|
PLATE VOLAR DR INTER XL R 10H
|
Facility
|
OP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem Medicaid |
$1,744.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Humana KY Medicaid |
$1,744.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,761.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR NAR L 8H X-SHRT
|
Facility
|
IP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR NAR L 8H X-SHRT
|
Facility
|
OP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem Medicaid |
$1,744.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Humana KY Medicaid |
$1,744.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,761.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR NAR R 8H X-SHRT
|
Facility
|
OP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem Medicaid |
$1,744.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Humana KY Medicaid |
$1,744.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,761.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR NAR R 8H X-SHRT
|
Facility
|
IP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE VOLAR DR STD 10H R EX SH
|
Facility
|
IP
|
$7,248.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.50 |
| Max. Negotiated Rate |
$6,958.41 |
| Rate for Payer: Aetna Commercial |
$5,581.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,653.71
|
| Rate for Payer: Cash Price |
$3,624.17
|
| Rate for Payer: Cigna Commercial |
$6,016.12
|
| Rate for Payer: First Health Commercial |
$6,885.92
|
| Rate for Payer: Humana Commercial |
$6,161.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,943.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,349.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,378.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,436.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,798.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,306.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,001.35
|
| Rate for Payer: PHCS Commercial |
$6,958.41
|
| Rate for Payer: United Healthcare All Payer |
$6,378.54
|
|
|
PLATE VOLAR DR STD 10H R EX SH
|
Facility
|
OP
|
$7,248.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,174.50 |
| Max. Negotiated Rate |
$6,958.41 |
| Rate for Payer: Aetna Commercial |
$5,581.22
|
| Rate for Payer: Anthem Medicaid |
$2,492.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,653.71
|
| Rate for Payer: Cash Price |
$3,624.17
|
| Rate for Payer: Cigna Commercial |
$6,016.12
|
| Rate for Payer: First Health Commercial |
$6,885.92
|
| Rate for Payer: Humana Commercial |
$6,161.09
|
| Rate for Payer: Humana KY Medicaid |
$2,492.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,518.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,943.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,349.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,542.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,378.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,436.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,798.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,306.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,001.35
|
| Rate for Payer: PHCS Commercial |
$6,958.41
|
| Rate for Payer: United Healthcare All Payer |
$6,378.54
|
|
|
PLATE VOLAR DR STRD 10H L EX S
|
Facility
|
IP
|
$4,779.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.71 |
| Max. Negotiated Rate |
$4,587.89 |
| Rate for Payer: Aetna Commercial |
$3,679.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.66
|
| Rate for Payer: Cash Price |
$2,389.52
|
| Rate for Payer: Cigna Commercial |
$3,966.61
|
| Rate for Payer: First Health Commercial |
$4,540.10
|
| Rate for Payer: Humana Commercial |
$4,062.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.54
|
| Rate for Payer: PHCS Commercial |
$4,587.89
|
| Rate for Payer: United Healthcare All Payer |
$4,205.56
|
|
|
PLATE VOLAR DR STRD 10H L EX S
|
Facility
|
OP
|
$4,779.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.71 |
| Max. Negotiated Rate |
$4,587.89 |
| Rate for Payer: Aetna Commercial |
$3,679.87
|
| Rate for Payer: Anthem Medicaid |
$1,643.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.66
|
| Rate for Payer: Cash Price |
$2,389.52
|
| Rate for Payer: Cigna Commercial |
$3,966.61
|
| Rate for Payer: First Health Commercial |
$4,540.10
|
| Rate for Payer: Humana Commercial |
$4,062.19
|
| Rate for Payer: Humana KY Medicaid |
$1,643.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.54
|
| Rate for Payer: PHCS Commercial |
$4,587.89
|
| Rate for Payer: United Healthcare All Payer |
$4,205.56
|
|
|
PLATE VOLAR HOOK DIS RAD 4H
|
Facility
|
OP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem Medicaid |
$1,584.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Humana KY Medicaid |
$1,584.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,615.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE VOLAR HOOK DIS RAD 4H
|
Facility
|
IP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE VOLAR HOOK DIS RAD 6H
|
Facility
|
OP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem Medicaid |
$1,584.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Humana KY Medicaid |
$1,584.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,615.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE VOLAR HOOK DIS RAD 6H
|
Facility
|
IP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE VOLAR LUNATE SUTURE
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE VOLAR LUNATE SUTURE
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE VOLAR MIDSHAFT RAD 10H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 10H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 12H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 12H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 14H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 14H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 16H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 16H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 6H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE VOLAR MIDSHAFT RAD 6H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
