|
PLATE V PROFL LCK 2.3 LE MC 5H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE V PROFL LCK 2.3 RI MC 5H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE V PROFL LCK 2.3 RI MC 5H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE WDE HD V-D-R LK 3 62MM R
|
Facility
|
IP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE HD V-D-R LK 3 62MM R
|
Facility
|
OP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem Medicaid |
$1,725.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Humana KY Medicaid |
$1,725.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE HD V-D-R LK 5 86MM R
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WDE HD V-D-R LK 5 86MM R
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WDE LCK HD VDR 3H 62MM L
|
Facility
|
IP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE LCK HD VDR 3H 62MM L
|
Facility
|
OP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem Medicaid |
$1,725.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Humana KY Medicaid |
$1,725.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE LCK HD VDR 3H 62MM R
|
Facility
|
OP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem Medicaid |
$1,725.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Humana KY Medicaid |
$1,725.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE LCK HD VDR 3H 62MM R
|
Facility
|
IP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE LCK HD VDR 5H 86MM L
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WDE LCK HD VDR 5H 86MM L
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WDE LCK HD VDR 5H 86MM R
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WDE LCK HD VDR 5H 86MM R
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WDE V-D-R HD LK 3 62MM L
|
Facility
|
OP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem Medicaid |
$1,725.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Humana KY Medicaid |
$1,725.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE V-D-R HD LK 3 62MM L
|
Facility
|
IP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE WDE V-D-R HD LK 5 86MM L
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WDE V-D-R HD LK 5 86MM L
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE WEDGED PROFILE
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
PLATE WEDGED PROFILE
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
PLATE WRIST FUSION SHRT BND 12
|
Facility
|
OP
|
$13,570.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.14 |
| Max. Negotiated Rate |
$13,027.66 |
| Rate for Payer: Aetna Commercial |
$10,449.27
|
| Rate for Payer: Anthem Medicaid |
$4,666.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,584.97
|
| Rate for Payer: Cash Price |
$6,785.24
|
| Rate for Payer: Cigna Commercial |
$11,263.50
|
| Rate for Payer: First Health Commercial |
$12,891.96
|
| Rate for Payer: Humana Commercial |
$11,534.91
|
| Rate for Payer: Humana KY Medicaid |
$4,666.89
|
| Rate for Payer: Kentucky WC Medicaid |
$4,714.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,127.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,015.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,760.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,942.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,177.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,856.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,806.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,363.63
|
| Rate for Payer: PHCS Commercial |
$13,027.66
|
| Rate for Payer: United Healthcare All Payer |
$11,942.02
|
|
|
PLATE WRIST FUSION SHRT BND 12
|
Facility
|
IP
|
$13,570.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,071.14 |
| Max. Negotiated Rate |
$13,027.66 |
| Rate for Payer: Aetna Commercial |
$10,449.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,584.97
|
| Rate for Payer: Cash Price |
$6,785.24
|
| Rate for Payer: Cigna Commercial |
$11,263.50
|
| Rate for Payer: First Health Commercial |
$12,891.96
|
| Rate for Payer: Humana Commercial |
$11,534.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,127.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,015.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,071.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,942.02
|
| Rate for Payer: Ohio Health Group HMO |
$10,177.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,856.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,806.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,363.63
|
| Rate for Payer: PHCS Commercial |
$13,027.66
|
| Rate for Payer: United Healthcare All Payer |
$11,942.02
|
|
|
PLATE WRIST FUSION STR 120MM
|
Facility
|
OP
|
$9,715.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.54 |
| Max. Negotiated Rate |
$9,326.52 |
| Rate for Payer: Aetna Commercial |
$7,480.64
|
| Rate for Payer: Anthem Medicaid |
$3,341.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,577.79
|
| Rate for Payer: Cash Price |
$4,857.56
|
| Rate for Payer: Cigna Commercial |
$8,063.55
|
| Rate for Payer: First Health Commercial |
$9,229.36
|
| Rate for Payer: Humana Commercial |
$8,257.85
|
| Rate for Payer: Humana KY Medicaid |
$3,341.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,966.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,169.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,549.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,286.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,703.43
|
| Rate for Payer: PHCS Commercial |
$9,326.52
|
| Rate for Payer: United Healthcare All Payer |
$8,549.31
|
|
|
PLATE WRIST FUSION STR 120MM
|
Facility
|
IP
|
$9,715.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.54 |
| Max. Negotiated Rate |
$9,326.52 |
| Rate for Payer: Aetna Commercial |
$7,480.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,577.79
|
| Rate for Payer: Cash Price |
$4,857.56
|
| Rate for Payer: Cigna Commercial |
$8,063.55
|
| Rate for Payer: First Health Commercial |
$9,229.36
|
| Rate for Payer: Humana Commercial |
$8,257.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,966.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,169.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,549.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,286.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,703.43
|
| Rate for Payer: PHCS Commercial |
$9,326.52
|
| Rate for Payer: United Healthcare All Payer |
$8,549.31
|
|
