|
PLATE 0.8 T
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 10H 1/3TUB W/COLLR 117MM
|
Facility
|
IP
|
$2,022.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.96 |
| Max. Negotiated Rate |
$1,941.86 |
| Rate for Payer: Aetna Commercial |
$1,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.76
|
| Rate for Payer: Cash Price |
$1,011.38
|
| Rate for Payer: Cigna Commercial |
$1,678.90
|
| Rate for Payer: First Health Commercial |
$1,921.63
|
| Rate for Payer: Humana Commercial |
$1,719.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.06
|
| Rate for Payer: PHCS Commercial |
$1,941.86
|
| Rate for Payer: United Healthcare All Payer |
$1,780.04
|
|
|
PLATE 10H 1/3TUB W/COLLR 117MM
|
Facility
|
OP
|
$2,022.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.96 |
| Max. Negotiated Rate |
$1,941.86 |
| Rate for Payer: Aetna Commercial |
$1,557.53
|
| Rate for Payer: Anthem Medicaid |
$695.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.76
|
| Rate for Payer: Cash Price |
$1,011.38
|
| Rate for Payer: Cigna Commercial |
$1,678.90
|
| Rate for Payer: First Health Commercial |
$1,921.63
|
| Rate for Payer: Humana Commercial |
$1,719.35
|
| Rate for Payer: Humana KY Medicaid |
$695.63
|
| Rate for Payer: Kentucky WC Medicaid |
$702.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.06
|
| Rate for Payer: PHCS Commercial |
$1,941.86
|
| Rate for Payer: United Healthcare All Payer |
$1,780.04
|
|
|
PLATE 10H 3.5*137MM SM FRAG
|
Facility
|
OP
|
$3,627.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.55 |
| Max. Negotiated Rate |
$3,482.21 |
| Rate for Payer: Aetna Commercial |
$2,793.02
|
| Rate for Payer: Anthem Medicaid |
$1,247.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.29
|
| Rate for Payer: Cash Price |
$1,813.65
|
| Rate for Payer: Cigna Commercial |
$3,010.66
|
| Rate for Payer: First Health Commercial |
$3,445.94
|
| Rate for Payer: Humana Commercial |
$3,083.20
|
| Rate for Payer: Humana KY Medicaid |
$1,247.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,260.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,676.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,272.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,720.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.46
|
| Rate for Payer: PHCS Commercial |
$3,482.21
|
| Rate for Payer: United Healthcare All Payer |
$3,192.02
|
|
|
PLATE 10H 3.5*137MM SM FRAG
|
Facility
|
IP
|
$3,627.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.55 |
| Max. Negotiated Rate |
$3,482.21 |
| Rate for Payer: Aetna Commercial |
$2,793.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.29
|
| Rate for Payer: Cash Price |
$1,813.65
|
| Rate for Payer: Cigna Commercial |
$3,010.66
|
| Rate for Payer: First Health Commercial |
$3,445.94
|
| Rate for Payer: Humana Commercial |
$3,083.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,676.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,720.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.46
|
| Rate for Payer: PHCS Commercial |
$3,482.21
|
| Rate for Payer: United Healthcare All Payer |
$3,192.02
|
|
|
PLATE 10H RECON 3.5*140MM
|
Facility
|
OP
|
$3,746.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.00 |
| Max. Negotiated Rate |
$3,596.28 |
| Rate for Payer: Aetna Commercial |
$2,884.51
|
| Rate for Payer: Anthem Medicaid |
$1,288.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,921.97
|
| Rate for Payer: Cash Price |
$1,873.06
|
| Rate for Payer: Cigna Commercial |
$3,109.28
|
| Rate for Payer: First Health Commercial |
$3,558.81
|
| Rate for Payer: Humana Commercial |
$3,184.20
|
| Rate for Payer: Humana KY Medicaid |
$1,288.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,301.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,071.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,764.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,314.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,296.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,809.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$749.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.30
|
| Rate for Payer: PHCS Commercial |
$3,596.28
|
| Rate for Payer: United Healthcare All Payer |
$3,296.59
|
|
|
PLATE 10H RECON 3.5*140MM
|
Facility
|
IP
|
$3,746.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$487.00 |
| Max. Negotiated Rate |
$3,596.28 |
| Rate for Payer: Aetna Commercial |
$2,884.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,921.97
|
| Rate for Payer: Cash Price |
$1,873.06
|
| Rate for Payer: Cigna Commercial |
$3,109.28
|
| Rate for Payer: First Health Commercial |
$3,558.81
|
| Rate for Payer: Humana Commercial |
$3,184.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,071.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,764.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,123.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,296.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,809.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$749.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$487.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.30
