|
PLATE EPICONDYAL LAT LONG LEFT
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE EPINCONDYAL LAT LONG RT
|
Facility
|
OP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem Medicaid |
$1,751.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Humana KY Medicaid |
$1,751.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,769.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,786.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE EPINCONDYAL LAT LONG RT
|
Facility
|
IP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE EPINCONDYAL LAT SM LEFT
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE EPINCONDYAL LAT SM LEFT
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE EPINCONDYAL LAT SM RT
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE EPINCONDYAL LAT SM RT
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE EVOS 2.7MM COMP 8H 67MM
|
Facility
|
IP
|
$3,274.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.39 |
| Max. Negotiated Rate |
$3,143.64 |
| Rate for Payer: Aetna Commercial |
$2,521.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.20
|
| Rate for Payer: Cash Price |
$1,637.31
|
| Rate for Payer: Cigna Commercial |
$2,717.93
|
| Rate for Payer: First Health Commercial |
$3,110.89
|
| Rate for Payer: Humana Commercial |
$2,783.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,881.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,455.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,619.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,848.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.49
|
| Rate for Payer: PHCS Commercial |
$3,143.64
|
| Rate for Payer: United Healthcare All Payer |
$2,881.67
|
|
|
PLATE EVOS 2.7MM COMP 8H 67MM
|
Facility
|
OP
|
$3,274.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.39 |
| Max. Negotiated Rate |
$3,143.64 |
| Rate for Payer: Aetna Commercial |
$2,521.46
|
| Rate for Payer: Anthem Medicaid |
$1,126.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.20
|
| Rate for Payer: Cash Price |
$1,637.31
|
| Rate for Payer: Cigna Commercial |
$2,717.93
|
| Rate for Payer: First Health Commercial |
$3,110.89
|
| Rate for Payer: Humana Commercial |
$2,783.43
|
| Rate for Payer: Humana KY Medicaid |
$1,126.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,137.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,148.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,881.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,455.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,619.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,848.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.49
|
| Rate for Payer: PHCS Commercial |
$3,143.64
|
| Rate for Payer: United Healthcare All Payer |
$2,881.67
|
|
|
PLATE EVOS DRS 3H STD TI 56M L
|
Facility
|
OP
|
$7,468.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.61 |
| Max. Negotiated Rate |
$7,169.95 |
| Rate for Payer: Aetna Commercial |
$5,750.90
|
| Rate for Payer: Anthem Medicaid |
$2,568.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.59
|
| Rate for Payer: Cash Price |
$3,734.35
|
| Rate for Payer: Cigna Commercial |
$6,199.02
|
| Rate for Payer: First Health Commercial |
$7,095.27
|
| Rate for Payer: Humana Commercial |
$6,348.40
|
| Rate for Payer: Humana KY Medicaid |
$2,568.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,124.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,620.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,572.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,153.40
|
| Rate for Payer: PHCS Commercial |
$7,169.95
|
| Rate for Payer: United Healthcare All Payer |
$6,572.46
|
|
|
PLATE EVOS DRS 3H STD TI 56M L
|
Facility
|
IP
|
$7,468.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.61 |
| Max. Negotiated Rate |
$7,169.95 |
| Rate for Payer: Aetna Commercial |
$5,750.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.59
|
| Rate for Payer: Cash Price |
$3,734.35
|
| Rate for Payer: Cigna Commercial |
$6,199.02
|
| Rate for Payer: First Health Commercial |
$7,095.27
|
| Rate for Payer: Humana Commercial |
$6,348.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,124.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,572.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,153.40
|
| Rate for Payer: PHCS Commercial |
$7,169.95
|
| Rate for Payer: United Healthcare All Payer |
$6,572.46
|
|
|
PLATE EVOS DRS 3H WDE TI 56M L
|
Facility
|
OP
|
$7,468.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.61 |
| Max. Negotiated Rate |
$7,169.95 |
| Rate for Payer: Aetna Commercial |
$5,750.90
|
| Rate for Payer: Anthem Medicaid |
$2,568.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.59
|
| Rate for Payer: Cash Price |
$3,734.35
|
| Rate for Payer: Cigna Commercial |
$6,199.02
|
| Rate for Payer: First Health Commercial |
$7,095.27
|
| Rate for Payer: Humana Commercial |
$6,348.40
|
| Rate for Payer: Humana KY Medicaid |
$2,568.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,124.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,620.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,572.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,153.40
|
| Rate for Payer: PHCS Commercial |
$7,169.95
|
| Rate for Payer: United Healthcare All Payer |
$6,572.46
|
|
|
PLATE EVOS DRS 3H WDE TI 56M L
|
Facility
|
IP
|
$7,468.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.61 |
| Max. Negotiated Rate |
$7,169.95 |
| Rate for Payer: Aetna Commercial |
$5,750.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.59
|
| Rate for Payer: Cash Price |
$3,734.35
|
| Rate for Payer: Cigna Commercial |
$6,199.02
|
| Rate for Payer: First Health Commercial |
$7,095.27
|
| Rate for Payer: Humana Commercial |
$6,348.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,124.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,572.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,153.40
|
| Rate for Payer: PHCS Commercial |
$7,169.95
|
| Rate for Payer: United Healthcare All Payer |
$6,572.46
|
|
|
PLATE EVOS DST ULN 7H TI 56M L
|
Facility
|
OP
|
$7,468.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.61 |
