|
PLATE T LOPRO 3.0MM 3H TI
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T LOPRO 3.0MM 3H TI
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T LOPRO 3.0MM 4H TI
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T LOPRO 3.0MM 4H TI
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T-METATAR 4 HOLE
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PLATE T-METATAR 4 HOLE
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PLATE T OBLIQUE 3H 52MM
|
Facility
|
OP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem Medicaid |
$706.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Humana KY Medicaid |
$706.98
|
| Rate for Payer: Kentucky WC Medicaid |
$714.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
|
PLATE T OBLIQUE 3H 52MM
|
Facility
|
IP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
|
PLATE T OBLIQUE 3H 71829613
|
Facility
|
IP
|
$2,067.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$1,984.80 |
| Rate for Payer: Aetna Commercial |
$1,591.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.65
|
| Rate for Payer: Cash Price |
$1,033.75
|
| Rate for Payer: Cigna Commercial |
$1,716.02
|
| Rate for Payer: First Health Commercial |
$1,964.12
|
| Rate for Payer: Humana Commercial |
$1,757.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.92
|
| Rate for Payer: PHCS Commercial |
$1,984.80
|
| Rate for Payer: United Healthcare All Payer |
$1,819.40
|
|
|
PLATE T OBLIQUE 3H 71829613
|
Facility
|
OP
|
$2,067.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$1,984.80 |
| Rate for Payer: Aetna Commercial |
$1,591.98
|
| Rate for Payer: Anthem Medicaid |
$711.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.65
|
| Rate for Payer: Cash Price |
$1,033.75
|
| Rate for Payer: Cigna Commercial |
$1,716.02
|
| Rate for Payer: First Health Commercial |
$1,964.12
|
| Rate for Payer: Humana Commercial |
$1,757.38
|
| Rate for Payer: Humana KY Medicaid |
$711.01
|
| Rate for Payer: Kentucky WC Medicaid |
$718.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.92
|
| Rate for Payer: PHCS Commercial |
$1,984.80
|
| Rate for Payer: United Healthcare All Payer |
$1,819.40
|
|
|
PLATE T OBLIQUE 4H 63MM
|
Facility
|
IP
|
$2,094.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.30 |
| Max. Negotiated Rate |
$2,010.84 |
| Rate for Payer: Aetna Commercial |
$1,612.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,633.80
|
| Rate for Payer: Cash Price |
$1,047.31
|
| Rate for Payer: Cigna Commercial |
$1,738.53
|
| Rate for Payer: First Health Commercial |
$1,989.89
|
| Rate for Payer: Humana Commercial |
$1,780.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,717.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,545.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,843.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,570.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.33
|
| Rate for Payer: PHCS Commercial |
$2,010.84
|
| Rate for Payer: United Healthcare All Payer |
$1,843.27
|
|
|
PLATE T OBLIQUE 4H 63MM
|
Facility
|
OP
|
$2,094.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.30 |
| Max. Negotiated Rate |
$2,010.84 |
| Rate for Payer: Aetna Commercial |
$1,612.86
|
| Rate for Payer: Anthem Medicaid |
$720.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,633.80
|
| Rate for Payer: Cash Price |
$1,047.31
|
| Rate for Payer: Cigna Commercial |
$1,738.53
|
| Rate for Payer: First Health Commercial |
$1,989.89
|
| Rate for Payer: Humana Commercial |
$1,780.43
|
| Rate for Payer: Humana KY Medicaid |
$720.34
|
| Rate for Payer: Kentucky WC Medicaid |
$727.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,717.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,545.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$734.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,843.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,570.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.33
|
| Rate for Payer: PHCS Commercial |
$2,010.84
|
| Rate for Payer: United Healthcare All Payer |
$1,843.27
|
|
|
PLATE T OBLIQUE 4H 71829614
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
PLATE T OBLIQUE 4H 71829614
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
PLATE T OBLIQUE 5H 71829615
|
Facility
