|
PLATE BLADE CHILD 3H 100 45/8
|
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: 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
|
| 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
|
|
|
PLATE BLADE CHILD 3H 80 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 80 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 80 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
|
|
|
PLATE BLADE CHILD 3H 80 45/8
|
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 90 35/8
|
Facility
|
IP
|
$3,635.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.55 |
| Max. Negotiated Rate |
$3,489.60 |
| Rate for Payer: Aetna Commercial |
$2,798.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,835.30
|
| Rate for Payer: Cash Price |
$1,817.50
|
| Rate for Payer: Cigna Commercial |
$3,017.05
|
| Rate for Payer: First Health Commercial |
$3,453.25
|
| Rate for Payer: Humana Commercial |
$3,089.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,980.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,198.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,726.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,126.85
|
| Rate for Payer: PHCS Commercial |
$3,489.60
|
| Rate for Payer: United Healthcare All Payer |
$3,198.80
|
|
|
PLATE BLADE CHILD 3H 90 35/8
|
Facility
|
OP
|
$3,635.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.55 |
| Max. Negotiated Rate |
$3,489.60 |
| Rate for Payer: Aetna Commercial |
$2,798.95
|
| Rate for Payer: Anthem Medicaid |
$1,250.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,835.30
|
| Rate for Payer: Cash Price |
$1,817.50
|
| Rate for Payer: Cigna Commercial |
$3,017.05
|
| Rate for Payer: First Health Commercial |
$3,453.25
|
| Rate for Payer: Humana Commercial |
$3,089.75
|
| Rate for Payer: Humana KY Medicaid |
$1,250.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,262.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,980.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,275.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,198.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,726.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,126.85
|
| Rate for Payer: PHCS Commercial |
$3,489.60
|
| Rate for Payer: United Healthcare All Payer |
$3,198.80
|
|
|
PLATE BLADE CHILD 3H 90 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: 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
|
| 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
|
|
|
PLATE BLADE CHILD 3H 90 45/8
|
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 INF 3H 90 25/12
|
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 INF 3H 90 25/12
|
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 INF 3H 90 25/7
|
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 INF 3H 90 25/7
|
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 INF 3H 90 32/12
|
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 INF 3H 90 32/12
|
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 INF 3H 90 32/7
|
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 INF 3H 90 32/7
|
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 BLD BIF INF 3H 115 30/5
|
Facility
|
IP
|
$3,226.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.38 |
| Max. Negotiated Rate |
$3,096.98 |
| Rate for Payer: Aetna Commercial |
$2,484.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,516.30
|
| Rate for Payer: Cash Price |
$1,613.01
|
| Rate for Payer: Cigna Commercial |
$2,677.60
|
| Rate for Payer: First Health Commercial |
$3,064.72
|
| Rate for Payer: Humana Commercial |
$2,742.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,645.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,380.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$967.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,838.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,419.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.07
|
| Rate for Payer: PHCS Commercial |
$3,096.98
|
| Rate for Payer: United Healthcare All Payer |
$2,838.90
|
|
|
PLATE BLD BIF INF 3H 115 30/5
|
Facility
|
OP
|
$3,226.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.38 |
| Max. Negotiated Rate |
$3,096.98 |
| Rate for Payer: Aetna Commercial |
$2,484.04
|
| Rate for Payer: Anthem Medicaid |
$1,109.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,516.30
|
| Rate for Payer: Cash Price |
$1,613.01
|
| Rate for Payer: Cigna Commercial |
$2,677.60
|
| Rate for Payer: First Health Commercial |
$3,064.72
|
| Rate for Payer: Humana Commercial |
$2,742.12
|
| Rate for Payer: Humana KY Medicaid |
$1,109.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,120.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,645.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,380.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$967.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,131.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,838.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,419.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.07
|
| Rate for Payer: PHCS Commercial |
$3,096.98
|
| Rate for Payer: United Healthcare All Payer |
$2,838.90
|
|
|
PLATE BLD BIF INF 3H 115 35/5
|
Facility
|
IP
|
$3,226.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.38 |
| Max. Negotiated Rate |
$3,096.98 |
| Rate for Payer: Aetna Commercial |
