|
PLATE TUBULAR THRD 5H
|
Facility
|
IP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
PLATE TUBULAR THRD 5H
|
Facility
|
OP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem Medicaid |
$747.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Humana KY Medicaid |
$747.12
|
| Rate for Payer: Kentucky WC Medicaid |
$754.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
PLATE TUBULAR THRD 6H
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem Medicaid |
$753.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Humana KY Medicaid |
$753.14
|
| Rate for Payer: Kentucky WC Medicaid |
$760.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
PLATE TUBULAR THRD 6H
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
PLATE TUBULAR THRD 7H
|
Facility
|
OP
|
$3,092.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.02 |
| Max. Negotiated Rate |
$2,968.80 |
| Rate for Payer: Aetna Commercial |
$2,381.22
|
| Rate for Payer: Anthem Medicaid |
$1,063.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.15
|
| Rate for Payer: Cash Price |
$1,546.25
|
| Rate for Payer: Cigna Commercial |
$2,566.78
|
| Rate for Payer: First Health Commercial |
$2,937.88
|
| Rate for Payer: Humana Commercial |
$2,628.62
|
| Rate for Payer: Humana KY Medicaid |
$1,063.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,535.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,282.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,084.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,319.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$958.68
|
| Rate for Payer: PHCS Commercial |
$2,968.80
|
| Rate for Payer: United Healthcare All Payer |
$2,721.40
|
|
|
PLATE TUBULAR THRD 7H
|
Facility
|
IP
|
$3,092.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.02 |
| Max. Negotiated Rate |
$2,968.80 |
| Rate for Payer: Aetna Commercial |
$2,381.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.15
|
| Rate for Payer: Cash Price |
$1,546.25
|
| Rate for Payer: Cigna Commercial |
$2,566.78
|
| Rate for Payer: First Health Commercial |
$2,937.88
|
| Rate for Payer: Humana Commercial |
$2,628.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,535.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,282.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,319.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$958.68
|
| Rate for Payer: PHCS Commercial |
$2,968.80
|
| Rate for Payer: United Healthcare All Payer |
$2,721.40
|
|
|
PLATE TUBULAR THRD 8H
|
Facility
|
OP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Anthem Medicaid |
$1,075.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Humana KY Medicaid |
$1,075.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
| Rate for Payer: Aetna Commercial |
$2,408.18
|
|
|
PLATE TUBULAR THRD 8H
|
Facility
|
IP
|
$3,127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.58 |
| Max. Negotiated Rate |
$3,002.40 |
| Rate for Payer: Aetna Commercial |
$2,408.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,439.45
|
| Rate for Payer: Cash Price |
$1,563.75
|
| Rate for Payer: Cigna Commercial |
$2,595.82
|
| Rate for Payer: First Health Commercial |
$2,971.12
|
| Rate for Payer: Humana Commercial |
$2,658.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,564.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,308.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,752.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,345.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.52
|
| Rate for Payer: PHCS Commercial |
$3,002.40
|
| Rate for Payer: United Healthcare All Payer |
$2,752.20
|
|
|
PLATE TW 3H 65MM LG
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE TW 3H 65MM LG
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem Medicaid |
$635.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Humana KY Medicaid |
$635.18
|
| Rate for Payer: Kentucky WC Medicaid |
$641.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE TW 4H 85MM
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem Medicaid |
$635.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Humana KY Medicaid |
$635.18
|
| Rate for Payer: Kentucky WC Medicaid |
$641.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE TW 4H 85MM
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE T W/PF HOLES 4H
|
Facility
|
IP
|
$1,859.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.72 |
| Max. Negotiated Rate |
$1,785.04 |
| Rate for Payer: Aetna Commercial |
