|
PLATE ADVMT 5H L 2MM 100D RT
|
Facility
|
OP
|
$2,101.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.39 |
| Max. Negotiated Rate |
$2,017.26 |
| Rate for Payer: Aetna Commercial |
$1,618.01
|
| Rate for Payer: Anthem Medicaid |
$722.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.02
|
| Rate for Payer: Cash Price |
$1,050.65
|
| Rate for Payer: Cigna Commercial |
$1,744.09
|
| Rate for Payer: First Health Commercial |
$1,996.24
|
| Rate for Payer: Humana Commercial |
$1,786.11
|
| Rate for Payer: Humana KY Medicaid |
$722.64
|
| Rate for Payer: Kentucky WC Medicaid |
$730.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,849.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,828.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.90
|
| Rate for Payer: PHCS Commercial |
$2,017.26
|
| Rate for Payer: United Healthcare All Payer |
$1,849.15
|
|
|
PLATE ADVMT 5H L 2MM 100D RT
|
Facility
|
IP
|
$2,101.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.39 |
| Max. Negotiated Rate |
$2,017.26 |
| Rate for Payer: Aetna Commercial |
$1,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.02
|
| Rate for Payer: Cash Price |
$1,050.65
|
| Rate for Payer: Cigna Commercial |
$1,744.09
|
| Rate for Payer: First Health Commercial |
$1,996.24
|
| Rate for Payer: Humana Commercial |
$1,786.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,849.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,828.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.90
|
| Rate for Payer: PHCS Commercial |
$2,017.26
|
| Rate for Payer: United Healthcare All Payer |
$1,849.15
|
|
|
PLATE ADVMT 5H L 5MM 100D LT
|
Facility
|
IP
|
$2,124.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.44 |
| Max. Negotiated Rate |
$2,039.80 |
| Rate for Payer: Aetna Commercial |
$1,636.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.34
|
| Rate for Payer: Cash Price |
$1,062.39
|
| Rate for Payer: Cigna Commercial |
$1,763.58
|
| Rate for Payer: First Health Commercial |
$2,018.55
|
| Rate for Payer: Humana Commercial |
$1,806.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.11
|
| Rate for Payer: PHCS Commercial |
$2,039.80
|
| Rate for Payer: United Healthcare All Payer |
$1,869.82
|
|
|
PLATE ADVMT 5H L 5MM 100D LT
|
Facility
|
OP
|
$2,124.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.44 |
| Max. Negotiated Rate |
$2,039.80 |
| Rate for Payer: Aetna Commercial |
$1,636.09
|
| Rate for Payer: Anthem Medicaid |
$730.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.34
|
| Rate for Payer: Cash Price |
$1,062.39
|
| Rate for Payer: Cigna Commercial |
$1,763.58
|
| Rate for Payer: First Health Commercial |
$2,018.55
|
| Rate for Payer: Humana Commercial |
$1,806.07
|
| Rate for Payer: Humana KY Medicaid |
$730.72
|
| Rate for Payer: Kentucky WC Medicaid |
$738.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.11
|
| Rate for Payer: PHCS Commercial |
$2,039.80
|
| Rate for Payer: United Healthcare All Payer |
$1,869.82
|
|
|
PLATE ADVMT 5H L 5MM 100D RT
|
Facility
|
IP
|
$2,124.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.44 |
| Max. Negotiated Rate |
$2,039.80 |
| Rate for Payer: Aetna Commercial |
$1,636.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.34
|
| Rate for Payer: Cash Price |
$1,062.39
|
| Rate for Payer: Cigna Commercial |
$1,763.58
|
| Rate for Payer: First Health Commercial |
$2,018.55
|
| Rate for Payer: Humana Commercial |
$1,806.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.11
|
| Rate for Payer: PHCS Commercial |
$2,039.80
|
| Rate for Payer: United Healthcare All Payer |
$1,869.82
|
|
|
PLATE ADVMT 5H L 5MM 100D RT
|
Facility
|
OP
|
$2,124.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.44 |
| Max. Negotiated Rate |
$2,039.80 |
| Rate for Payer: Aetna Commercial |
$1,636.09
|
| Rate for Payer: Anthem Medicaid |
$730.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.34
|
| Rate for Payer: Cash Price |
$1,062.39
|
| Rate for Payer: Cigna Commercial |
$1,763.58
|
| Rate for Payer: First Health Commercial |
$2,018.55
|
| Rate for Payer: Humana Commercial |
$1,806.07
|
| Rate for Payer: Humana KY Medicaid |
$730.72
|
| Rate for Payer: Kentucky WC Medicaid |
$738.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.11
|
| Rate for Payer: PHCS Commercial |
$2,039.80
|
| Rate for Payer: United Healthcare All Payer |
$1,869.82
|
|
|
PLATE ADVMT 6H L 12MM 100D RT
|
Facility
|
OP
|