$2,484.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,516.30
|
| Rate for Payer: Cash Price |
$1,613.01
|
| Rate for Payer: Cigna Commercial |
$2,677.60
|
| Rate for Payer: First Health Commercial |
$3,064.72
|
| Rate for Payer: Humana Commercial |
$2,742.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,645.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,380.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$967.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,838.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,419.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.07
|
| Rate for Payer: PHCS Commercial |
$3,096.98
|
| Rate for Payer: United Healthcare All Payer |
$2,838.90
|
|
|
PLATE BLD BIF INF 3H 115 35/5
|
Facility
|
OP
|
$3,226.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.38 |
| Max. Negotiated Rate |
$3,096.98 |
| Rate for Payer: Aetna Commercial |
$2,484.04
|
| Rate for Payer: Anthem Medicaid |
$1,109.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,516.30
|
| Rate for Payer: Cash Price |
$1,613.01
|
| Rate for Payer: Cigna Commercial |
$2,677.60
|
| Rate for Payer: First Health Commercial |
$3,064.72
|
| Rate for Payer: Humana Commercial |
$2,742.12
|
| Rate for Payer: Humana KY Medicaid |
$1,109.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,120.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,645.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,380.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$967.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,131.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,838.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,419.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.07
|
| Rate for Payer: PHCS Commercial |
$3,096.98
|
| Rate for Payer: United Healthcare All Payer |
$2,838.90
|
|
|
PLATE BNE LNG TN POLYAX LCK 6H
|
Facility
|
IP
|
$8,034.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.49 |
| Max. Negotiated Rate |
$7,713.19 |
| Rate for Payer: Aetna Commercial |
$6,186.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,266.96
|
| Rate for Payer: Cash Price |
$4,017.29
|
| Rate for Payer: Cigna Commercial |
$6,668.69
|
| Rate for Payer: First Health Commercial |
$7,632.84
|
| Rate for Payer: Humana Commercial |
$6,829.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,588.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,929.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,410.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,070.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,025.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,490.72
|
| Rate for Payer: PHCS Commercial |
$7,713.19
|
| Rate for Payer: United Healthcare All Payer |
$7,070.42
|
|
|
PLATE BNE LNG TN POLYAX LCK 6H
|
Facility
|
OP
|
$8,034.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.49 |
| Max. Negotiated Rate |
$7,713.19 |
| Rate for Payer: Aetna Commercial |
$6,186.62
|
| Rate for Payer: Anthem Medicaid |
$2,763.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,266.96
|
| Rate for Payer: Cash Price |
$4,017.29
|
| Rate for Payer: Cigna Commercial |
$6,668.69
|
| Rate for Payer: First Health Commercial |
$7,632.84
|
| Rate for Payer: Humana Commercial |
$6,829.38
|
| Rate for Payer: Humana KY Medicaid |
$2,763.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,791.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,588.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,929.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,410.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,818.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,070.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,025.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,490.72
|
| Rate for Payer: PHCS Commercial |
$7,713.19
|
| Rate for Payer: United Healthcare All Payer |
$7,070.42
|
|
|
PLATE BONE 10.00
|
Facility
|
OP
|
$4,620.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.68 |
| Max. Negotiated Rate |
$4,435.78 |
| Rate for Payer: Aetna Commercial |
$3,557.86
|
| Rate for Payer: Anthem Medicaid |
$1,589.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,604.07
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$3,835.10
|
| Rate for Payer: First Health Commercial |
$4,389.57
|
| Rate for Payer: Humana Commercial |
$3,927.51
|
| Rate for Payer: Humana KY Medicaid |
$1,589.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,605.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,410.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.39
|
| Rate for Payer: PHCS Commercial |
$4,435.78
|
| Rate for Payer: United Healthcare All Payer |
$4,066.13
|
|
|
PLATE BONE 10.00
|
Facility
|
IP
|
$4,620.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.68 |
| Max. Negotiated Rate |
$4,435.78 |
| Rate for Payer: Aetna Commercial |
$3,557.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,604.07
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$3,835.10
|
| Rate for Payer: First Health Commercial |
$4,389.57
|
| Rate for Payer: Humana Commercial |
$3,927.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,410.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.39
|
| Rate for Payer: PHCS Commercial |
$4,435.78
|
| Rate for Payer: United Healthcare All Payer |
$4,066.13
|
|
