|
PLATE DORSAL RIM BUTTRESS RT
|
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 DORSOLATL MIDSHFT RAD 6H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLATL MIDSHFT RAD 6H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLATL MIDSHFT RAD 8H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLATL MIDSHFT RAD 8H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 10H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 10H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 12H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 12H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 14H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 14H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 16H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DORSOLAT MIDSHFT RAD 16H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE DST HM LK MD 11H L 151M
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE DST HM LK MD 11H L 151M
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE DST HM LK MD 11H R 151M
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE DST HM LK MD 11H R 151M
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE DST HM LK MD 13H L 174M
|
Facility
|
OP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem Medicaid |
$2,730.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Humana KY Medicaid |
$2,730.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE DST HM LK MD 13H L 174M
|
Facility
|
IP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE DST HM LK MD 13H R 174M
|
Facility
|
OP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem Medicaid |
$2,730.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Humana KY Medicaid |
$2,730.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE DST HM LK MD 13H R 174M
|
Facility
|
IP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE DVRAN NARROW LEFT
|
Facility
|
OP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Anthem Medicaid |
$2,317.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Humana KY Medicaid |
$2,317.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE DVRAN NARROW LEFT
|
Facility
|
IP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE DVRAN NARROW RIGHT
|
Facility
|
OP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem Medicaid |
$2,317.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Humana KY Medicaid |
$2,317.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE DVRAN NARROW RIGHT
|
Facility
|
IP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