$2,175.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.69 |
| Max. Negotiated Rate |
$2,088.60 |
| Rate for Payer: Aetna Commercial |
$1,675.24
|
| Rate for Payer: Anthem Medicaid |
$748.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.99
|
| Rate for Payer: Cash Price |
$1,087.82
|
| Rate for Payer: Cigna Commercial |
$1,805.77
|
| Rate for Payer: First Health Commercial |
$2,066.85
|
| Rate for Payer: Humana Commercial |
$1,849.29
|
| Rate for Payer: Humana KY Medicaid |
$748.20
|
| Rate for Payer: Kentucky WC Medicaid |
$755.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,784.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,740.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,892.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,501.18
|
| Rate for Payer: PHCS Commercial |
$2,088.60
|
| Rate for Payer: United Healthcare All Payer |
$1,914.55
|
|
|
PLATE ADVMT 6H L 12MM 100D RT
|
Facility
|
IP
|
$2,175.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.69 |
| Max. Negotiated Rate |
$2,088.60 |
| Rate for Payer: Aetna Commercial |
$1,675.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.99
|
| Rate for Payer: Cash Price |
$1,087.82
|
| Rate for Payer: Cigna Commercial |
$1,805.77
|
| Rate for Payer: First Health Commercial |
$2,066.85
|
| Rate for Payer: Humana Commercial |
$1,849.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,784.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,740.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,892.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,501.18
|
| Rate for Payer: PHCS Commercial |
$2,088.60
|
| Rate for Payer: United Healthcare All Payer |
$1,914.55
|
|
|
PLATE ADVMT 6H L 8MM 100D LT
|
Facility
|
OP
|
$2,156.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.84 |
| Max. Negotiated Rate |
$2,069.89 |
| Rate for Payer: Aetna Commercial |
$1,660.23
|
| Rate for Payer: Anthem Medicaid |
$741.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,681.79
|
| Rate for Payer: Cash Price |
$1,078.07
|
| Rate for Payer: Cigna Commercial |
$1,789.60
|
| Rate for Payer: First Health Commercial |
$2,048.33
|
| Rate for Payer: Humana Commercial |
$1,832.72
|
| Rate for Payer: Humana KY Medicaid |
$741.50
|
| Rate for Payer: Kentucky WC Medicaid |
$749.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$756.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,875.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.74
|
| Rate for Payer: PHCS Commercial |
$2,069.89
|
| Rate for Payer: United Healthcare All Payer |
$1,897.40
|
|
|
PLATE ADVMT 6H L 8MM 100D LT
|
Facility
|
IP
|
$2,156.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.84 |
| Max. Negotiated Rate |
$2,069.89 |
| Rate for Payer: Aetna Commercial |
$1,660.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,681.79
|
| Rate for Payer: Cash Price |
$1,078.07
|
| Rate for Payer: Cigna Commercial |
$1,789.60
|
| Rate for Payer: First Health Commercial |
$2,048.33
|
| Rate for Payer: Humana Commercial |
$1,832.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,875.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.74
|
| Rate for Payer: PHCS Commercial |
$2,069.89
|
| Rate for Payer: United Healthcare All Payer |
$1,897.40
|
|
|
PLATE ADVMT 6H L 8MM 100D RT
|
Facility
|
IP
|
$2,156.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.84 |
| Max. Negotiated Rate |
$2,069.89 |
| Rate for Payer: Aetna Commercial |
$1,660.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,681.79
|
| Rate for Payer: Cash Price |
$1,078.07
|
| Rate for Payer: Cigna Commercial |
$1,789.60
|
| Rate for Payer: First Health Commercial |
$2,048.33
|
| Rate for Payer: Humana Commercial |
$1,832.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,875.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.74
|
| Rate for Payer: PHCS Commercial |
$2,069.89
|
| Rate for Payer: United Healthcare All Payer |
$1,897.40
|
|
|
PLATE ADVMT 6H L 8MM 100D RT
|
Facility
|
OP
|
$2,156.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$646.84 |
| Max. Negotiated Rate |
$2,069.89 |
| Rate for Payer: Aetna Commercial |
$1,660.23
|
| Rate for Payer: Anthem Medicaid |
$741.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,681.79
|
| Rate for Payer: Cash Price |
$1,078.07
|
| Rate for Payer: Cigna Commercial |
$1,789.60
|
| Rate for Payer: First Health Commercial |
$2,048.33
|
| Rate for Payer: Humana Commercial |
