|
PLATE DIST TIB MED L 15H 244M
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED L 15H 244M
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED L 5H 115M
|
Facility
|
OP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Anthem Medicaid |
$2,826.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Humana KY Medicaid |
$2,826.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DIST TIB MED L 5H 115M
|
Facility
|
IP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DIST TIB MED L 8H 153M
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED L 8H 153M
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 11H 193M
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 11H 193M
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 15H 244M
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 15H 244M
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 5H 115M
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 5H 115M
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 8H 153M
|
Facility
|
OP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem Medicaid |
$2,720.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Humana KY Medicaid |
$2,720.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,747.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,774.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIST TIB MED R 8H 153M
|
Facility
|
IP
|
$7,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.30 |
| Max. Negotiated Rate |
$7,593.60 |
| Rate for Payer: Aetna Commercial |
$6,090.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,169.80
|
| Rate for Payer: Cash Price |
$3,955.00
|
| Rate for Payer: Cigna Commercial |
$6,565.30
|
| Rate for Payer: First Health Commercial |
$7,514.50
|
| Rate for Payer: Humana Commercial |
$6,723.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,486.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,837.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,373.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,960.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,932.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,028.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.10
|
| Rate for Payer: PHCS Commercial |
$7,593.60
|
| Rate for Payer: United Healthcare All Payer |
$6,960.80
|
|
|
PLATE DIVERGENT RADIAL STYLOID
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem Medicaid |
$1,464.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Humana KY Medicaid |
$1,464.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DIVERGENT RADIAL STYLOID
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DOGBONE 10MM
|
Facility
|
IP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
PLATE DOGBONE 10MM
|
Facility
|
OP
|
$6,815.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$885.95 |
| Max. Negotiated Rate |
$6,542.40 |
| Rate for Payer: Anthem Medicaid |
$2,343.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,315.70
|
| Rate for Payer: Cash Price |
$3,407.50
|
| Rate for Payer: Cigna Commercial |
$5,656.45
|
| Rate for Payer: First Health Commercial |
$6,474.25
|
| Rate for Payer: Humana Commercial |
$5,792.75
|
| Rate for Payer: Humana KY Medicaid |
$2,343.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,367.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,588.30
|
| Rate for Payer: Aetna Commercial |
$5,247.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,029.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,044.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,390.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,997.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,111.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,363.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$885.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,112.65
|
| Rate for Payer: PHCS Commercial |
$6,542.40
|
| Rate for Payer: United Healthcare All Payer |
$5,997.20
|
|
|
PLATE DOR DIS RAD 2H 2.4*37+90
|
Facility
|
IP
|
$4,008.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.13 |
| Max. Negotiated Rate |
$3,848.38 |
| Rate for Payer: Aetna Commercial |
$3,086.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,126.81
|
| Rate for Payer: Cash Price |
$2,004.37
|
| Rate for Payer: Cigna Commercial |
$3,327.25
|
| Rate for Payer: First Health Commercial |
$3,808.29
|
| Rate for Payer: Humana Commercial |
$3,407.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,287.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,958.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,202.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,527.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,006.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.71
|
| Rate for Payer: PHCS Commercial |
$3,848.38
|
| Rate for Payer: United Healthcare All Payer |
$3,527.68
|
|
|
PLATE DOR DIS RAD 2H 2.4*37+90
|
Facility
|
OP
|
$4,008.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.13 |
| Max. Negotiated Rate |
$3,848.38 |
| Rate for Payer: Aetna Commercial |
$3,086.72
|
| Rate for Payer: Anthem Medicaid |
$1,378.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,126.81
|
| Rate for Payer: Cash Price |
$2,004.37
|
| Rate for Payer: Cigna Commercial |
$3,327.25
|
| Rate for Payer: First Health Commercial |
$3,808.29
|
| Rate for Payer: Humana Commercial |
$3,407.42
|
| Rate for Payer: Humana KY Medicaid |
