|
PLATE DIST TIB MED R 15H 244M
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
PLATE DIST TIB MED R 15H 244M
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
PLATE DIST TIB MED R 5H 115M
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
PLATE DIST TIB MED R 5H 115M
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
PLATE DIST TIB MED R 8H 153M
|
Facility
|
OP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem Medicaid |
$2,789.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Humana KY Medicaid |
$2,789.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,817.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,844.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
PLATE DIST TIB MED R 8H 153M
|
Facility
|
IP
|
$8,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,433.00 |
| Max. Negotiated Rate |
$7,785.60 |
| Rate for Payer: Aetna Commercial |
$6,244.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,325.80
|
| Rate for Payer: Cash Price |
$4,055.00
|
| Rate for Payer: Cigna Commercial |
$6,731.30
|
| Rate for Payer: First Health Commercial |
$7,704.50
|
| Rate for Payer: Humana Commercial |
$6,893.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,650.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,985.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,433.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,136.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,082.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,488.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,055.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,595.90
|
| Rate for Payer: PHCS Commercial |
$7,785.60
|
| Rate for Payer: United Healthcare All Payer |
$7,136.80
|
|
|
PLATE DIVERGENT RADIAL STYLOID
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DIVERGENT RADIAL STYLOID
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DOGBONE 10MM
|
Facility
|
IP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
PLATE DOGBONE 10MM
|
Facility
|
OP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem Medicaid |
$2,412.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Humana KY Medicaid |
$2,412.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
PLATE DOR DIS RAD 2H 2.4*37+90
|
Facility
|
IP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RAD 2H 2.4*37+90
|
Facility
|
OP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem Medicaid |
$1,354.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Humana KY Medicaid |
$1,354.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,368.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RAD T 3H 2.4*37
|
Facility
|
IP
|
$4,001.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.51 |
| Max. Negotiated Rate |
$3,841.64 |
| Rate for Payer: Aetna Commercial |
$3,081.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.33
|
| Rate for Payer: Cash Price |
$2,000.86
|
| Rate for Payer: Cigna Commercial |
$3,321.42
|
| Rate for Payer: First Health Commercial |
$3,801.62
|
| Rate for Payer: Humana Commercial |
$3,401.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,201.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.18
|
| Rate for Payer: PHCS Commercial |
$3,841.64
|
| Rate for Payer: United Healthcare All Payer |
$3,521.50
|
|
|
PLATE DOR DIS RAD T 3H 2.4*37
|
Facility
|
OP
|
$4,001.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,200.51 |
| Max. Negotiated Rate |
$3,841.64 |
| Rate for Payer: Aetna Commercial |
$3,081.32
|
| Rate for Payer: Anthem Medicaid |
$1,376.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,121.33
|
| Rate for Payer: Cash Price |
$2,000.86
|
| Rate for Payer: Cigna Commercial |
$3,321.42
|
| Rate for Payer: First Health Commercial |
$3,801.62
|
| Rate for Payer: Humana Commercial |
$3,401.45
|
| Rate for Payer: Humana KY Medicaid |
$1,376.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,390.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,281.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,953.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,200.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,403.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,521.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,001.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,201.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,481.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,761.18
|
| Rate for Payer: PHCS Commercial |
$3,841.64
|
| Rate for Payer: United Healthcare All Payer |
$3,521.50
|
|
|
PLATE DOR DIS RAD T 5H 2.4*51
|
Facility
|
IP
|
$4,089.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.94 |
| Max. Negotiated Rate |
$3,926.21 |
| Rate for Payer: Aetna Commercial |
$3,149.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.04
|
| Rate for Payer: Cash Price |
$2,044.90
|
| Rate for Payer: Cigna Commercial |
$3,394.53
|
| Rate for Payer: First Health Commercial |
$3,885.31
|
| Rate for Payer: Humana Commercial |
$3,476.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,271.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,558.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,821.96
|
| Rate for Payer: PHCS Commercial |
$3,926.21
|
| Rate for Payer: United Healthcare All Payer |
$3,599.02
|
|
|
PLATE DOR DIS RAD T 5H 2.4*51
|
Facility
|
OP
|
$4,089.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.94 |
| Max. Negotiated Rate |
$3,926.21 |
| Rate for Payer: Aetna Commercial |
$3,149.15
|
| Rate for Payer: Anthem Medicaid |
$1,406.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,190.04
|
| Rate for Payer: Cash Price |
$2,044.90
|
| Rate for Payer: Cigna Commercial |
$3,394.53
|