|
IP
|
$2,123.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.06 |
| Max. Negotiated Rate |
$2,038.56 |
| Rate for Payer: Aetna Commercial |
$1,635.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,656.33
|
| Rate for Payer: Cash Price |
$1,061.75
|
| Rate for Payer: Cigna Commercial |
$1,762.50
|
| Rate for Payer: First Health Commercial |
$2,017.32
|
| Rate for Payer: Humana Commercial |
$1,804.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,741.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,868.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,592.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.28
|
| Rate for Payer: PHCS Commercial |
$2,038.56
|
| Rate for Payer: United Healthcare All Payer |
$1,868.68
|
|
|
PLATE T OBLIQUE 5H 71829615
|
Facility
|
OP
|
$2,123.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$276.06 |
| Max. Negotiated Rate |
$2,038.56 |
| Rate for Payer: Aetna Commercial |
$1,635.10
|
| Rate for Payer: Anthem Medicaid |
$730.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,656.33
|
| Rate for Payer: Cash Price |
$1,061.75
|
| Rate for Payer: Cigna Commercial |
$1,762.50
|
| Rate for Payer: First Health Commercial |
$2,017.32
|
| Rate for Payer: Humana Commercial |
$1,804.98
|
| Rate for Payer: Humana KY Medicaid |
$730.27
|
| Rate for Payer: Kentucky WC Medicaid |
$737.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,741.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$744.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,868.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,592.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$424.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$276.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$658.28
|
| Rate for Payer: PHCS Commercial |
$2,038.56
|
| Rate for Payer: United Healthcare All Payer |
$1,868.68
|
|
|
PLATE T OBLIQUE 5H 73MM
|
Facility
|
IP
|
$2,114.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.83 |
| Max. Negotiated Rate |
$2,029.49 |
| Rate for Payer: Aetna Commercial |
$1,627.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.96
|
| Rate for Payer: Cash Price |
$1,057.03
|
| Rate for Payer: Cigna Commercial |
$1,754.66
|
| Rate for Payer: First Health Commercial |
$2,008.35
|
| Rate for Payer: Humana Commercial |
$1,796.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.36
|
| Rate for Payer: PHCS Commercial |
$2,029.49
|
| Rate for Payer: United Healthcare All Payer |
$1,860.36
|
|
|
PLATE T OBLIQUE 5H 73MM
|
Facility
|
OP
|
$2,114.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.83 |
| Max. Negotiated Rate |
$2,029.49 |
| Rate for Payer: Anthem Medicaid |
$727.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,648.96
|
| Rate for Payer: Cash Price |
$1,057.03
|
| Rate for Payer: Cigna Commercial |
$1,754.66
|
| Rate for Payer: First Health Commercial |
$2,008.35
|
| Rate for Payer: Humana Commercial |
$1,796.94
|
| Rate for Payer: Humana KY Medicaid |
$727.02
|
| Rate for Payer: Kentucky WC Medicaid |
$734.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.36
|
| Rate for Payer: PHCS Commercial |
$2,029.49
|
| Rate for Payer: United Healthcare All Payer |
$1,860.36
|
| Rate for Payer: Aetna Commercial |
$1,627.82
|
|
|
PLATE T OBLIQUE SM
|
Facility
|
IP
|
$2,196.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.56 |
| Max. Negotiated Rate |
$2,108.78 |
| Rate for Payer: Aetna Commercial |
$1,691.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.39
|
| Rate for Payer: Cash Price |
$1,098.33
|
| Rate for Payer: Cigna Commercial |
$1,823.22
|
| Rate for Payer: First Health Commercial |
$2,086.82
|
| Rate for Payer: Humana Commercial |
$1,867.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,801.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$680.96
|
| Rate for Payer: PHCS Commercial |
$2,108.78
|
| Rate for Payer: United Healthcare All Payer |
$1,933.05
|
|
|
PLATE T OBLIQUE SM
|
Facility
|
OP
|
$2,196.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.56 |
| Max. Negotiated Rate |
$2,108.78 |
| Rate for Payer: Aetna Commercial |
$1,691.42
|
| Rate for Payer: Anthem Medicaid |
$755.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.39
|
| Rate for Payer: Cash Price |
$1,098.33
|
