|
PLATE ELBOW POSTERIOR
|
Facility
|
IP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
|
PLATE ELBW LAT EPICONDYAL XL L
|
Facility
|
IP
|
$5,381.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.60 |
| Max. Negotiated Rate |
$5,166.24 |
| Rate for Payer: Aetna Commercial |
$4,143.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,197.57
|
| Rate for Payer: Cash Price |
$2,690.75
|
| Rate for Payer: Cigna Commercial |
$4,466.64
|
| Rate for Payer: First Health Commercial |
$5,112.42
|
| Rate for Payer: Humana Commercial |
$4,574.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,412.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,971.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,614.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,735.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,036.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.26
|
| Rate for Payer: PHCS Commercial |
$5,166.24
|
| Rate for Payer: United Healthcare All Payer |
$4,735.72
|
|
|
PLATE ELBW LAT EPICONDYAL XL L
|
Facility
|
OP
|
$5,381.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$699.60 |
| Max. Negotiated Rate |
$5,166.24 |
| Rate for Payer: Anthem Medicaid |
$1,850.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,197.57
|
| Rate for Payer: Cash Price |
$2,690.75
|
| Rate for Payer: Cigna Commercial |
$4,466.64
|
| Rate for Payer: First Health Commercial |
$5,112.42
|
| Rate for Payer: Humana Commercial |
$4,574.28
|
| Rate for Payer: Humana KY Medicaid |
$1,850.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,869.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,412.83
|
| Rate for Payer: Aetna Commercial |
$4,143.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,971.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,614.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,887.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,735.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,036.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,076.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$699.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,668.26
|
| Rate for Payer: PHCS Commercial |
$5,166.24
|
| Rate for Payer: United Healthcare All Payer |
$4,735.72
|
|
|
PLATE ELBW LAT EPICONDYAL XL R
|
Facility
|
IP
|
$4,341.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.44 |
| Max. Negotiated Rate |
$4,168.19 |
| Rate for Payer: Aetna Commercial |
$3,343.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,386.65
|
| Rate for Payer: Cash Price |
$2,170.93
|
| Rate for Payer: Cigna Commercial |
$3,603.74
|
| Rate for Payer: First Health Commercial |
$4,124.77
|
| Rate for Payer: Humana Commercial |
$3,690.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,560.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,204.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,820.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,256.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.98
|
| Rate for Payer: PHCS Commercial |
$4,168.19
|
| Rate for Payer: United Healthcare All Payer |
$3,820.84
|
|
|
PLATE ELBW LAT EPICONDYAL XL R
|
Facility
|
OP
|
$4,341.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.44 |
| Max. Negotiated Rate |
$4,168.19 |
| Rate for Payer: Aetna Commercial |
$3,343.23
|
| Rate for Payer: Anthem Medicaid |
$1,493.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,386.65
|
| Rate for Payer: Cash Price |
$2,170.93
|
| Rate for Payer: Cigna Commercial |
$3,603.74
|
| Rate for Payer: First Health Commercial |
$4,124.77
|
| Rate for Payer: Humana Commercial |
$3,690.58
|
| Rate for Payer: Humana KY Medicaid |
$1,493.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,560.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,204.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,820.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,256.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.98
|
| Rate for Payer: PHCS Commercial |
$4,168.19
|
| Rate for Payer: United Healthcare All Payer |
$3,820.84
|
|
|
PLATE ELBW MEDL EPICONDYAL XL
|
Facility
|
IP
|
$4,341.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.44 |
| Max. Negotiated Rate |
$4,168.19 |
| Rate for Payer: Aetna Commercial |
$3,343.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,386.65
|
| Rate for Payer: Cash Price |
$2,170.93
|
| Rate for Payer: Cigna Commercial |
$3,603.74
|
| Rate for Payer: First Health Commercial |
$4,124.77
|
| Rate for Payer: Humana Commercial |
$3,690.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,560.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,204.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,820.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,256.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.98