| Rate for Payer: First Health Commercial |
$3,885.31
|
| Rate for Payer: Humana Commercial |
$3,476.33
|
| Rate for Payer: Humana KY Medicaid |
$1,406.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,353.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,018.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,599.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,067.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,271.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,558.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,821.96
|
| Rate for Payer: PHCS Commercial |
$3,926.21
|
| Rate for Payer: United Healthcare All Payer |
$3,599.02
|
|
|
PLATE DOR DIS RD 2H 2.4*37 -90
|
Facility
|
OP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem Medicaid |
$1,354.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Humana KY Medicaid |
$1,354.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,368.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RD 2H 2.4*37 -90
|
Facility
|
IP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
|
PLATE DOR DIS RD 2H 2.4*51 +90
|
Facility
|
OP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem Medicaid |
$1,387.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Humana KY Medicaid |
$1,387.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,401.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 2H 2.4*51 +90
|
Facility
|
IP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 2H 2.4*51 -90
|
Facility
|
IP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 2H 2.4*51 -90
|
Facility
|
OP
|
$4,035.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.54 |
| Max. Negotiated Rate |
$3,873.72 |
| Rate for Payer: Aetna Commercial |
$3,107.04
|
| Rate for Payer: Anthem Medicaid |
$1,387.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,147.39
|
| Rate for Payer: Cash Price |
$2,017.56
|
| Rate for Payer: Cigna Commercial |
$3,349.15
|
| Rate for Payer: First Health Commercial |
$3,833.36
|
| Rate for Payer: Humana Commercial |
$3,429.85
|
| Rate for Payer: Humana KY Medicaid |
$1,387.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,401.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,308.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,977.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,550.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,026.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,228.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,510.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,784.23
|
| Rate for Payer: PHCS Commercial |
$3,873.72
|
| Rate for Payer: United Healthcare All Payer |
$3,550.91
|
|
|
PLATE DOR DIS RD 3H 2.4*37 +90
|
Facility
|
IP
|
$4,211.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.46 |
| Max. Negotiated Rate |
$4,043.06 |
| Rate for Payer: Aetna Commercial |
$3,242.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,284.99
|
| Rate for Payer: Cash Price |
$2,105.76
|
| Rate for Payer: Cigna Commercial |
$3,495.56
|
| Rate for Payer: First Health Commercial |
$4,000.94
|
| Rate for Payer: Humana Commercial |
$3,579.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,453.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,706.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,158.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,369.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,664.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,905.95
|
| Rate for Payer: PHCS Commercial |
$4,043.06
|
| Rate for Payer: United Healthcare All Payer |
$3,706.14
|
|
|
PLATE DOR DIS RD 3H 2.4*37 +90
|
Facility
|
OP
|
$4,211.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,263.46 |
| Max. Negotiated Rate |
$4,043.06 |
| Rate for Payer: Aetna Commercial |
$3,242.87
|
| Rate for Payer: Anthem Medicaid |
$1,448.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,284.99
|
| Rate for Payer: Cash Price |
$2,105.76
|
| Rate for Payer: Cigna Commercial |
$3,495.56
|
| Rate for Payer: First Health Commercial |
$4,000.94
|
| Rate for Payer: Humana Commercial |
$3,579.79
|
| Rate for Payer: Humana KY Medicaid |
$1,448.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,463.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,453.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,108.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,706.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,158.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,369.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,664.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,905.95
|
| Rate for Payer: PHCS Commercial |
$4,043.06
|
| Rate for Payer: United Healthcare All Payer |
$3,706.14
|
|
|
PLATE DOR DIS RD 3H 2.4*37 -90
|
Facility
|
IP
|
$3,937.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.38 |
| Max. Negotiated Rate |
$3,780.41 |
| Rate for Payer: Aetna Commercial |
$3,032.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.59
|
| Rate for Payer: Cash Price |
$1,968.96
|
| Rate for Payer: Cigna Commercial |
$3,268.48
|
| Rate for Payer: First Health Commercial |
$3,741.03
|
| Rate for Payer: Humana Commercial |
$3,347.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,229.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,906.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,465.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,953.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,150.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,426.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,717.17
|
| Rate for Payer: PHCS Commercial |
$3,780.41
|
| Rate for Payer: United Healthcare All Payer |
$3,465.38
|
|