$1,431.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.35
|
| Rate for Payer: Cash Price |
$929.71
|
| Rate for Payer: Cigna Commercial |
$1,543.32
|
| Rate for Payer: First Health Commercial |
$1,766.45
|
| Rate for Payer: Humana Commercial |
$1,580.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,394.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.42
|
| Rate for Payer: PHCS Commercial |
$1,785.04
|
| Rate for Payer: United Healthcare All Payer |
$1,636.29
|
|
|
PLATE T W/PF HOLES 4H
|
Facility
|
OP
|
$1,859.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.72 |
| Max. Negotiated Rate |
$1,785.04 |
| Rate for Payer: Aetna Commercial |
$1,431.75
|
| Rate for Payer: Anthem Medicaid |
$639.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.35
|
| Rate for Payer: Cash Price |
$929.71
|
| Rate for Payer: Cigna Commercial |
$1,543.32
|
| Rate for Payer: First Health Commercial |
$1,766.45
|
| Rate for Payer: Humana Commercial |
$1,580.51
|
| Rate for Payer: Humana KY Medicaid |
$639.45
|
| Rate for Payer: Kentucky WC Medicaid |
$645.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,636.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,394.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.42
|
| Rate for Payer: PHCS Commercial |
$1,785.04
|
| Rate for Payer: United Healthcare All Payer |
$1,636.29
|
|
|
PLATE T W/PF HOLES 6H
|
Facility
|
OP
|
$1,916.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$1,840.16 |
| Rate for Payer: Aetna Commercial |
$1,475.96
|
| Rate for Payer: Anthem Medicaid |
$659.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.13
|
| Rate for Payer: Cash Price |
$958.41
|
| Rate for Payer: Cigna Commercial |
$1,590.97
|
| Rate for Payer: First Health Commercial |
$1,820.99
|
| Rate for Payer: Humana Commercial |
$1,629.31
|
| Rate for Payer: Humana KY Medicaid |
$659.20
|
| Rate for Payer: Kentucky WC Medicaid |
$665.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$672.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.22
|
| Rate for Payer: PHCS Commercial |
$1,840.16
|
| Rate for Payer: United Healthcare All Payer |
$1,686.81
|
|
|
PLATE T W/PF HOLES 6H
|
Facility
|
IP
|
$1,916.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$1,840.16 |
| Rate for Payer: Aetna Commercial |
$1,475.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.13
|
| Rate for Payer: Cash Price |
$958.41
|
| Rate for Payer: Cigna Commercial |
$1,590.97
|
| Rate for Payer: First Health Commercial |
$1,820.99
|
| Rate for Payer: Humana Commercial |
$1,629.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.22
|
| Rate for Payer: PHCS Commercial |
$1,840.16
|
| Rate for Payer: United Healthcare All Payer |
$1,686.81
|
|
|
PLATE T W/PF HOLES 8H
|
Facility
|
IP
|
$3,886.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$3,730.68 |
| Rate for Payer: Aetna Commercial |
$2,992.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.17
|
| Rate for Payer: Cash Price |
$1,943.06
|
| Rate for Payer: Cigna Commercial |
$3,225.48
|
| Rate for Payer: First Health Commercial |
$3,691.81
|
| Rate for Payer: Humana Commercial |
$3,303.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.70
|
| Rate for Payer: PHCS Commercial |
$3,730.68
|
| Rate for Payer: United Healthcare All Payer |
$3,419.79
|
|
|
PLATE T W/PF HOLES 8H
|
Facility
|
OP
|
$3,886.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$3,730.68 |
| Rate for Payer: Aetna Commercial |
$2,992.31
|
| Rate for Payer: Anthem Medicaid |
$1,336.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.17
|
| Rate for Payer: Cash Price |
$1,943.06
|
| Rate for Payer: Cigna Commercial |
$3,225.48
|
| Rate for Payer: First Health Commercial |
$3,691.81
|
| Rate for Payer: Humana Commercial |
$3,303.20
|
| Rate for Payer: Humana KY Medicaid |
$1,336.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,363.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.70
|
| Rate for Payer: PHCS Commercial |
$3,730.68
|
| Rate for Payer: United Healthcare All Payer |
$3,419.79
|
|
|
PLATE ULNA MIDSAFT 14H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSAFT 14H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSAFT 16H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSAFT 16H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
|
|
PLATE ULNA MIDSHAFT 10H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSHAFT 10H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSHAFT 12H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
