Payer: Humana KY Medicaid |
$1,720.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,738.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,103.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,693.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,755.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,403.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,753.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.32
|
| Rate for Payer: PHCS Commercial |
$4,804.10
|
| Rate for Payer: United Healthcare All Payer |
$4,403.76
|
|
|
PLATE ANTMC VOL DR RT NAR LG
|
Facility
|
IP
|
$5,004.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.56 |
| Max. Negotiated Rate |
$4,804.10 |
| Rate for Payer: Aetna Commercial |
$3,853.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,903.33
|
| Rate for Payer: Cash Price |
$2,502.14
|
| Rate for Payer: Cigna Commercial |
$4,153.54
|
| Rate for Payer: First Health Commercial |
$4,754.06
|
| Rate for Payer: Humana Commercial |
$4,253.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,103.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,693.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,403.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,753.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.32
|
| Rate for Payer: PHCS Commercial |
$4,804.10
|
| Rate for Payer: United Healthcare All Payer |
$4,403.76
|
|
|
PLATE ANTMC VOL DR RT STD
|
Facility
|
OP
|
$8,731.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.06 |
| Max. Negotiated Rate |
$8,382.00 |
| Rate for Payer: Aetna Commercial |
$6,723.06
|
| Rate for Payer: Anthem Medicaid |
$3,002.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
| Rate for Payer: Cash Price |
$4,365.62
|
| Rate for Payer: Cigna Commercial |
$7,246.94
|
| Rate for Payer: First Health Commercial |
$8,294.69
|
| Rate for Payer: Humana Commercial |
$7,421.56
|
| Rate for Payer: Humana KY Medicaid |
$3,002.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,033.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,062.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
| Rate for Payer: PHCS Commercial |
$8,382.00
|
| Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
|
PLATE ANTMC VOL DR RT STD
|
Facility
|
IP
|
$8,731.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.06 |
| Max. Negotiated Rate |
$8,382.00 |
| Rate for Payer: Aetna Commercial |
$6,723.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
| Rate for Payer: Cash Price |
$4,365.62
|
| Rate for Payer: Cigna Commercial |
$7,246.94
|
| Rate for Payer: First Health Commercial |
$8,294.69
|
| Rate for Payer: Humana Commercial |
$7,421.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
| Rate for Payer: PHCS Commercial |
$8,382.00
|
| Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
|
PLATE ANTMC VOL DR RT STD LG
|
Facility
|
IP
|
$6,980.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.52 |
| Max. Negotiated Rate |
$6,701.69 |
| Rate for Payer: Aetna Commercial |
$5,375.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,445.13
|
| Rate for Payer: Cash Price |
$3,490.46
|
| Rate for Payer: Cigna Commercial |
$5,794.17
|
| Rate for Payer: First Health Commercial |
$6,631.88
|
| Rate for Payer: Humana Commercial |
$5,933.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,724.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,151.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,094.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,143.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,235.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,164.09
|
| Rate for Payer: PHCS Commercial |
$6,701.69
|
| Rate for Payer: United Healthcare All Payer |
$6,143.22
|
|
|
PLATE ANTMC VOL DR RT STD LG
|
Facility
|
OP
|
$6,980.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.52 |
| Max. Negotiated Rate |
$6,701.69 |
| Rate for Payer: Aetna Commercial |
$5,375.32
|
| Rate for Payer: Anthem Medicaid |
$2,400.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,445.13
|
| Rate for Payer: Cash Price |
$3,490.46
|
| Rate for Payer: Cigna Commercial |
$5,794.17
|
| Rate for Payer: First Health Commercial |
$6,631.88
|
| Rate for Payer: Humana Commercial |
$5,933.79
|
| Rate for Payer: Humana KY Medicaid |
$2,400.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,425.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,724.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,151.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,094.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,448.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,143.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,235.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,396.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,164.09
|
| Rate for Payer: PHCS Commercial |
$6,701.69
|
| Rate for Payer: United Healthcare All Payer |
$6,143.22
|
|
|
PLATE ANT PRCES LONG RIGHT
|
Facility
|
IP
|
$6,996.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.56 |
| Max. Negotiated Rate |
$6,716.73 |
| Rate for Payer: Aetna Commercial |
$5,387.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.34
|
| Rate for Payer: Cash Price |
$3,498.29
|
| Rate for Payer: Cigna Commercial |
$5,807.17
|
| Rate for Payer: First Health Commercial |
$6,646.76
|
| Rate for Payer: Humana Commercial |
$5,947.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.94
|
| Rate for Payer: PHCS Commercial |
$6,716.73
|
| Rate for Payer: United Healthcare All Payer |
$6,157.00
|
|
|
PLATE ANT PRCES LONG RIGHT
|
Facility
|
OP
|
$6,996.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.56 |
| Max. Negotiated Rate |
$6,716.73 |
| Rate for Payer: Humana Commercial |
$5,947.10
|
| Rate for Payer: Humana KY Medicaid |
$2,406.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,737.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,163.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,157.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,247.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.94
|
| Rate for Payer: PHCS Commercial |
$6,716.73
|
| Rate for Payer: United Healthcare All Payer |
$6,157.00
|
| Rate for Payer: Aetna Commercial |