$1,832.72
|
| Rate for Payer: Humana KY Medicaid |
$741.50
|
| Rate for Payer: Kentucky WC Medicaid |
$749.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$756.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,897.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,724.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,875.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,487.74
|
| Rate for Payer: PHCS Commercial |
$2,069.89
|
| Rate for Payer: United Healthcare All Payer |
$1,897.40
|
|
|
PLATE ANATOMIC LK 4H
|
Facility
|
OP
|
$4,711.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.38 |
| Max. Negotiated Rate |
$4,522.80 |
| Rate for Payer: Aetna Commercial |
$3,627.66
|
| Rate for Payer: Anthem Medicaid |
$1,620.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,674.78
|
| Rate for Payer: Cash Price |
$2,355.62
|
| Rate for Payer: Cigna Commercial |
$3,910.34
|
| Rate for Payer: First Health Commercial |
$4,475.69
|
| Rate for Payer: Humana Commercial |
$4,004.56
|
| Rate for Payer: Humana KY Medicaid |
$1,620.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,863.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,476.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,413.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,145.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,533.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,769.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,098.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,250.76
|
| Rate for Payer: PHCS Commercial |
$4,522.80
|
| Rate for Payer: United Healthcare All Payer |
$4,145.90
|
|
|
PLATE ANATOMIC LK 4H
|
Facility
|
IP
|
$4,711.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,413.38 |
| Max. Negotiated Rate |
$4,522.80 |
| Rate for Payer: Aetna Commercial |
$3,627.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,674.78
|
| Rate for Payer: Cash Price |
$2,355.62
|
| Rate for Payer: Cigna Commercial |
$3,910.34
|
| Rate for Payer: First Health Commercial |
$4,475.69
|
| Rate for Payer: Humana Commercial |
$4,004.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,863.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,476.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,413.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,145.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,533.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,769.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,098.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,250.76
|
| Rate for Payer: PHCS Commercial |
$4,522.80
|
| Rate for Payer: United Healthcare All Payer |
$4,145.90
|
|
|
PLATE ANATOMIC TIB LOCKING 6H
|
Facility
|
OP
|
$5,123.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.12 |
| Max. Negotiated Rate |
$4,918.80 |
| Rate for Payer: Aetna Commercial |
$3,945.29
|
| Rate for Payer: Anthem Medicaid |
$1,762.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,996.53
|
| Rate for Payer: Cash Price |
$2,561.88
|
| Rate for Payer: Cigna Commercial |
$4,252.71
|
| Rate for Payer: First Health Commercial |
$4,867.56
|
| Rate for Payer: Humana Commercial |
$4,355.19
|
| Rate for Payer: Humana KY Medicaid |
$1,762.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,779.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,201.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,781.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,797.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,508.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,842.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,457.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,535.39
|
| Rate for Payer: PHCS Commercial |
$4,918.80
|
| Rate for Payer: United Healthcare All Payer |
$4,508.90
|
|
|
PLATE ANATOMIC TIB LOCKING 6H
|
Facility
|
IP
|
$5,123.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,537.12 |
| Max. Negotiated Rate |
$4,918.80 |
| Rate for Payer: Aetna Commercial |
$3,945.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,996.53
|
| Rate for Payer: Cash Price |
$2,561.88
|
| Rate for Payer: Cigna Commercial |
$4,252.71
|
| Rate for Payer: First Health Commercial |
$4,867.56
|
| Rate for Payer: Humana Commercial |