|
| Rate for Payer: PHCS Commercial |
$3,596.28
|
| Rate for Payer: United Healthcare All Payer |
$3,296.59
|
|
|
PLATE 12H 1/3TUB W/COLLR 141MM
|
Facility
|
IP
|
$2,049.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.48 |
| Max. Negotiated Rate |
$1,967.83 |
| Rate for Payer: Aetna Commercial |
$1,578.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,598.86
|
| Rate for Payer: Cash Price |
$1,024.91
|
| Rate for Payer: Cigna Commercial |
$1,701.35
|
| Rate for Payer: First Health Commercial |
$1,947.33
|
| Rate for Payer: Humana Commercial |
$1,742.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,680.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,803.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.44
|
| Rate for Payer: PHCS Commercial |
$1,967.83
|
| Rate for Payer: United Healthcare All Payer |
$1,803.84
|
|
|
PLATE 12H 1/3TUB W/COLLR 141MM
|
Facility
|
OP
|
$2,049.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.48 |
| Max. Negotiated Rate |
$1,967.83 |
| Rate for Payer: Aetna Commercial |
$1,578.36
|
| Rate for Payer: Anthem Medicaid |
$704.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,598.86
|
| Rate for Payer: Cash Price |
$1,024.91
|
| Rate for Payer: Cigna Commercial |
$1,701.35
|
| Rate for Payer: First Health Commercial |
$1,947.33
|
| Rate for Payer: Humana Commercial |
$1,742.35
|
| Rate for Payer: Humana KY Medicaid |
$704.93
|
| Rate for Payer: Kentucky WC Medicaid |
$712.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,680.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,512.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,803.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,537.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$409.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.44
|
| Rate for Payer: PHCS Commercial |
$1,967.83
|
| Rate for Payer: United Healthcare All Payer |
$1,803.84
|
|
|
PLATE 12H 3.5*163MM SM FRAG
|
Facility
|
IP
|
$3,737.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.84 |
| Max. Negotiated Rate |
$3,587.71 |
| Rate for Payer: Aetna Commercial |
$2,877.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,915.02
|
| Rate for Payer: Cash Price |
$1,868.60
|
| Rate for Payer: Cigna Commercial |
$3,101.88
|
| Rate for Payer: First Health Commercial |
$3,550.34
|
| Rate for Payer: Humana Commercial |
$3,176.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,064.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,758.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,288.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,802.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$747.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,158.53
|
| Rate for Payer: PHCS Commercial |
$3,587.71
|
| Rate for Payer: United Healthcare All Payer |
$3,288.74
|
|
|
PLATE 12H 3.5*163MM SM FRAG
|
Facility
|
OP
|
$3,737.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$485.84 |
| Max. Negotiated Rate |
$3,587.71 |
| Rate for Payer: Aetna Commercial |
$2,877.64
|
| Rate for Payer: Anthem Medicaid |
$1,285.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,915.02
|
| Rate for Payer: Cash Price |
$1,868.60
|
| Rate for Payer: Cigna Commercial |
$3,101.88
|
| Rate for Payer: First Health Commercial |
$3,550.34
|
| Rate for Payer: Humana Commercial |
$3,176.62
|
| Rate for Payer: Humana KY Medicaid |
$1,285.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,298.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,064.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,758.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,121.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,311.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,288.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,802.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$747.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$485.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,158.53
|
| Rate for Payer: PHCS Commercial |
$3,587.71
|
| Rate for Payer: United Healthcare All Payer |
$3,288.74
|
|
|
PLATE 12 HOLE 1.5 T
|
Facility
|
IP
|
$1,815.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,742.88 |
| Rate for Payer: Aetna Commercial |
$1,397.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.09
|
| Rate for Payer: Cash Price |
$907.75
|
| Rate for Payer: Cigna Commercial |
$1,506.86
|
| Rate for Payer: First Health Commercial |
$1,724.72
|
| Rate for Payer: Humana Commercial |
$1,543.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.80
|
| Rate for Payer: PHCS Commercial |
$1,742.88
|
| Rate for Payer: United Healthcare All Payer |
$1,597.64
|
|
|
PLATE 12 HOLE 1.5 T
|
Facility
|
OP
|
$1,815.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,742.88 |
| Rate for Payer: Aetna Commercial |
$1,397.94
|
| Rate for Payer: Anthem Medicaid |
