|
PLATE BLADE CHILD 3H 90 45/8
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 25/12
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 25/12
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 25/7
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 25/7
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 32/12
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 32/12
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 32/7
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE INF 3H 90 32/7
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLD BIF INF 3H 115 30/5
|
Facility
|
IP
|
$3,099.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.79 |
| Max. Negotiated Rate |
$2,975.34 |
| Rate for Payer: Aetna Commercial |
$2,386.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,417.46
|
| Rate for Payer: Cash Price |
$1,549.66
|
| Rate for Payer: Cigna Commercial |
$2,572.43
|
| Rate for Payer: First Health Commercial |
$2,944.34
|
| Rate for Payer: Humana Commercial |
$2,634.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,541.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,727.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,324.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,479.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,696.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.52
|
| Rate for Payer: PHCS Commercial |
$2,975.34
|
| Rate for Payer: United Healthcare All Payer |
$2,727.39
|
|
|
PLATE BLD BIF INF 3H 115 30/5
|
Facility
|
OP
|
$3,099.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.79 |
| Max. Negotiated Rate |
$2,975.34 |
| Rate for Payer: Aetna Commercial |
$2,386.47
|
| Rate for Payer: Anthem Medicaid |
$1,065.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,417.46
|
| Rate for Payer: Cash Price |
$1,549.66
|
| Rate for Payer: Cigna Commercial |
$2,572.43
|
| Rate for Payer: First Health Commercial |
$2,944.34
|
| Rate for Payer: Humana Commercial |
$2,634.41
|
| Rate for Payer: Humana KY Medicaid |
$1,065.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,076.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,541.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,087.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,727.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,324.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,479.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,696.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.52
|
| Rate for Payer: PHCS Commercial |
$2,975.34
|
| Rate for Payer: United Healthcare All Payer |
$2,727.39
|
|
|
PLATE BLD BIF INF 3H 115 35/5
|
Facility
|
IP
|
$3,099.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.79 |
| Max. Negotiated Rate |
$2,975.34 |
| Rate for Payer: Aetna Commercial |
$2,386.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,417.46
|
| Rate for Payer: Cash Price |
$1,549.66
|
| Rate for Payer: Cigna Commercial |
$2,572.43
|
| Rate for Payer: First Health Commercial |
$2,944.34
|
| Rate for Payer: Humana Commercial |
$2,634.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,541.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,727.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,324.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,479.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,696.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.52
|
| Rate for Payer: PHCS Commercial |
$2,975.34
|
| Rate for Payer: United Healthcare All Payer |
$2,727.39
|
|
|
PLATE BLD BIF INF 3H 115 35/5
|
Facility
|
OP
|
$3,099.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$929.79 |
| Max. Negotiated Rate |
$2,975.34 |
| Rate for Payer: Aetna Commercial |
$2,386.47
|
| Rate for Payer: Anthem Medicaid |
$1,065.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,417.46
|
| Rate for Payer: Cash Price |
$1,549.66
|
| Rate for Payer: Cigna Commercial |
$2,572.43
|
| Rate for Payer: First Health Commercial |
$2,944.34
|
| Rate for Payer: Humana Commercial |
$2,634.41
|
| Rate for Payer: Humana KY Medicaid |
$1,065.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,076.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,541.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,287.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$929.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,087.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,727.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,324.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,479.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,696.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.52
|
| Rate for Payer: PHCS Commercial |
$2,975.34
|
| Rate for Payer: United Healthcare All Payer |
$2,727.39
|
|
|
PLATE BNE LNG TN POLYAX LCK 6H
|
Facility
|
IP
|
$8,234.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,470.37 |
| Max. Negotiated Rate |
$7,905.19 |
| Rate for Payer: Aetna Commercial |
$6,340.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,422.96
|
| Rate for Payer: Cash Price |
$4,117.29
|
| Rate for Payer: Cigna Commercial |
$6,834.69
|
| Rate for Payer: First Health Commercial |
$7,822.84
|
| Rate for Payer: Humana Commercial |
$6,999.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,470.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,246.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,175.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,587.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,164.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,681.85
|
| Rate for Payer: PHCS Commercial |
$7,905.19
|
| Rate for Payer: United Healthcare All Payer |
$7,246.42
|
|
|
PLATE BNE LNG TN POLYAX LCK 6H
|
Facility