| Max. Negotiated Rate |
$7,169.95 |
| Rate for Payer: Aetna Commercial |
$5,750.90
|
| Rate for Payer: Anthem Medicaid |
$2,568.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.59
|
| Rate for Payer: Cash Price |
$3,734.35
|
| Rate for Payer: Cigna Commercial |
$6,199.02
|
| Rate for Payer: First Health Commercial |
$7,095.27
|
| Rate for Payer: Humana Commercial |
$6,348.40
|
| Rate for Payer: Humana KY Medicaid |
$2,568.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,594.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,124.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,620.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,572.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,153.40
|
| Rate for Payer: PHCS Commercial |
$7,169.95
|
| Rate for Payer: United Healthcare All Payer |
$6,572.46
|
|
|
PLATE EVOS DST ULN 7H TI 56M L
|
Facility
|
IP
|
$7,468.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,240.61 |
| Max. Negotiated Rate |
$7,169.95 |
| Rate for Payer: Aetna Commercial |
$5,750.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,825.59
|
| Rate for Payer: Cash Price |
$3,734.35
|
| Rate for Payer: Cigna Commercial |
$6,199.02
|
| Rate for Payer: First Health Commercial |
$7,095.27
|
| Rate for Payer: Humana Commercial |
$6,348.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,124.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,511.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,240.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,572.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,601.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,974.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,497.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,153.40
|
| Rate for Payer: PHCS Commercial |
$7,169.95
|
| Rate for Payer: United Healthcare All Payer |
$6,572.46
|
|
|
PLATE EVOS VL 7H STD TI 105M R
|
Facility
|
OP
|
$9,130.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.27 |
| Max. Negotiated Rate |
$8,765.67 |
| Rate for Payer: Aetna Commercial |
$7,030.80
|
| Rate for Payer: Anthem Medicaid |
$3,140.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.11
|
| Rate for Payer: Cash Price |
$4,565.45
|
| Rate for Payer: Cigna Commercial |
$7,578.66
|
| Rate for Payer: First Health Commercial |
$8,674.36
|
| Rate for Payer: Humana Commercial |
$7,761.27
|
| Rate for Payer: Humana KY Medicaid |
$3,140.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,487.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,738.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,035.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,848.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,943.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,300.33
|
| Rate for Payer: PHCS Commercial |
$8,765.67
|
| Rate for Payer: United Healthcare All Payer |
$8,035.20
|
|
|
PLATE EVOS VL 7H STD TI 105M R
|
Facility
|
IP
|
$9,130.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.27 |
| Max. Negotiated Rate |
$8,765.67 |
| Rate for Payer: Aetna Commercial |
$7,030.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.11
|
| Rate for Payer: Cash Price |
$4,565.45
|
| Rate for Payer: Cigna Commercial |
$7,578.66
|
| Rate for Payer: First Health Commercial |
$8,674.36
|
| Rate for Payer: Humana Commercial |
$7,761.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,487.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,738.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,035.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,848.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,943.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,300.33
|
| Rate for Payer: PHCS Commercial |
$8,765.67
|
| Rate for Payer: United Healthcare All Payer |
$8,035.20
|
|
|
PLATE EVOS VL 7H WDE TI 105M L
|
Facility
|
OP
|
$9,130.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.27 |
| Max. Negotiated Rate |
$8,765.67 |
| Rate for Payer: Aetna Commercial |
$7,030.80
|
| Rate for Payer: Anthem Medicaid |
$3,140.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.11
|
| Rate for Payer: Cash Price |
$4,565.45
|
| Rate for Payer: Cigna Commercial |
$7,578.66
|
| Rate for Payer: First Health Commercial |
$8,674.36
|
| Rate for Payer: Humana Commercial |
$7,761.27
|
| Rate for Payer: Humana KY Medicaid |
$3,140.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,487.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,738.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,035.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,848.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,943.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,300.33
|
| Rate for Payer: PHCS Commercial |
$8,765.67
|
| Rate for Payer: United Healthcare All Payer |
$8,035.20
|
|
|
PLATE EVOS VL 7H WDE TI 105M L
|
Facility
|
IP
|
$9,130.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.27 |
| Max. Negotiated Rate |
$8,765.67 |
| Rate for Payer: Aetna Commercial |
$7,030.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.11
|
| Rate for Payer: Cash Price |
$4,565.45
|
| Rate for Payer: Cigna Commercial |
$7,578.66
|
| Rate for Payer: First Health Commercial |
$8,674.36
|
| Rate for Payer: Humana Commercial |
$7,761.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,487.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,738.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,035.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,848.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,943.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,300.33
|
| Rate for Payer: PHCS Commercial |
$8,765.67
|
| Rate for Payer: United Healthcare All Payer |
$8,035.20
|
|
|
PLATE EVOS VL 7H WDE TI 105M R
|
Facility
|
OP
|
$9,130.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.27 |
| Max. Negotiated Rate |
$8,765.67 |
| Rate for Payer: Aetna Commercial |
$7,030.80
|
| Rate for Payer: Anthem Medicaid |
$3,140.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.11
|
| Rate for Payer: Cash Price |
$4,565.45
|
| Rate for Payer: Cigna Commercial |
$7,578.66
|