$5,387.37
|
| Rate for Payer: Anthem Medicaid |
$2,406.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,457.34
|
| Rate for Payer: Cash Price |
$3,498.29
|
| Rate for Payer: Cigna Commercial |
$5,807.17
|
| Rate for Payer: First Health Commercial |
$6,646.76
|
|
|
PLATE AXSOS 3 DIS TIB 8H
|
Facility
|
IP
|
$9,772.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.48 |
| Max. Negotiated Rate |
$9,382.04 |
| Rate for Payer: Aetna Commercial |
$7,525.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,622.91
|
| Rate for Payer: Cash Price |
$4,886.48
|
| Rate for Payer: Cigna Commercial |
$8,111.56
|
| Rate for Payer: First Health Commercial |
$9,284.31
|
| Rate for Payer: Humana Commercial |
$8,307.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,013.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,212.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,600.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,329.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.62
|
| Rate for Payer: PHCS Commercial |
$9,382.04
|
| Rate for Payer: United Healthcare All Payer |
$8,600.20
|
|
|
PLATE AXSOS 3 DIS TIB 8H
|
Facility
|
OP
|
$9,772.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,270.48 |
| Max. Negotiated Rate |
$9,382.04 |
| Rate for Payer: Aetna Commercial |
$7,525.18
|
| Rate for Payer: Anthem Medicaid |
$3,360.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,622.91
|
| Rate for Payer: Cash Price |
$4,886.48
|
| Rate for Payer: Cigna Commercial |
$8,111.56
|
| Rate for Payer: First Health Commercial |
$9,284.31
|
| Rate for Payer: Humana Commercial |
$8,307.02
|
| Rate for Payer: Humana KY Medicaid |
$3,360.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,395.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,013.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,212.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,931.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,428.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,600.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,329.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,954.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,270.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.62
|
| Rate for Payer: PHCS Commercial |
$9,382.04
|
| Rate for Payer: United Healthcare All Payer |
$8,600.20
|
|
|
PLATE AXSOS 3 TI COMP 10H
|
Facility
|
IP
|
$7,958.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.61 |
| Max. Negotiated Rate |
$7,640.17 |
| Rate for Payer: Aetna Commercial |
$6,128.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,207.64
|
| Rate for Payer: Cash Price |
$3,979.25
|
| Rate for Payer: Cigna Commercial |
$6,605.56
|
| Rate for Payer: First Health Commercial |
$7,560.58
|
| Rate for Payer: Humana Commercial |
$6,764.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,873.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,003.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,467.14
|
| Rate for Payer: PHCS Commercial |
$7,640.17
|
| Rate for Payer: United Healthcare All Payer |
$7,003.49
|
|
|
PLATE AXSOS 3 TI COMP 10H
|
Facility
|
OP
|
$7,958.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.61 |
| Max. Negotiated Rate |
$7,640.17 |
| Rate for Payer: Aetna Commercial |
$6,128.05
|
| Rate for Payer: Anthem Medicaid |
$2,736.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,207.64
|
| Rate for Payer: Cash Price |
$3,979.25
|
| Rate for Payer: Cigna Commercial |
$6,605.56
|
| Rate for Payer: First Health Commercial |
$7,560.58
|
| Rate for Payer: Humana Commercial |
$6,764.73
|
| Rate for Payer: Humana KY Medicaid |
$2,736.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,764.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,525.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,873.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,387.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,791.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,003.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,968.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,034.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,467.14
|
| Rate for Payer: PHCS Commercial |
$7,640.17
|
| Rate for Payer: United Healthcare All Payer |
$7,003.49
|
|
|
PLATE AXSOS 3 TI COMP 7H
|
Facility
|
OP
|
$7,618.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.42 |
| Max. Negotiated Rate |
$7,313.88 |
| Rate for Payer: Aetna Commercial |
$5,866.34
|
| Rate for Payer: Anthem Medicaid |
$2,620.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.52
|
| Rate for Payer: Cash Price |
$3,809.31
|
| Rate for Payer: Cigna Commercial |
$6,323.45
|
| Rate for Payer: First Health Commercial |
$7,237.69
|
| Rate for Payer: Humana Commercial |
$6,475.83
|
| Rate for Payer: Humana KY Medicaid |
$2,620.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,646.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,247.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,672.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,704.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.77
|
| Rate for Payer: PHCS Commercial |
$7,313.88
|
| Rate for Payer: United Healthcare All Payer |
$6,704.39
|
|
|
PLATE AXSOS 3 TI COMP 7H
|
Facility
|
IP
|
$7,618.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.42 |
| Max. Negotiated Rate |
$7,313.88 |
| Rate for Payer: Aetna Commercial |
$5,866.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,942.52
|
| Rate for Payer: Cash Price |
$3,809.31
|
| Rate for Payer: Cigna Commercial |
$6,323.45
|
| Rate for Payer: First Health Commercial |
$7,237.69
|
| Rate for Payer: Humana Commercial |
$6,475.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,247.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,622.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,285.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,704.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,713.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,523.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,361.77
|
| Rate for Payer: PHCS Commercial |
$7,313.88
|
| Rate for Payer: United Healthcare All Payer |
$6,704.39
|
|