| Rate for Payer: Cigna Commercial |
$1,823.22
|
| Rate for Payer: First Health Commercial |
$2,086.82
|
| Rate for Payer: Humana Commercial |
$1,867.15
|
| Rate for Payer: Humana KY Medicaid |
$755.43
|
| Rate for Payer: Kentucky WC Medicaid |
$763.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,801.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,933.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$680.96
|
| Rate for Payer: PHCS Commercial |
$2,108.78
|
| Rate for Payer: United Healthcare All Payer |
$1,933.05
|
|
|
PLATE T OBLIQUE W PF 3H
|
Facility
|
OP
|
$3,075.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$2,952.34 |
| Rate for Payer: Aetna Commercial |
$2,368.02
|
| Rate for Payer: Anthem Medicaid |
$1,057.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.77
|
| Rate for Payer: Cash Price |
$1,537.67
|
| Rate for Payer: Cigna Commercial |
$2,552.54
|
| Rate for Payer: First Health Commercial |
$2,921.58
|
| Rate for Payer: Humana Commercial |
$2,614.05
|
| Rate for Payer: Humana KY Medicaid |
$1,057.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.36
|
| Rate for Payer: PHCS Commercial |
$2,952.34
|
| Rate for Payer: United Healthcare All Payer |
$2,706.31
|
|
|
PLATE T OBLIQUE W PF 3H
|
Facility
|
IP
|
$3,075.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$2,952.34 |
| Rate for Payer: Aetna Commercial |
$2,368.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.77
|
| Rate for Payer: Cash Price |
$1,537.67
|
| Rate for Payer: Cigna Commercial |
$2,552.54
|
| Rate for Payer: First Health Commercial |
$2,921.58
|
| Rate for Payer: Humana Commercial |
$2,614.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.36
|
| Rate for Payer: PHCS Commercial |
$2,952.34
|
| Rate for Payer: United Healthcare All Payer |
$2,706.31
|
|
|
PLATE T OBLIQUE W PF 4H
|
Facility
|
IP
|
$3,147.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.12 |
| Max. Negotiated Rate |
$3,021.22 |
| Rate for Payer: Aetna Commercial |
$2,423.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.74
|
| Rate for Payer: Cash Price |
$1,573.55
|
| Rate for Payer: Cigna Commercial |
$2,612.09
|
| Rate for Payer: First Health Commercial |
$2,989.74
|
| Rate for Payer: Humana Commercial |
$2,675.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$975.60
|
| Rate for Payer: PHCS Commercial |
$3,021.22
|
| Rate for Payer: United Healthcare All Payer |
$2,769.45
|
|
|
PLATE T OBLIQUE W PF 4H
|
Facility
|
OP
|
$3,147.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$409.12 |
| Max. Negotiated Rate |
$3,021.22 |
| Rate for Payer: Aetna Commercial |
$2,423.27
|
| Rate for Payer: Anthem Medicaid |
$1,082.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.74
|
| Rate for Payer: Cash Price |
$1,573.55
|
| Rate for Payer: Cigna Commercial |
$2,612.09
|
| Rate for Payer: First Health Commercial |
$2,989.74
|
| Rate for Payer: Humana Commercial |
$2,675.04
|
| Rate for Payer: Humana KY Medicaid |
$1,082.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$629.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$409.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$975.60
|
| Rate for Payer: PHCS Commercial |
$3,021.22
|
| Rate for Payer: United Healthcare All Payer |
$2,769.45
|
|
|
PLATE T OBLIQUE W PF 5H
|
Facility
|
OP
|
$3,168.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.92 |
| Max. Negotiated Rate |
$3,041.88 |
| Rate for Payer: Aetna Commercial |
$2,439.84
|
| Rate for Payer: Anthem Medicaid |
$1,089.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,471.52
|
| Rate for Payer: Cash Price |
$1,584.31
|
| Rate for Payer: Cigna Commercial |
$2,629.95
|
| Rate for Payer: First Health Commercial |
$3,010.19
|
| Rate for Payer: Humana Commercial |
$2,693.33
|
| Rate for Payer: Humana KY Medicaid |
$1,089.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,598.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,338.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,111.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,788.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,376.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$982.27
|
| Rate for Payer: PHCS Commercial |
$3,041.88
|
| Rate for Payer: United Healthcare All Payer |
$2,788.39
|
|
