|
PLATE CLAVICLE NRW PROF 8H R
|
Facility
|
OP
|
$5,567.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.71 |
| Max. Negotiated Rate |
$5,344.32 |
| Rate for Payer: Aetna Commercial |
$4,286.59
|
| Rate for Payer: Anthem Medicaid |
$1,914.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.26
|
| Rate for Payer: Cash Price |
$2,783.50
|
| Rate for Payer: Cigna Commercial |
$4,620.61
|
| Rate for Payer: First Health Commercial |
$5,288.65
|
| Rate for Payer: Humana Commercial |
$4,731.95
|
| Rate for Payer: Humana KY Medicaid |
$1,914.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,933.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,564.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,952.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,898.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.77
|
| Rate for Payer: PHCS Commercial |
$5,344.32
|
| Rate for Payer: United Healthcare All Payer |
$4,898.96
|
|
|
PLATE CLAV INF DIST 81MM
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV INF DIST 81MM
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV INF MED 10H 117MM
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV INF MED 10H 117MM
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV INF MED 6H 73MM
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV INF MED 6H 73MM
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV INF MED 7H 85MM
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV INF MED 7H 85MM
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV INF MED 8H 96MM
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV INF MED 8H 96MM
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV NRW PROF 8H LRG L
|
Facility
|
IP
|
$5,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.97 |
| Max. Negotiated Rate |
$5,250.24 |
| Rate for Payer: Aetna Commercial |
$4,211.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.82
|
| Rate for Payer: Cash Price |
$2,734.50
|
| Rate for Payer: Cigna Commercial |
$4,539.27
|
| Rate for Payer: First Health Commercial |
$5,195.55
|
| Rate for Payer: Humana Commercial |
$4,648.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,036.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,695.39
|
| Rate for Payer: PHCS Commercial |
$5,250.24
|
| Rate for Payer: United Healthcare All Payer |
$4,812.72
|
|
|
PLATE CLAV NRW PROF 8H LRG L
|
Facility
|
OP
|
$5,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.97 |
| Max. Negotiated Rate |
$5,250.24 |
| Rate for Payer: Anthem Medicaid |
$1,880.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.82
|
| Rate for Payer: Cash Price |
$2,734.50
|
| Rate for Payer: Cigna Commercial |
$4,539.27
|
| Rate for Payer: First Health Commercial |
$5,195.55
|
| Rate for Payer: Humana Commercial |
$4,648.65
|
| Rate for Payer: Humana KY Medicaid |
$1,880.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,036.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,695.39
|
| Rate for Payer: PHCS Commercial |
$5,250.24
|
| Rate for Payer: United Healthcare All Payer |
$4,812.72
|
| Rate for Payer: Aetna Commercial |
$4,211.13
|
|
|
PLATE CLAV NRW PROF 8H STR L
|
Facility
|
OP
|
$5,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.97 |
| Max. Negotiated Rate |
$5,250.24 |
| Rate for Payer: Aetna Commercial |
$4,211.13
|
| Rate for Payer: Anthem Medicaid |
$1,880.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.82
|
| Rate for Payer: Cash Price |
$2,734.50
|
| Rate for Payer: Cigna Commercial |
$4,539.27
|
| Rate for Payer: First Health Commercial |
$5,195.55
|
| Rate for Payer: Humana Commercial |
$4,648.65
|
| Rate for Payer: Humana KY Medicaid |
$1,880.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,899.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,036.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,918.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,695.39
|
| Rate for Payer: PHCS Commercial |
$5,250.24
|
| Rate for Payer: United Healthcare All Payer |
$4,812.72
|
|
|
PLATE CLAV NRW PROF 8H STR L
|
Facility
|
IP
|
$5,469.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$710.97 |
| Max. Negotiated Rate |
$5,250.24 |
| Rate for Payer: Aetna Commercial |
$4,211.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,265.82
|
| Rate for Payer: Cash Price |
$2,734.50
|
| Rate for Payer: Cigna Commercial |
$4,539.27
|
| Rate for Payer: First Health Commercial |
$5,195.55
|
| Rate for Payer: Humana Commercial |
$4,648.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,484.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,036.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,640.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,812.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,101.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,093.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$710.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,695.39
|
| Rate for Payer: PHCS Commercial |
$5,250.24
|
| Rate for Payer: United Healthcare All Payer |
$4,812.72
|
|
|
PLATE CLAV NRW PROF 8H STR R
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
PLATE CLAV NRW PROF 8H STR R
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
PLATE CLAV SUP DIST 109MM L
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP DIST 109MM L
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP DIST 109MM R
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP DIST 109MM R
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP MED 10 171MM L
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 10 171MM L
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 10H 121MM R
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP MED 10H 121MM R
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