|
| Rate for Payer: PHCS Commercial |
$4,168.19
|
| Rate for Payer: United Healthcare All Payer |
$3,820.84
|
|
|
PLATE ELBW MEDL EPICONDYAL XL
|
Facility
|
OP
|
$4,341.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.44 |
| Max. Negotiated Rate |
$4,168.19 |
| Rate for Payer: Aetna Commercial |
$3,343.23
|
| Rate for Payer: Anthem Medicaid |
$1,493.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,386.65
|
| Rate for Payer: Cash Price |
$2,170.93
|
| Rate for Payer: Cigna Commercial |
$3,603.74
|
| Rate for Payer: First Health Commercial |
$4,124.77
|
| Rate for Payer: Humana Commercial |
$3,690.58
|
| Rate for Payer: Humana KY Medicaid |
$1,493.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,508.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,560.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,204.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,302.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,523.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,820.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,256.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$868.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,345.98
|
| Rate for Payer: PHCS Commercial |
$4,168.19
|
| Rate for Payer: United Healthcare All Payer |
$3,820.84
|
|
|
PLATE EPICONDYAL LAT LONG LEFT
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE EPICONDYAL LAT LONG LEFT
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE EPINCONDYAL LAT LONG RT
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE EPINCONDYAL LAT LONG RT
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE EPINCONDYAL LAT SM LEFT
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE EPINCONDYAL LAT SM LEFT
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE EPINCONDYAL LAT SM RT
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE EPINCONDYAL LAT SM RT
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE EVOS 2.7MM COMP 8H 67MM
|
Facility
|
OP
|
$3,389.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.65 |
| Max. Negotiated Rate |
$3,254.06 |
| Rate for Payer: Aetna Commercial |
$2,610.03
|
| Rate for Payer: Anthem Medicaid |
$1,165.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,643.93
|
| Rate for Payer: Cash Price |
$1,694.83
|
| Rate for Payer: Cigna Commercial |
$2,813.41
|
| Rate for Payer: First Health Commercial |
$3,220.17
|
| Rate for Payer: Humana Commercial |
$2,881.20
|
| Rate for Payer: Humana KY Medicaid |
$1,165.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,177.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,016.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,982.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.79
|
| Rate for Payer: PHCS Commercial |
$3,254.06
|
| Rate for Payer: United Healthcare All Payer |
$2,982.89
|
|
|
PLATE EVOS 2.7MM COMP 8H 67MM
|
Facility
|
IP
|
$3,389.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.65 |
| Max. Negotiated Rate |
$3,254.06 |
| Rate for Payer: Aetna Commercial |
$2,610.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,643.93
|
| Rate for Payer: Cash Price |
$1,694.83
|
| Rate for Payer: Cigna Commercial |
$2,813.41
|
| Rate for Payer: First Health Commercial |
$3,220.17
|
| Rate for Payer: Humana Commercial |
$2,881.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,016.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,982.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$677.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.79
|
| Rate for Payer: PHCS Commercial |
$3,254.06
|
| Rate for Payer: United Healthcare All Payer |
$2,982.89
|
|
|
PLATE EVOS DRS 3H STD TI 56M L
|
Facility
|
IP
|
$7,268.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.93 |
| Max. Negotiated Rate |
$6,977.95 |
| Rate for Payer: Aetna Commercial |
$5,596.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.59
|
| Rate for Payer: Cash Price |
$3,634.35
|
| Rate for Payer: Cigna Commercial |
$6,033.02
|
| Rate for Payer: First Health Commercial |
$6,905.26
|
| Rate for Payer: Humana Commercial |
$6,178.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.30
|
| Rate for Payer: PHCS Commercial |
$6,977.95
|
| Rate for Payer: United Healthcare All Payer |
$6,396.46
|
|
|
PLATE EVOS DRS 3H STD TI 56M L
|
Facility
|
OP
|
$7,268.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.93 |
| Max. Negotiated Rate |
$6,977.95 |
| Rate for Payer: Aetna Commercial |
$5,596.90
|
| Rate for Payer: Anthem Medicaid |
$2,499.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.59
|
| Rate for Payer: Cash Price |
$3,634.35
|
