|
PLATE AXSOS 3 TI COMP 9H
|
Facility
|
OP
|
$9,564.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.38 |
| Max. Negotiated Rate |
$9,181.89 |
| Rate for Payer: Aetna Commercial |
$7,364.64
|
| Rate for Payer: Anthem Medicaid |
$3,289.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,460.29
|
| Rate for Payer: Cash Price |
$4,782.24
|
| Rate for Payer: Cigna Commercial |
$7,938.51
|
| Rate for Payer: First Health Commercial |
$9,086.25
|
| Rate for Payer: Humana Commercial |
$8,129.80
|
| Rate for Payer: Humana KY Medicaid |
$3,289.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,322.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,842.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,058.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,355.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,416.73
|
| Rate for Payer: Ohio Health Group HMO |
$7,173.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,243.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,964.99
|
| Rate for Payer: PHCS Commercial |
$9,181.89
|
| Rate for Payer: United Healthcare All Payer |
$8,416.73
|
|
|
PLATE AXSOS 3 TI COMP 9H
|
Facility
|
IP
|
$9,564.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.38 |
| Max. Negotiated Rate |
$9,181.89 |
| Rate for Payer: Aetna Commercial |
$7,364.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,460.29
|
| Rate for Payer: Cash Price |
$4,782.24
|
| Rate for Payer: Cigna Commercial |
$7,938.51
|
| Rate for Payer: First Health Commercial |
$9,086.25
|
| Rate for Payer: Humana Commercial |
$8,129.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,842.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,058.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,416.73
|
| Rate for Payer: Ohio Health Group HMO |
$7,173.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,243.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,964.99
|
| Rate for Payer: PHCS Commercial |
$9,181.89
|
| Rate for Payer: United Healthcare All Payer |
$8,416.73
|
|
|
PLATE AXSOS 4.0 TI COMP 12H
|
Facility
|
IP
|
$7,444.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.80 |
| Max. Negotiated Rate |
$7,146.84 |
| Rate for Payer: Aetna Commercial |
$5,732.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,806.80
|
| Rate for Payer: Cash Price |
$3,722.31
|
| Rate for Payer: Cigna Commercial |
$6,179.03
|
| Rate for Payer: First Health Commercial |
$7,072.39
|
| Rate for Payer: Humana Commercial |
$6,327.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,104.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,494.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,551.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,583.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,307.83
|
| Rate for Payer: PHCS Commercial |
$7,146.84
|
| Rate for Payer: United Healthcare All Payer |
$6,551.27
|
|
|
PLATE AXSOS 4.0 TI COMP 12H
|
Facility
|
OP
|
$7,444.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.80 |
| Max. Negotiated Rate |
$7,146.84 |
| Rate for Payer: Aetna Commercial |
$5,732.36
|
| Rate for Payer: Anthem Medicaid |
$2,560.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,806.80
|
| Rate for Payer: Cash Price |
$3,722.31
|
| Rate for Payer: Cigna Commercial |
$6,179.03
|
| Rate for Payer: First Health Commercial |
$7,072.39
|
| Rate for Payer: Humana Commercial |
$6,327.93
|
| Rate for Payer: Humana KY Medicaid |
$2,560.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,586.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,104.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,494.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,611.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,551.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,583.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,307.83
|
| Rate for Payer: PHCS Commercial |
$7,146.84
|
| Rate for Payer: United Healthcare All Payer |
$6,551.27
|
|
|
PLATE AXSOS 4.0 TI COMP 9H
|
Facility
|
IP
|
$7,444.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.81 |
| Max. Negotiated Rate |
$7,146.91 |
| Rate for Payer: Aetna Commercial |
$5,732.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,806.87
|
| Rate for Payer: Cash Price |
$3,722.35
|
| Rate for Payer: Cigna Commercial |
$6,179.10
|
| Rate for Payer: First Health Commercial |
$7,072.46
|
| Rate for Payer: Humana Commercial |
$6,328.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,104.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,494.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,551.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,583.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,307.86
|
| Rate for Payer: PHCS Commercial |
$7,146.91
|
| Rate for Payer: United Healthcare All Payer |
$6,551.34
|
|
|
PLATE AXSOS 4.0 TI COMP 9H
|
Facility
|
OP
|
$7,444.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.81 |
| Max. Negotiated Rate |
$7,146.91 |
| Rate for Payer: Aetna Commercial |
$5,732.42
|