$4,355.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,201.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,781.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,537.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,508.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,842.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,099.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,457.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,535.39
|
| Rate for Payer: PHCS Commercial |
$4,918.80
|
| Rate for Payer: United Healthcare All Payer |
$4,508.90
|
|
|
PLATE ANTERIOR CLAVICLE 10H
|
Facility
|
OP
|
$4,793.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.12 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna Commercial |
$3,691.19
|
| Rate for Payer: Anthem Medicaid |
$1,648.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.12
|
| Rate for Payer: Cash Price |
$2,396.88
|
| Rate for Payer: Cigna Commercial |
$3,978.81
|
| Rate for Payer: First Health Commercial |
$4,554.06
|
| Rate for Payer: Humana Commercial |
$4,074.69
|
| Rate for Payer: Humana KY Medicaid |
$1,648.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,835.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.69
|
| Rate for Payer: PHCS Commercial |
$4,602.00
|
| Rate for Payer: United Healthcare All Payer |
$4,218.50
|
|
|
PLATE ANTERIOR CLAVICLE 10H
|
Facility
|
IP
|
$4,793.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.12 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna Commercial |
$3,691.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.12
|
| Rate for Payer: Cash Price |
$2,396.88
|
| Rate for Payer: Cigna Commercial |
$3,978.81
|
| Rate for Payer: First Health Commercial |
$4,554.06
|
| Rate for Payer: Humana Commercial |
$4,074.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,835.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.69
|
| Rate for Payer: PHCS Commercial |
$4,602.00
|
| Rate for Payer: United Healthcare All Payer |
$4,218.50
|
|
|
PLATE ANTERIOR MALLEOLAR
|
Facility
|
IP
|
$3,293.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
PLATE ANTERIOR MALLEOLAR
|
Facility
|
OP
|
$3,293.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem Medicaid |
$1,132.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Humana KY Medicaid |
$1,132.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,144.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
PLATE ANTMC VOL DR LT NAR
|
Facility
|
OP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem Medicaid |
$1,676.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Humana KY Medicaid |
$1,676.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,710.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE ANTMC VOL DR LT NAR
|
Facility
|
IP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE ANTMC VOL DR LT NAR LG
|
Facility
|
OP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem Medicaid |
$1,802.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Humana KY Medicaid |
$1,802.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,820.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,838.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
PLATE ANTMC VOL DR LT NAR LG
|
Facility
|
IP
|
$5,240.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,572.00 |
| Max. Negotiated Rate |
$5,030.40 |
| Rate for Payer: Aetna Commercial |
$4,034.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,087.20
|
| Rate for Payer: Cash Price |
$2,620.00
|
| Rate for Payer: Cigna Commercial |
$4,349.20
|
| Rate for Payer: First Health Commercial |
$4,978.00
|
| Rate for Payer: Humana Commercial |
$4,454.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,296.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,867.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,572.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,611.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,930.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,192.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,558.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,615.60
|
| Rate for Payer: PHCS Commercial |
$5,030.40
|
| Rate for Payer: United Healthcare All Payer |
$4,611.20
|
|
|
PLATE ANTMC VOL DR LT STD
|
Facility
|
OP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem Medicaid |
$2,663.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Humana KY Medicaid |
$2,663.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,690.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,716.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
