|
PLATE UNIV LOCKING FIB 4H 53MM
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKING FIB 4H 53MM
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKING FIB 6H 76MM
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKING FIB 6H 76MM
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKING FIB 8H 99MM
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKING FIB 8H 99MM
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKNG FIB 10H 121M
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKNG FIB 10H 121M
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKNG FIB 12H 144M
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKNG FIB 12H 144M
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKNG FIB 14H 167M
|
Facility
|
OP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem Medicaid |
$747.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Humana KY Medicaid |
$747.64
|
| Rate for Payer: Kentucky WC Medicaid |
$755.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV LOCKNG FIB 14H 167M
|
Facility
|
IP
|
$2,174.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.20 |
| Max. Negotiated Rate |
$2,087.04 |
| Rate for Payer: Aetna Commercial |
$1,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.72
|
| Rate for Payer: Cash Price |
$1,087.00
|
| Rate for Payer: Cigna Commercial |
$1,804.42
|
| Rate for Payer: First Health Commercial |
$2,065.30
|
| Rate for Payer: Humana Commercial |
$1,847.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,913.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.06
|
| Rate for Payer: PHCS Commercial |
$2,087.04
|
| Rate for Payer: United Healthcare All Payer |
$1,913.12
|
|
|
PLATE UNIV RADIAL 5H
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE UNIV RADIAL 5H
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem Medicaid |
$1,683.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Humana KY Medicaid |
$1,683.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,700.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE UNIV RADIAL 6H
|
Facility
|
IP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE UNIV RADIAL 6H
|
Facility
|
OP
|
$4,895.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,468.50 |
| Max. Negotiated Rate |
$4,699.20 |
| Rate for Payer: Aetna Commercial |
$3,769.15
|
| Rate for Payer: Anthem Medicaid |
$1,683.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,818.10
|
| Rate for Payer: Cash Price |
$2,447.50
|
| Rate for Payer: Cigna Commercial |
$4,062.85
|
| Rate for Payer: First Health Commercial |
$4,650.25
|
| Rate for Payer: Humana Commercial |
$4,160.75
|
| Rate for Payer: Humana KY Medicaid |
$1,683.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,700.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,013.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,612.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,468.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,717.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,307.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,671.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,916.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,258.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,377.55
|
| Rate for Payer: PHCS Commercial |
$4,699.20
|
| Rate for Payer: United Healthcare All Payer |
$4,307.60
|
|
|
PLATE UNIV RADIAL 7H
|
Facility
|
OP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem Medicaid |
$1,612.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Humana KY Medicaid |
$1,612.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE UNIV RADIAL 7H
|
Facility
|
IP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 L
|
Facility
|
IP
|
$7,478.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.51 |
| Max. Negotiated Rate |
$7,179.24 |
| Rate for Payer: Aetna Commercial |
$5,758.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,833.13
|
| Rate for Payer: Cash Price |
$3,739.18
|
| Rate for Payer: Cigna Commercial |
$6,207.05
|
| Rate for Payer: First Health Commercial |
$7,104.45
|
| Rate for Payer: Humana Commercial |
$6,356.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,132.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,519.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,580.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,608.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,982.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,506.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,160.08
|
| Rate for Payer: PHCS Commercial |
$7,179.24
|
| Rate for Payer: United Healthcare All Payer |
$6,580.97
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 L
|
Facility
|
OP
|
$7,478.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.51 |
| Max. Negotiated Rate |
$7,179.24 |
| Rate for Payer: Aetna Commercial |
$5,758.34
|
| Rate for Payer: Anthem Medicaid |
$2,571.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,833.13
|
| Rate for Payer: Cash Price |
$3,739.18
|
| Rate for Payer: Cigna Commercial |
$6,207.05
|
| Rate for Payer: First Health Commercial |
$7,104.45
|
| Rate for Payer: Humana Commercial |
$6,356.61
|
| Rate for Payer: Humana KY Medicaid |
$2,571.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,597.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,132.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,519.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,623.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,580.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,608.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,982.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,506.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,160.08
|
| Rate for Payer: PHCS Commercial |
$7,179.24
|
| Rate for Payer: United Healthcare All Payer |