|
OP
|
$8,234.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,470.37 |
| Max. Negotiated Rate |
$7,905.19 |
| Rate for Payer: Aetna Commercial |
$6,340.62
|
| Rate for Payer: Anthem Medicaid |
$2,831.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,422.96
|
| Rate for Payer: Cash Price |
$4,117.29
|
| Rate for Payer: Cigna Commercial |
$6,834.69
|
| Rate for Payer: First Health Commercial |
$7,822.84
|
| Rate for Payer: Humana Commercial |
$6,999.38
|
| Rate for Payer: Humana KY Medicaid |
$2,831.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,860.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,752.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,077.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,470.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,888.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,246.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,175.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,587.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,164.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,681.85
|
| Rate for Payer: PHCS Commercial |
$7,905.19
|
| Rate for Payer: United Healthcare All Payer |
$7,246.42
|
|
|
PLATE BONE 10.00
|
Facility
|
IP
|
$4,593.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.05 |
| Max. Negotiated Rate |
$4,409.76 |
| Rate for Payer: Aetna Commercial |
$3,536.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,582.93
|
| Rate for Payer: Cash Price |
$2,296.75
|
| Rate for Payer: Cigna Commercial |
$3,812.61
|
| Rate for Payer: First Health Commercial |
$4,363.82
|
| Rate for Payer: Humana Commercial |
$3,904.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,766.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,390.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,378.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,042.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,445.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,674.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,996.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,169.51
|
| Rate for Payer: PHCS Commercial |
$4,409.76
|
| Rate for Payer: United Healthcare All Payer |
$4,042.28
|
|
|
PLATE BONE 10.00
|
Facility
|
OP
|
$4,593.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.05 |
| Max. Negotiated Rate |
$4,409.76 |
| Rate for Payer: Aetna Commercial |
$3,536.99
|
| Rate for Payer: Anthem Medicaid |
$1,579.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,582.93
|
| Rate for Payer: Cash Price |
$2,296.75
|
| Rate for Payer: Cigna Commercial |
$3,812.61
|
| Rate for Payer: First Health Commercial |
$4,363.82
|
| Rate for Payer: Humana Commercial |
$3,904.47
|
| Rate for Payer: Humana KY Medicaid |
$1,579.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,595.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,766.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,390.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,378.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,611.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,042.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,445.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,674.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,996.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,169.51
|
| Rate for Payer: PHCS Commercial |
$4,409.76
|
| Rate for Payer: United Healthcare All Payer |
$4,042.28
|
|
|
PLATE BONE 12.00
|
Facility
|
IP
|
$4,593.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.05 |
| Max. Negotiated Rate |
$4,409.76 |
| Rate for Payer: Aetna Commercial |
$3,536.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,582.93
|
| Rate for Payer: Cash Price |
$2,296.75
|
| Rate for Payer: Cigna Commercial |
$3,812.61
|
| Rate for Payer: First Health Commercial |
$4,363.82
|
| Rate for Payer: Humana Commercial |
$3,904.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,766.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,390.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,378.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,042.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,445.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,674.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,996.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,169.51
|
| Rate for Payer: PHCS Commercial |
$4,409.76
|
| Rate for Payer: United Healthcare All Payer |
$4,042.28
|
|
|
PLATE BONE 12.00
|
Facility
|
OP
|
$4,593.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.05 |
| Max. Negotiated Rate |
$4,409.76 |
| Rate for Payer: Aetna Commercial |
$3,536.99
|
| Rate for Payer: Anthem Medicaid |
$1,579.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,582.93
|
| Rate for Payer: Cash Price |
$2,296.75
|
| Rate for Payer: Cigna Commercial |
$3,812.61
|
| Rate for Payer: First Health Commercial |
$4,363.82
|
| Rate for Payer: Humana Commercial |
$3,904.47
|
| Rate for Payer: Humana KY Medicaid |
$1,579.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,595.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,766.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,390.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,378.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,611.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,042.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,445.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,674.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,996.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,169.51
|
| Rate for Payer: PHCS Commercial |
$4,409.76
|
| Rate for Payer: United Healthcare All Payer |
$4,042.28
|
|
|