| Rate for Payer: Anthem Medicaid |
$2,560.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,806.87
|
| Rate for Payer: Cash Price |
$3,722.35
|
| Rate for Payer: Cigna Commercial |
$6,179.10
|
| Rate for Payer: First Health Commercial |
$7,072.46
|
| Rate for Payer: Humana Commercial |
$6,328.00
|
| Rate for Payer: Humana KY Medicaid |
$2,560.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,586.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,104.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,494.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,611.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,551.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,583.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,307.86
|
| Rate for Payer: PHCS Commercial |
$7,146.91
|
| Rate for Payer: United Healthcare All Payer |
$6,551.34
|
|
|
PLATE AXSOS LAT HUM 12H L
|
Facility
|
OP
|
$9,922.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.89 |
| Max. Negotiated Rate |
$9,525.32 |
| Rate for Payer: Aetna Commercial |
$7,640.10
|
| Rate for Payer: Anthem Medicaid |
$3,412.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,739.32
|
| Rate for Payer: Cash Price |
$4,961.10
|
| Rate for Payer: Cigna Commercial |
$8,235.43
|
| Rate for Payer: First Health Commercial |
$9,426.10
|
| Rate for Payer: Humana Commercial |
$8,433.88
|
| Rate for Payer: Humana KY Medicaid |
$3,412.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,446.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,136.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,322.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,976.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,480.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,731.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,441.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,075.89
|
| Rate for Payer: PHCS Commercial |
$9,525.32
|
| Rate for Payer: United Healthcare All Payer |
$8,731.54
|
|
|
PLATE AXSOS LAT HUM 12H L
|
Facility
|
IP
|
$9,922.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.89 |
| Max. Negotiated Rate |
$9,525.32 |
| Rate for Payer: Aetna Commercial |
$7,640.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,739.32
|
| Rate for Payer: Cash Price |
$4,961.10
|
| Rate for Payer: Cigna Commercial |
$8,235.43
|
| Rate for Payer: First Health Commercial |
$9,426.10
|
| Rate for Payer: Humana Commercial |
$8,433.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,136.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,322.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,976.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,731.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,441.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,984.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,289.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,075.89
|
| Rate for Payer: PHCS Commercial |
$9,525.32
|
| Rate for Payer: United Healthcare All Payer |
$8,731.54
|
|
|
PLATE AXSOS LAT HUM 14H L
|
Facility
|
IP
|
$10,739.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.09 |
| Max. Negotiated Rate |
$10,309.57 |
| Rate for Payer: Aetna Commercial |
$8,269.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,376.53
|
| Rate for Payer: Cash Price |
$5,369.57
|
| Rate for Payer: Cigna Commercial |
$8,913.49
|
| Rate for Payer: First Health Commercial |
$10,202.18
|
| Rate for Payer: Humana Commercial |
$9,128.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,221.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,450.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,054.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.13
|
| Rate for Payer: PHCS Commercial |
$10,309.57
|
| Rate for Payer: United Healthcare All Payer |
$9,450.44
|
|
|
PLATE AXSOS LAT HUM 14H L
|
Facility
|
OP
|
$10,739.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.09 |
| Max. Negotiated Rate |
$10,309.57 |
| Rate for Payer: Aetna Commercial |
$8,269.14
|
| Rate for Payer: Anthem Medicaid |
$3,693.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,376.53
|
| Rate for Payer: Cash Price |
$5,369.57
|
| Rate for Payer: Cigna Commercial |
$8,913.49
|
| Rate for Payer: First Health Commercial |
$10,202.18
|
| Rate for Payer: Humana Commercial |
$9,128.27
|
| Rate for Payer: Humana KY Medicaid |
$3,693.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,730.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,221.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,767.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,450.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,054.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.13
|
| Rate for Payer: PHCS Commercial |
$10,309.57
|
| Rate for Payer: United Healthcare All Payer |
$9,450.44
|
|
|
PLATE BARBELL 2.7MM
|
Facility
|
OP
|
$4,157.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.41 |
| Max. Negotiated Rate |
$3,990.74 |
| Rate for Payer: Anthem Medicaid |
