|
PLATE LK MD CLAV SUP 8H 97M R
|
Facility
|
IP
|
$4,576.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.92 |
| Max. Negotiated Rate |
$4,393.27 |
| Rate for Payer: Aetna Commercial |
$3,523.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,569.53
|
| Rate for Payer: Cash Price |
$2,288.16
|
| Rate for Payer: Cigna Commercial |
$3,798.35
|
| Rate for Payer: First Health Commercial |
$4,347.50
|
| Rate for Payer: Humana Commercial |
$3,889.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,752.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,377.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,027.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,432.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.66
|
| Rate for Payer: PHCS Commercial |
$4,393.27
|
| Rate for Payer: United Healthcare All Payer |
$4,027.16
|
|
|
PLATE LK MD CLAV SUP 8H 97M R
|
Facility
|
OP
|
$4,576.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.92 |
| Max. Negotiated Rate |
$4,393.27 |
| Rate for Payer: Aetna Commercial |
$3,523.77
|
| Rate for Payer: Anthem Medicaid |
$1,573.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,569.53
|
| Rate for Payer: Cash Price |
$2,288.16
|
| Rate for Payer: Cigna Commercial |
$3,798.35
|
| Rate for Payer: First Health Commercial |
$4,347.50
|
| Rate for Payer: Humana Commercial |
$3,889.87
|
| Rate for Payer: Humana KY Medicaid |
$1,573.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,752.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,377.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,605.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,027.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,432.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.66
|
| Rate for Payer: PHCS Commercial |
$4,393.27
|
| Rate for Payer: United Healthcare All Payer |
$4,027.16
|
|
|
PLATE LK MD CLV SP 10H 121M R
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK MD CLV SP 10H 121M R
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK OLECRANON 10H 132MM R
|
Facility
|
OP
|
$8,033.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.31 |
| Max. Negotiated Rate |
$7,711.86 |
| Rate for Payer: Aetna Commercial |
$6,185.56
|
| Rate for Payer: Anthem Medicaid |
$2,762.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,265.89
|
| Rate for Payer: Cash Price |
$4,016.59
|
| Rate for Payer: Cigna Commercial |
$6,667.55
|
| Rate for Payer: First Health Commercial |
$7,631.53
|
| Rate for Payer: Humana Commercial |
$6,828.21
|
| Rate for Payer: Humana KY Medicaid |
$2,762.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,790.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,587.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,928.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,818.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,069.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,024.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,490.29
|
| Rate for Payer: PHCS Commercial |
$7,711.86
|
| Rate for Payer: United Healthcare All Payer |
$7,069.21
|
|
|
PLATE LK OLECRANON 10H 132MM R
|
Facility
|
IP
|
$8,033.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.31 |
| Max. Negotiated Rate |
$7,711.86 |
| Rate for Payer: Aetna Commercial |
$6,185.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,265.89
|
| Rate for Payer: Cash Price |
$4,016.59
|
| Rate for Payer: Cigna Commercial |
$6,667.55
|
| Rate for Payer: First Health Commercial |
$7,631.53
|
| Rate for Payer: Humana Commercial |
$6,828.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,587.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,928.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,069.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,024.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,490.29
|
| Rate for Payer: PHCS Commercial |
$7,711.86
|
| Rate for Payer: United Healthcare All Payer |
$7,069.21
|
|
|
PLATE LK OLECRANON 12H 157MM R
|
Facility
|
IP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE LK OLECRANON 12H 157MM R
|
Facility
|
OP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Anthem Medicaid |
$2,785.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Humana KY Medicaid |
$2,785.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,814.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE LK OLECRANON 4H 56MM R
|
Facility
|
OP
|
$7,101.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.17 |
| Max. Negotiated Rate |
$6,817.29 |
| Rate for Payer: Aetna Commercial |
$5,468.03
|
| Rate for Payer: Anthem Medicaid |
$2,442.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,539.05
|
| Rate for Payer: Cash Price |
$3,550.67
|
| Rate for Payer: Cigna Commercial |
$5,894.11
|
| Rate for Payer: First Health Commercial |
$6,746.27
|
| Rate for Payer: Humana Commercial |
$6,036.14
|
| Rate for Payer: Humana KY Medicaid |
$2,442.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,823.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,240.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,130.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,491.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,249.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,326.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.42
|
| Rate for Payer: PHCS Commercial |
$6,817.29
|
| Rate for Payer: United Healthcare All Payer |
$6,249.18
|
|
|
PLATE LK OLECRANON 4H 56MM R
|
Facility
|
IP
|
$7,101.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.17 |
| Max. Negotiated Rate |
$6,817.29 |
| Rate for Payer: Humana Commercial |
$6,036.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,823.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,240.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,130.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,249.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,326.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.42
|
| Rate for Payer: PHCS Commercial |
$6,817.29
|
| Rate for Payer: United Healthcare All Payer |