| Rate for Payer: First Health Commercial |
$8,674.36
|
| Rate for Payer: Humana Commercial |
$7,761.27
|
| Rate for Payer: Humana KY Medicaid |
$3,140.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,487.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,738.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,203.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,035.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,848.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,943.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,300.33
|
| Rate for Payer: PHCS Commercial |
$8,765.67
|
| Rate for Payer: United Healthcare All Payer |
$8,035.20
|
|
|
PLATE EVOS VL 7H WDE TI 105M R
|
Facility
|
IP
|
$9,130.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,739.27 |
| Max. Negotiated Rate |
$8,765.67 |
| Rate for Payer: Aetna Commercial |
$7,030.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,122.11
|
| Rate for Payer: Cash Price |
$4,565.45
|
| Rate for Payer: Cigna Commercial |
$7,578.66
|
| Rate for Payer: First Health Commercial |
$8,674.36
|
| Rate for Payer: Humana Commercial |
$7,761.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,487.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,738.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,739.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,035.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,848.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,304.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,943.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,300.33
|
| Rate for Payer: PHCS Commercial |
$8,765.67
|
| Rate for Payer: United Healthcare All Payer |
$8,035.20
|
|
|
PLATE EVOS VOL 3H WDE TI 48M L
|
Facility
|
IP
|
$5,588.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,676.62 |
| Max. Negotiated Rate |
$5,365.20 |
| Rate for Payer: Aetna Commercial |
$4,303.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,359.23
|
| Rate for Payer: Cash Price |
$2,794.38
|
| Rate for Payer: Cigna Commercial |
$4,638.66
|
| Rate for Payer: First Health Commercial |
$5,309.31
|
| Rate for Payer: Humana Commercial |
$4,750.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,582.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,124.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,676.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,918.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,191.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,471.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,862.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,856.24
|
| Rate for Payer: PHCS Commercial |
$5,365.20
|
| Rate for Payer: United Healthcare All Payer |
$4,918.10
|
|
|
PLATE EVOS VOL 3H WDE TI 48M L
|
Facility
|
OP
|
$5,588.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,676.62 |
| Max. Negotiated Rate |
$5,365.20 |
| Rate for Payer: Aetna Commercial |
$4,303.34
|
| Rate for Payer: Anthem Medicaid |
$1,921.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,359.23
|
| Rate for Payer: Cash Price |
$2,794.38
|
| Rate for Payer: Cigna Commercial |
$4,638.66
|
| Rate for Payer: First Health Commercial |
$5,309.31
|
| Rate for Payer: Humana Commercial |
$4,750.44
|
| Rate for Payer: Humana KY Medicaid |
$1,921.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,941.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,582.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,124.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,676.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,960.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,918.10
|
| Rate for Payer: Ohio Health Group HMO |
$4,191.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,471.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,862.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,856.24
|
| Rate for Payer: PHCS Commercial |
$5,365.20
|
| Rate for Payer: United Healthcare All Payer |
$4,918.10
|
|
|
PLATE EVOS VOL 3H WDE TI 48M R
|
Facility
|
IP
|
$5,660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.00 |
| Max. Negotiated Rate |
$5,433.60 |
| Rate for Payer: Aetna Commercial |
$4,358.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,414.80
|
| Rate for Payer: Cash Price |
$2,830.00
|
| Rate for Payer: Cigna Commercial |
$4,697.80
|
| Rate for Payer: First Health Commercial |
$5,377.00
|
| Rate for Payer: Humana Commercial |
$4,811.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,641.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,177.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,698.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,980.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,924.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,905.40
|
| Rate for Payer: PHCS Commercial |
$5,433.60
|
| Rate for Payer: United Healthcare All Payer |
$4,980.80
|
|
|
PLATE EVOS VOL 3H WDE TI 48M R
|
Facility
|
OP
|
$5,660.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,698.00 |
| Max. Negotiated Rate |
$5,433.60 |
| Rate for Payer: Aetna Commercial |
$4,358.20
|
| Rate for Payer: Anthem Medicaid |
$1,946.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,414.80
|
| Rate for Payer: Cash Price |
$2,830.00
|
| Rate for Payer: Cigna Commercial |
$4,697.80
|
| Rate for Payer: First Health Commercial |
$5,377.00
|
| Rate for Payer: Humana Commercial |
$4,811.00
|
| Rate for Payer: Humana KY Medicaid |
$1,946.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,966.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,641.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,177.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,698.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,985.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,980.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,245.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,528.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,924.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,905.40
|
| Rate for Payer: PHCS Commercial |
$5,433.60
|
| Rate for Payer: United Healthcare All Payer |
$4,980.80
|
|