$6,580.97
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 R
|
Facility
|
OP
|
$7,478.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.51 |
| Max. Negotiated Rate |
$7,179.24 |
| Rate for Payer: Aetna Commercial |
$5,758.34
|
| Rate for Payer: Anthem Medicaid |
$2,571.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,833.13
|
| Rate for Payer: Cash Price |
$3,739.18
|
| Rate for Payer: Cigna Commercial |
$6,207.05
|
| Rate for Payer: First Health Commercial |
$7,104.45
|
| Rate for Payer: Humana Commercial |
$6,356.61
|
| Rate for Payer: Humana KY Medicaid |
$2,571.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,597.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,132.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,519.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,623.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,580.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,608.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,982.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,506.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,160.08
|
| Rate for Payer: PHCS Commercial |
$7,179.24
|
| Rate for Payer: United Healthcare All Payer |
$6,580.97
|
|
|
PLATE UTL HD FSN 3.5M 104M 5 R
|
Facility
|
IP
|
$7,478.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,243.51 |
| Max. Negotiated Rate |
$7,179.24 |
| Rate for Payer: Aetna Commercial |
$5,758.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,833.13
|
| Rate for Payer: Cash Price |
$3,739.18
|
| Rate for Payer: Cigna Commercial |
$6,207.05
|
| Rate for Payer: First Health Commercial |
$7,104.45
|
| Rate for Payer: Humana Commercial |
$6,356.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,132.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,519.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,243.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,580.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,608.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,982.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,506.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,160.08
|
| Rate for Payer: PHCS Commercial |
$7,179.24
|
| Rate for Payer: United Healthcare All Payer |
$6,580.97
|
|
|
PLATE UTL HND FSN 3.5M 79M 3 L
|
Facility
|
IP
|
$7,400.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,220.30 |
| Max. Negotiated Rate |
$7,104.95 |
| Rate for Payer: Aetna Commercial |
$5,698.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,772.77
|
| Rate for Payer: Cash Price |
$3,700.49
|
| Rate for Payer: Cigna Commercial |
$6,142.82
|
| Rate for Payer: First Health Commercial |
$7,030.94
|
| Rate for Payer: Humana Commercial |
$6,290.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,068.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,461.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,220.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,512.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,550.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,920.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,438.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,106.68
|
| Rate for Payer: PHCS Commercial |
$7,104.95
|
| Rate for Payer: United Healthcare All Payer |
$6,512.87
|
|
|
PLATE UTL HND FSN 3.5M 79M 3 L
|
Facility
|
OP
|
$7,400.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,220.30 |
| Max. Negotiated Rate |
$7,104.95 |
| Rate for Payer: Aetna Commercial |
$5,698.76
|
| Rate for Payer: Anthem Medicaid |
$2,545.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,772.77
|
| Rate for Payer: Cash Price |
$3,700.49
|
| Rate for Payer: Cigna Commercial |
$6,142.82
|
| Rate for Payer: First Health Commercial |
$7,030.94
|
| Rate for Payer: Humana Commercial |
$6,290.84
|
| Rate for Payer: Humana KY Medicaid |
$2,545.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,571.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,068.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,461.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,220.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,596.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,512.87
|
| Rate for Payer: Ohio Health Group HMO |
$5,550.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,920.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,438.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,106.68
|
| Rate for Payer: PHCS Commercial |
$7,104.95
|
| Rate for Payer: United Healthcare All Payer |
$6,512.87
|
|
|
PLATE UTL HND FSN 3.5M 79M 3 R
|
Facility
|
OP
|
$7,439.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,231.90 |
| Max. Negotiated Rate |
$7,142.09 |
| Rate for Payer: Aetna Commercial |
$5,728.55
|
| Rate for Payer: Anthem Medicaid |
$2,558.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,802.95
|
| Rate for Payer: Cash Price |
$3,719.84
|
| Rate for Payer: Cigna Commercial |
$6,174.93
|
| Rate for Payer: First Health Commercial |
$7,067.70
|
| Rate for Payer: Humana Commercial |
$6,323.73
|
| Rate for Payer: Humana KY Medicaid |
$2,558.51
|
| Rate for Payer: Kentucky WC Medicaid |
$2,584.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,100.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,490.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,231.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,609.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,546.92
|
| Rate for Payer: Ohio Health Group HMO |
$5,579.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,951.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,472.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,133.38
|
| Rate for Payer: PHCS Commercial |
$7,142.09
|
| Rate for Payer: United Healthcare All Payer |
$6,546.92
|
|