$6,249.18
|
| Rate for Payer: Aetna Commercial |
$5,468.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,539.05
|
| Rate for Payer: Cash Price |
$3,550.67
|
| Rate for Payer: Cigna Commercial |
$5,894.11
|
| Rate for Payer: First Health Commercial |
$6,746.27
|
|
|
PLATE LK OLECRANON 6H 81MM R
|
Facility
|
IP
|
$7,492.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.09 |
| Max. Negotiated Rate |
$7,193.27 |
| Rate for Payer: Aetna Commercial |
$5,769.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.53
|
| Rate for Payer: Cash Price |
$3,746.49
|
| Rate for Payer: Cigna Commercial |
$6,219.18
|
| Rate for Payer: First Health Commercial |
$7,118.34
|
| Rate for Payer: Humana Commercial |
$6,369.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.83
|
| Rate for Payer: PHCS Commercial |
$7,193.27
|
| Rate for Payer: United Healthcare All Payer |
$6,593.83
|
|
|
PLATE LK OLECRANON 6H 81MM R
|
Facility
|
OP
|
$7,492.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.09 |
| Max. Negotiated Rate |
$7,193.27 |
| Rate for Payer: Aetna Commercial |
$5,769.60
|
| Rate for Payer: Anthem Medicaid |
$2,576.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.53
|
| Rate for Payer: Cash Price |
$3,746.49
|
| Rate for Payer: Cigna Commercial |
$6,219.18
|
| Rate for Payer: First Health Commercial |
$7,118.34
|
| Rate for Payer: Humana Commercial |
$6,369.04
|
| Rate for Payer: Humana KY Medicaid |
$2,576.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,603.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.83
|
| Rate for Payer: PHCS Commercial |
$7,193.27
|
| Rate for Payer: United Healthcare All Payer |
$6,593.83
|
|
|
PLATE LK OLECRANON 8H 107MM R
|
Facility
|
IP
|
$7,857.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.49 |
| Max. Negotiated Rate |
$7,543.32 |
| Rate for Payer: Aetna Commercial |
$6,050.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,128.94
|
| Rate for Payer: Cash Price |
$3,928.81
|
| Rate for Payer: Cigna Commercial |
$6,521.82
|
| Rate for Payer: First Health Commercial |
$7,464.74
|
| Rate for Payer: Humana Commercial |
$6,678.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,798.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,914.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.86
|
| Rate for Payer: PHCS Commercial |
$7,543.32
|
| Rate for Payer: United Healthcare All Payer |
$6,914.71
|
|
|
PLATE LK OLECRANON 8H 107MM R
|
Facility
|
OP
|
$7,857.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.49 |
| Max. Negotiated Rate |
$7,543.32 |
| Rate for Payer: Aetna Commercial |
$6,050.37
|
| Rate for Payer: Anthem Medicaid |
$2,702.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,128.94
|
| Rate for Payer: Cash Price |
$3,928.81
|
| Rate for Payer: Cigna Commercial |
$6,521.82
|
| Rate for Payer: First Health Commercial |
$7,464.74
|
| Rate for Payer: Humana Commercial |
$6,678.98
|
| Rate for Payer: Humana KY Medicaid |
$2,702.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,729.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,798.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,914.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.86
|
| Rate for Payer: PHCS Commercial |
$7,543.32
|
| Rate for Payer: United Healthcare All Payer |
$6,914.71
|
|
|
PLATE L LT 2.7MM
|
Facility
|
IP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE L LT 2.7MM
|
Facility
|
OP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem Medicaid |
$383.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Humana KY Medicaid |
$383.26
|
| Rate for Payer: Kentucky WC Medicaid |
$387.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$390.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE L OBLIQUE LT 2.0MM
|
Facility
|
IP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
|
|
PLATE L OBLIQUE LT 2.0MM
|
Facility
|
OP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Humana KY Medicaid |
$377.20
|
| Rate for Payer: Kentucky WC Medicaid |
$381.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem Medicaid |
$377.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
|
|
PLATE L OBLIQUE LT 2.7MM
|
Facility
|
IP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE L OBLIQUE LT 2.7MM
|
Facility
|
OP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem Medicaid |
$383.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Humana KY Medicaid |
$383.26
|
| Rate for Payer: Kentucky WC Medicaid |
$387.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$390.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE L OBLIQUE RT 2.0MM
|
Facility
|
IP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
|
|
PLATE L OBLIQUE RT 2.0MM
|
Facility
|
OP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem Medicaid |
$377.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Humana KY Medicaid |
$377.20
|
| Rate for Payer: Kentucky WC Medicaid |
$381.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
|
|
PLATE L OBLIQUE RT 2.7MM
|
Facility
|
IP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE L OBLIQUE RT 2.7MM
|
Facility
|
OP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem Medicaid |
$383.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Humana KY Medicaid |
$383.26
|
| Rate for Payer: Kentucky WC Medicaid |
$387.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$390.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE LOCK 1/3 TUB 7H 89MM
|
Facility
|
IP
|
$1,859.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.75 |
| Max. Negotiated Rate |
$1,785.22 |
| Rate for Payer: Aetna Commercial |
$1,431.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.49
|
| Rate for Payer: Cash Price |
$929.80
|
| Rate for Payer: Cigna Commercial |
$1,543.47
|
| Rate for Payer: First Health Commercial |
$1,766.62
|
| Rate for Payer: Humana Commercial |
$1,580.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,394.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.48
|
| Rate for Payer: PHCS Commercial |
$1,785.22
|
| Rate for Payer: United Healthcare All Payer |
$1,636.45
|
|