$624.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.09
|
| Rate for Payer: Cash Price |
$907.75
|
| Rate for Payer: Cigna Commercial |
$1,506.86
|
| Rate for Payer: First Health Commercial |
$1,724.72
|
| Rate for Payer: Humana Commercial |
$1,543.18
|
| Rate for Payer: Humana KY Medicaid |
$624.35
|
| Rate for Payer: Kentucky WC Medicaid |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.80
|
| Rate for Payer: PHCS Commercial |
$1,742.88
|
| Rate for Payer: United Healthcare All Payer |
$1,597.64
|
|
|
PLATE 12 HOLE 2.0 T
|
Facility
|
OP
|
$1,815.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,742.88 |
| Rate for Payer: Anthem Medicaid |
$624.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.09
|
| Rate for Payer: Cash Price |
$907.75
|
| Rate for Payer: Cigna Commercial |
$1,506.86
|
| Rate for Payer: First Health Commercial |
$1,724.72
|
| Rate for Payer: Humana Commercial |
$1,543.18
|
| Rate for Payer: Humana KY Medicaid |
$624.35
|
| Rate for Payer: Kentucky WC Medicaid |
$630.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.80
|
| Rate for Payer: PHCS Commercial |
$1,742.88
|
| Rate for Payer: United Healthcare All Payer |
$1,597.64
|
| Rate for Payer: Aetna Commercial |
$1,397.94
|
|
|
PLATE 12 HOLE 2.0 T
|
Facility
|
IP
|
$1,815.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.02 |
| Max. Negotiated Rate |
$1,742.88 |
| Rate for Payer: Aetna Commercial |
$1,397.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.09
|
| Rate for Payer: Cash Price |
$907.75
|
| Rate for Payer: Cigna Commercial |
$1,506.86
|
| Rate for Payer: First Health Commercial |
$1,724.72
|
| Rate for Payer: Humana Commercial |
$1,543.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,488.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,339.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,597.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,361.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$562.80
|
| Rate for Payer: PHCS Commercial |
$1,742.88
|
| Rate for Payer: United Healthcare All Payer |
$1,597.64
|
|
|
PLATE 12H RECON 3.5 168MM
|
Facility
|
OP
|
$3,886.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.19 |
| Max. Negotiated Rate |
$3,730.65 |
| Rate for Payer: Aetna Commercial |
$2,992.29
|
| Rate for Payer: Anthem Medicaid |
$1,336.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.15
|
| Rate for Payer: Cash Price |
$1,943.05
|
| Rate for Payer: Cigna Commercial |
$3,225.45
|
| Rate for Payer: First Health Commercial |
$3,691.79
|
| Rate for Payer: Humana Commercial |
$3,303.18
|
| Rate for Payer: Humana KY Medicaid |
$1,336.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,350.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,363.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.69
|
| Rate for Payer: PHCS Commercial |
$3,730.65
|
| Rate for Payer: United Healthcare All Payer |
$3,419.76
|
|
|
PLATE 12H RECON 3.5 168MM
|
Facility
|
IP
|
$3,886.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.19 |
| Max. Negotiated Rate |
$3,730.65 |
| Rate for Payer: Aetna Commercial |
$2,992.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.15
|
| Rate for Payer: Cash Price |
$1,943.05
|
| Rate for Payer: Cigna Commercial |
$3,225.45
|
| Rate for Payer: First Health Commercial |
$3,691.79
|
| Rate for Payer: Humana Commercial |
$3,303.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.69
|
| Rate for Payer: PHCS Commercial |
$3,730.65
|
| Rate for Payer: United Healthcare All Payer |
$3,419.76
|
|
|
PLATE 13 HOLE 1.5 T
|
Facility
|
OP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem Medicaid |
$638.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Humana KY Medicaid |
$638.79
|
| Rate for Payer: Kentucky WC Medicaid |
$645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
PLATE 13 HOLE 1.5 T
|
Facility
|
IP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
PLATE 13 HOLE 2.0 T
|
Facility
|
OP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem Medicaid |
$638.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Humana KY Medicaid |
$638.79
|
| Rate for Payer: Kentucky WC Medicaid |
$645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
PLATE 13 HOLE 2.0 T
|
Facility
|
IP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
PLATE 1.3MM METACARPAL NECK L
|
Facility
|
OP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem Medicaid |
$1,239.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Humana KY Medicaid |
$1,239.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
|
|
PLATE 1.3MM METACARPAL NECK L
|
Facility
|
IP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
|
|
PLATE 1.3MM METACARPAL NECK R
|
Facility
|
IP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
|
|
PLATE 1.3MM METACARPAL NECK R
|
Facility
|
OP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem Medicaid |
$1,239.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Humana KY Medicaid |
$1,239.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
|