| Rate for Payer: Cigna Commercial |
$6,033.02
|
| Rate for Payer: First Health Commercial |
$6,905.26
|
| Rate for Payer: Humana Commercial |
$6,178.40
|
| Rate for Payer: Humana KY Medicaid |
$2,499.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,525.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.30
|
| Rate for Payer: PHCS Commercial |
$6,977.95
|
| Rate for Payer: United Healthcare All Payer |
$6,396.46
|
|
|
PLATE EVOS DRS 3H WDE TI 56M L
|
Facility
|
IP
|
$7,268.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.93 |
| Max. Negotiated Rate |
$6,977.95 |
| Rate for Payer: Aetna Commercial |
$5,596.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.59
|
| Rate for Payer: Cash Price |
$3,634.35
|
| Rate for Payer: Cigna Commercial |
$6,033.02
|
| Rate for Payer: First Health Commercial |
$6,905.26
|
| Rate for Payer: Humana Commercial |
$6,178.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.30
|
| Rate for Payer: PHCS Commercial |
$6,977.95
|
| Rate for Payer: United Healthcare All Payer |
$6,396.46
|
|
|
PLATE EVOS DRS 3H WDE TI 56M L
|
Facility
|
OP
|
$7,268.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.93 |
| Max. Negotiated Rate |
$6,977.95 |
| Rate for Payer: Aetna Commercial |
$5,596.90
|
| Rate for Payer: Anthem Medicaid |
$2,499.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.59
|
| Rate for Payer: Cash Price |
$3,634.35
|
| Rate for Payer: Cigna Commercial |
$6,033.02
|
| Rate for Payer: First Health Commercial |
$6,905.26
|
| Rate for Payer: Humana Commercial |
$6,178.40
|
| Rate for Payer: Humana KY Medicaid |
$2,499.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,525.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.30
|
| Rate for Payer: PHCS Commercial |
$6,977.95
|
| Rate for Payer: United Healthcare All Payer |
$6,396.46
|
|
|
PLATE EVOS DST ULN 7H TI 56M L
|
Facility
|
IP
|
$7,268.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.93 |
| Max. Negotiated Rate |
$6,977.95 |
| Rate for Payer: Aetna Commercial |
$5,596.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.59
|
| Rate for Payer: Cash Price |
$3,634.35
|
| Rate for Payer: Cigna Commercial |
$6,033.02
|
| Rate for Payer: First Health Commercial |
$6,905.26
|
| Rate for Payer: Humana Commercial |
$6,178.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.30
|
| Rate for Payer: PHCS Commercial |
$6,977.95
|
| Rate for Payer: United Healthcare All Payer |
$6,396.46
|
|
|
PLATE EVOS DST ULN 7H TI 56M L
|
Facility
|
OP
|
$7,268.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.93 |
| Max. Negotiated Rate |
$6,977.95 |
| Rate for Payer: Anthem Medicaid |
$2,499.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.59
|
| Rate for Payer: Cash Price |
$3,634.35
|
| Rate for Payer: Cigna Commercial |
$6,033.02
|
| Rate for Payer: First Health Commercial |
$6,905.26
|
| Rate for Payer: Humana Commercial |
$6,178.40
|
| Rate for Payer: Humana KY Medicaid |
$2,499.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,525.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.33
|
| Rate for Payer: Aetna Commercial |
$5,596.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,549.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.30
|
| Rate for Payer: PHCS Commercial |
$6,977.95
|
| Rate for Payer: United Healthcare All Payer |
$6,396.46
|
|
|
PLATE EVOS VL 7H STD TI 105M R
|
Facility
|
OP
|
$8,930.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.02 |
| Max. Negotiated Rate |
$8,573.67 |
| Rate for Payer: Aetna Commercial |
$6,876.80
|
| Rate for Payer: Anthem Medicaid |
$3,071.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.11
|
| Rate for Payer: Cash Price |
$4,465.45
|
| Rate for Payer: Cigna Commercial |
$7,412.66
|
| Rate for Payer: First Health Commercial |
$8,484.36
|
| Rate for Payer: Humana Commercial |
$7,591.27
|
| Rate for Payer: Humana KY Medicaid |
$3,071.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,132.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.58
|
| Rate for Payer: PHCS Commercial |
$8,573.67
|
| Rate for Payer: United Healthcare All Payer |
$7,859.20
|
|
|
PLATE EVOS VL 7H STD TI 105M R
|
Facility
|
IP
|
$8,930.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.02 |
| Max. Negotiated Rate |
$8,573.67 |
| Rate for Payer: Aetna Commercial |
$6,876.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.11
|
| Rate for Payer: Cash Price |
$4,465.45
|
| Rate for Payer: Cigna Commercial |
$7,412.66
|
| Rate for Payer: First Health Commercial |
$8,484.36
|
| Rate for Payer: Humana Commercial |
$7,591.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.58
|
| Rate for Payer: PHCS Commercial |
$8,573.67
|
| Rate for Payer: United Healthcare All Payer |
$7,859.20
|
|