PLATE BONE 6.5
|
Facility
|
IP
|
$4,493.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.12 |
| Max. Negotiated Rate |
$4,314.00 |
| Rate for Payer: Aetna Commercial |
$3,460.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,505.12
|
| Rate for Payer: Cash Price |
$2,246.88
|
| Rate for Payer: Cigna Commercial |
$3,729.81
|
| Rate for Payer: First Health Commercial |
$4,269.06
|
| Rate for Payer: Humana Commercial |
$3,819.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,316.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,954.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,370.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,909.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,100.69
|
| Rate for Payer: PHCS Commercial |
$4,314.00
|
| Rate for Payer: United Healthcare All Payer |
$3,954.50
|
|
|
PLATE BONE 6.5
|
Facility
|
OP
|
$4,493.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,348.12 |
| Max. Negotiated Rate |
$4,314.00 |
| Rate for Payer: Aetna Commercial |
$3,460.19
|
| Rate for Payer: Anthem Medicaid |
$1,545.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,505.12
|
| Rate for Payer: Cash Price |
$2,246.88
|
| Rate for Payer: Cigna Commercial |
$3,729.81
|
| Rate for Payer: First Health Commercial |
$4,269.06
|
| Rate for Payer: Humana Commercial |
$3,819.69
|
| Rate for Payer: Humana KY Medicaid |
$1,545.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,561.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,316.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,348.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,954.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,370.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,595.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,909.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,100.69
|
| Rate for Payer: PHCS Commercial |
$4,314.00
|
| Rate for Payer: United Healthcare All Payer |
$3,954.50
|
|
|
PLATE BONE 8.0
|
Facility
|
OP
|
$3,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$3,809.28 |
| Rate for Payer: Aetna Commercial |
$3,055.36
|
| Rate for Payer: Anthem Medicaid |
$1,364.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.04
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cigna Commercial |
$3,293.44
|
| Rate for Payer: First Health Commercial |
$3,769.60
|
| Rate for Payer: Humana Commercial |
$3,372.80
|
| Rate for Payer: Humana KY Medicaid |
$1,364.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,253.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,391.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,491.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,737.92
|
| Rate for Payer: PHCS Commercial |
$3,809.28
|
| Rate for Payer: United Healthcare All Payer |
$3,491.84
|
|
|
PLATE BONE 8.0
|
Facility
|
IP
|
$3,968.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.40 |
| Max. Negotiated Rate |
$3,809.28 |
| Rate for Payer: Aetna Commercial |
$3,055.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.04
|
| Rate for Payer: Cash Price |
$1,984.00
|
| Rate for Payer: Cigna Commercial |
$3,293.44
|
| Rate for Payer: First Health Commercial |
$3,769.60
|
| Rate for Payer: Humana Commercial |
$3,372.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,253.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,491.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,174.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,737.92
|
| Rate for Payer: PHCS Commercial |
$3,809.28
|
| Rate for Payer: United Healthcare All Payer |
$3,491.84
|
|
|
PLATE BONE BROAD Y 5H
|
Facility
|
IP
|
$7,378.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,213.42 |
| Max. Negotiated Rate |
$7,082.95 |
| Rate for Payer: Aetna Commercial |
$5,681.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,754.89
|
| Rate for Payer: Cash Price |
$3,689.03
|
| Rate for Payer: Cigna Commercial |
$6,123.80
|
| Rate for Payer: First Health Commercial |
$7,009.17
|
| Rate for Payer: Humana Commercial |
$6,271.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,050.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,445.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,213.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,492.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,533.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,902.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,418.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.87
|
| Rate for Payer: PHCS Commercial |
$7,082.95
|
| Rate for Payer: United Healthcare All Payer |
$6,492.70
|
|
|
PLATE BONE BROAD Y 5H
|
Facility
|
OP
|
$7,378.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,213.42 |
| Max. Negotiated Rate |
$7,082.95 |
| Rate for Payer: Aetna Commercial |
$5,681.11
|
| Rate for Payer: Anthem Medicaid |
$2,537.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,754.89
|
| Rate for Payer: Cash Price |
$3,689.03
|
| Rate for Payer: Cigna Commercial |
$6,123.80
|
| Rate for Payer: First Health Commercial |
$7,009.17
|
| Rate for Payer: Humana Commercial |
$6,271.36
|
| Rate for Payer: Humana KY Medicaid |
$2,537.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,050.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,445.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,213.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,492.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,533.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,902.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,418.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.87
|
| Rate for Payer: PHCS Commercial |
$7,082.95
|
| Rate for Payer: United Healthcare All Payer |
$6,492.70
|
|