$1,378.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,392.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,287.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,958.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,202.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,406.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,527.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,006.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.71
|
| Rate for Payer: PHCS Commercial |
$3,848.38
|
| Rate for Payer: United Healthcare All Payer |
$3,527.68
|
|
|
PLATE DOR DIS RAD T 3H 2.4*37
|
Facility
|
IP
|
$4,068.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.87 |
| Max. Negotiated Rate |
$3,905.53 |
| Rate for Payer: Aetna Commercial |
$3,132.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,173.24
|
| Rate for Payer: Cash Price |
$2,034.13
|
| Rate for Payer: Cigna Commercial |
$3,376.66
|
| Rate for Payer: First Health Commercial |
$3,864.85
|
| Rate for Payer: Humana Commercial |
$3,458.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,335.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,002.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,580.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,051.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$813.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,261.16
|
| Rate for Payer: PHCS Commercial |
$3,905.53
|
| Rate for Payer: United Healthcare All Payer |
$3,580.07
|
|
|
PLATE DOR DIS RAD T 3H 2.4*37
|
Facility
|
OP
|
$4,068.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$528.87 |
| Max. Negotiated Rate |
$3,905.53 |
| Rate for Payer: Aetna Commercial |
$3,132.56
|
| Rate for Payer: Anthem Medicaid |
$1,399.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,173.24
|
| Rate for Payer: Cash Price |
$2,034.13
|
| Rate for Payer: Cigna Commercial |
$3,376.66
|
| Rate for Payer: First Health Commercial |
$3,864.85
|
| Rate for Payer: Humana Commercial |
$3,458.02
|
| Rate for Payer: Humana KY Medicaid |
$1,399.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,413.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,335.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,002.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,427.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,580.07
|
| Rate for Payer: Ohio Health Group HMO |
$3,051.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$813.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$528.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,261.16
|
| Rate for Payer: PHCS Commercial |
$3,905.53
|
| Rate for Payer: United Healthcare All Payer |
$3,580.07
|
|
|
PLATE DOR DIS RAD T 5H 2.4*51
|
Facility
|
OP
|
$4,150.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$3,984.46 |
| Rate for Payer: Aetna Commercial |
$3,195.87
|
| Rate for Payer: Anthem Medicaid |
$1,427.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,237.37
|
| Rate for Payer: Cash Price |
$2,075.24
|
| Rate for Payer: Cigna Commercial |
$3,444.90
|
| Rate for Payer: First Health Commercial |
$3,942.96
|
| Rate for Payer: Humana Commercial |
$3,527.91
|
| Rate for Payer: Humana KY Medicaid |
$1,427.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,441.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,403.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,063.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,652.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$830.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.65
|
| Rate for Payer: PHCS Commercial |
$3,984.46
|
| Rate for Payer: United Healthcare All Payer |
$3,652.42
|
|
|
PLATE DOR DIS RAD T 5H 2.4*51
|
Facility
|
IP
|
$4,150.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.56 |
| Max. Negotiated Rate |
$3,984.46 |
| Rate for Payer: Aetna Commercial |
$3,195.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,237.37
|
| Rate for Payer: Cash Price |
$2,075.24
|
| Rate for Payer: Cigna Commercial |
$3,444.90
|
| Rate for Payer: First Health Commercial |
$3,942.96
|
| Rate for Payer: Humana Commercial |
$3,527.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,403.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,063.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,652.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$830.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.65
|
| Rate for Payer: PHCS Commercial |
$3,984.46
|
| Rate for Payer: United Healthcare All Payer |
$3,652.42
|
|
|
PLATE DOR DIS RD 2H 2.4*37 -90
|
Facility
|
IP
|
$4,008.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.13 |
| Max. Negotiated Rate |
$3,848.38 |
| Rate for Payer: Aetna Commercial |
$3,086.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,126.81
|
| Rate for Payer: Cash Price |
$2,004.37
|
| Rate for Payer: Cigna Commercial |
$3,327.25
|
| Rate for Payer: First Health Commercial |
$3,808.29
|
| Rate for Payer: Humana Commercial |
$3,407.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,287.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,958.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,202.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,527.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,006.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.71
|
| Rate for Payer: PHCS Commercial |
$3,848.38
|
| Rate for Payer: United Healthcare All Payer |
$3,527.68
|
|