$1,429.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,242.48
|
| Rate for Payer: Cash Price |
$2,078.51
|
| Rate for Payer: Cigna Commercial |
$3,450.33
|
| Rate for Payer: First Health Commercial |
$3,949.17
|
| Rate for Payer: Humana Commercial |
$3,533.47
|
| Rate for Payer: Humana KY Medicaid |
$1,429.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,658.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.68
|
| Rate for Payer: PHCS Commercial |
$3,990.74
|
| Rate for Payer: United Healthcare All Payer |
$3,658.18
|
| Rate for Payer: Aetna Commercial |
$3,200.91
|
|
|
PLATE BARBELL 2.7MM
|
Facility
|
IP
|
$4,157.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.41 |
| Max. Negotiated Rate |
$3,990.74 |
| Rate for Payer: Aetna Commercial |
$3,200.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,242.48
|
| Rate for Payer: Cash Price |
$2,078.51
|
| Rate for Payer: Cigna Commercial |
$3,450.33
|
| Rate for Payer: First Health Commercial |
$3,949.17
|
| Rate for Payer: Humana Commercial |
$3,533.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,067.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,658.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.68
|
| Rate for Payer: PHCS Commercial |
$3,990.74
|
| Rate for Payer: United Healthcare All Payer |
$3,658.18
|
|
|
PLATE BLADE ADOL 3H 90 40/10
|
Facility
|
IP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 40/10
|
Facility
|
OP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem Medicaid |
$1,430.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Humana KY Medicaid |
$1,430.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 40/15
|
Facility
|
OP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem Medicaid |
$1,430.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Humana KY Medicaid |
$1,430.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 40/15
|
Facility
|
IP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 50/10
|
Facility
|
IP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 50/10
|
Facility
|
OP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem Medicaid |
$1,430.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Humana KY Medicaid |
$1,430.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 50/15
|
Facility
|
IP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 50/15
|
Facility
|
OP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem Medicaid |
$1,430.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Humana KY Medicaid |
$1,430.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 60/15
|
Facility
|
IP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE ADOL 3H 90 60/15
|
Facility
|
OP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem Medicaid |
$1,430.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Humana KY Medicaid |
$1,430.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE BLADE CHILD 3H 100 35/8
|
Facility
|
IP
|
$3,936.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.73 |
| Max. Negotiated Rate |
$3,778.90 |
| Rate for Payer: Aetna Commercial |
$3,030.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.35
|
| Rate for Payer: Cash Price |
$1,968.17
|
| Rate for Payer: Cigna Commercial |
$3,267.17
|
| Rate for Payer: First Health Commercial |
$3,739.53
|
| Rate for Payer: Humana Commercial |
$3,345.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.27
|
| Rate for Payer: PHCS Commercial |
$3,778.90
|
| Rate for Payer: United Healthcare All Payer |
$3,463.99
|
|
|
PLATE BLADE CHILD 3H 100 35/8
|
Facility
|
OP
|
$3,936.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.73 |
| Max. Negotiated Rate |
$3,778.90 |
| Rate for Payer: Aetna Commercial |
$3,030.99
|
| Rate for Payer: Anthem Medicaid |
$1,353.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.35
|
| Rate for Payer: Cash Price |
$1,968.17
|
| Rate for Payer: Cigna Commercial |
$3,267.17
|
| Rate for Payer: First Health Commercial |
$3,739.53
|
| Rate for Payer: Humana Commercial |
$3,345.90
|
| Rate for Payer: Humana KY Medicaid |
$1,353.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,380.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.27
|
| Rate for Payer: PHCS Commercial |
$3,778.90
|
| Rate for Payer: United Healthcare All Payer |
$3,463.99
|
|
|
PLATE BLADE CHILD 3H 100 45/8
|
Facility
|
OP
|
$3,936.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.73 |
| Max. Negotiated Rate |
$3,778.90 |
| Rate for Payer: Aetna Commercial |
$3,030.99
|
| Rate for Payer: Anthem Medicaid |
$1,353.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.35
|
| Rate for Payer: Cash Price |
$1,968.17
|
| Rate for Payer: Cigna Commercial |
$3,267.17
|
| Rate for Payer: First Health Commercial |
$3,739.53
|
| Rate for Payer: Humana Commercial |
$3,345.90
|
| Rate for Payer: Humana KY Medicaid |
$1,353.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,380.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.27
|
| Rate for Payer: PHCS Commercial |
$3,778.90
|
| Rate for Payer: United Healthcare All Payer |
$3,463.99
|
|
