|
PLATE BROAD CP 4.5MM 6X108MM
|
Facility
|
OP
|
$2,218.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.36 |
| Max. Negotiated Rate |
$2,129.45 |
| Rate for Payer: Aetna Commercial |
$1,708.00
|
| Rate for Payer: Anthem Medicaid |
$762.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.18
|
| Rate for Payer: Cash Price |
$1,109.09
|
| Rate for Payer: Cigna Commercial |
$1,841.09
|
| Rate for Payer: First Health Commercial |
$2,107.27
|
| Rate for Payer: Humana Commercial |
$1,885.45
|
| Rate for Payer: Humana KY Medicaid |
$762.83
|
| Rate for Payer: Kentucky WC Medicaid |
$770.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,818.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$778.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,663.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$687.64
|
| Rate for Payer: PHCS Commercial |
$2,129.45
|
| Rate for Payer: United Healthcare All Payer |
$1,952.00
|
|
|
PLATE BROAD CP 4.5MM 7X126MM
|
Facility
|
IP
|
$2,218.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.36 |
| Max. Negotiated Rate |
$2,129.45 |
| Rate for Payer: Aetna Commercial |
$1,708.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.18
|
| Rate for Payer: Cash Price |
$1,109.09
|
| Rate for Payer: Cigna Commercial |
$1,841.09
|
| Rate for Payer: First Health Commercial |
$2,107.27
|
| Rate for Payer: Humana Commercial |
$1,885.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,818.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,663.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$687.64
|
| Rate for Payer: PHCS Commercial |
$2,129.45
|
| Rate for Payer: United Healthcare All Payer |
$1,952.00
|
|
|
PLATE BROAD CP 4.5MM 7X126MM
|
Facility
|
OP
|
$2,218.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.36 |
| Max. Negotiated Rate |
$2,129.45 |
| Rate for Payer: Aetna Commercial |
$1,708.00
|
| Rate for Payer: Anthem Medicaid |
$762.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.18
|
| Rate for Payer: Cash Price |
$1,109.09
|
| Rate for Payer: Cigna Commercial |
$1,841.09
|
| Rate for Payer: First Health Commercial |
$2,107.27
|
| Rate for Payer: Humana Commercial |
$1,885.45
|
| Rate for Payer: Humana KY Medicaid |
$762.83
|
| Rate for Payer: Kentucky WC Medicaid |
$770.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,818.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$778.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,663.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$687.64
|
| Rate for Payer: PHCS Commercial |
$2,129.45
|
| Rate for Payer: United Healthcare All Payer |
$1,952.00
|
|
|
PLATE BROAD CP 4.5MM 8X144MM
|
Facility
|
OP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem Medicaid |
$1,129.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Humana KY Medicaid |
$1,129.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,151.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE BROAD CP 4.5MM 8X144MM
|
Facility
|
IP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE BROAD CP 4.5MM 9X162MM
|
Facility
|
IP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE BROAD CP 4.5MM 9X162MM
|
Facility
|
OP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Anthem Medicaid |
$1,129.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Humana KY Medicaid |
$1,129.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,151.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
| Rate for Payer: Aetna Commercial |
$2,528.24
|
|
|
PLATE BSRD LCKG CMP 4.5MM 10H
|
Facility
|
IP
|
$4,363.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.19 |
| Max. Negotiated Rate |
$4,188.48 |
| Rate for Payer: Aetna Commercial |
$3,359.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.14
|
| Rate for Payer: Cash Price |
$2,181.50
|
| Rate for Payer: Cigna Commercial |
$3,621.29
|
| Rate for Payer: First Health Commercial |
$4,144.85
|
| Rate for Payer: Humana Commercial |
$3,708.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,577.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,219.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,839.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,352.53
|
| Rate for Payer: PHCS Commercial |
$4,188.48
|
| Rate for Payer: United Healthcare All Payer |
$3,839.44
|
|
|
PLATE BSRD LCKG CMP 4.5MM 10H
|
Facility
|
OP
|
$4,363.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.19 |
| Max. Negotiated Rate |
$4,188.48 |
| Rate for Payer: Aetna Commercial |
$3,359.51
|
| Rate for Payer: Anthem Medicaid |
$1,500.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,403.14
|
| Rate for Payer: Cash Price |
$2,181.50
|
| Rate for Payer: Cigna Commercial |
$3,621.29
|
| Rate for Payer: First Health Commercial |
$4,144.85
|
| Rate for Payer: Humana Commercial |
$3,708.55
|
| Rate for Payer: Humana KY Medicaid |
$1,500.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,577.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,219.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,530.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,839.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,272.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,352.53
|
| Rate for Payer: PHCS Commercial |
$4,188.48
|
| Rate for Payer: United Healthcare All Payer |
$3,839.44
|
|
|
PLATE BSRD LCKG CMP 4.5MM 12H
|
Facility
|
IP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
PLATE BSRD LCKG CMP 4.5MM 12H
|
Facility
|
OP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem Medicaid |
$1,536.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Humana KY Medicaid |
$1,536.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,552.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
PLATE BSRD LCKG CMP 4.5MM 14H
|
Facility
|
IP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
PLATE BSRD LCKG CMP 4.5MM 14H
|
Facility
|
OP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem Medicaid |
$1,536.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Humana KY Medicaid |
$1,536.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,552.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
PLATE BTTRS LAT TIB RT 5X118MM
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE BTTRS LAT TIB RT 5X118MM
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE BTTRS LAT TIB RT 7X149MM
|
Facility
|
IP
|
$4,890.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.78 |
| Max. Negotiated Rate |
$4,695.00 |
| Rate for Payer: Aetna Commercial |
$3,765.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.68
|
| Rate for Payer: Cash Price |
$2,445.31
|
| Rate for Payer: Cigna Commercial |
$4,059.21
|
| Rate for Payer: First Health Commercial |
$4,646.09
|
| Rate for Payer: Humana Commercial |
$4,157.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,010.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,609.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,467.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,303.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,667.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$978.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.09
|
| Rate for Payer: PHCS Commercial |
$4,695.00
|
| Rate for Payer: United Healthcare All Payer |
$4,303.75
|
|
|
PLATE BTTRS LAT TIB RT 7X149MM
|
Facility
|
OP
|
$4,890.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.78 |
| Max. Negotiated Rate |
$4,695.00 |
| Rate for Payer: Aetna Commercial |
$3,765.78
|
| Rate for Payer: Anthem Medicaid |
$1,681.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,814.68
|
| Rate for Payer: Cash Price |
$2,445.31
|
| Rate for Payer: Cigna Commercial |
$4,059.21
|
| Rate for Payer: First Health Commercial |
$4,646.09
|
| Rate for Payer: Humana Commercial |
$4,157.03
|
| Rate for Payer: Humana KY Medicaid |
$1,681.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,699.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,010.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,609.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,467.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,715.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,303.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,667.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$978.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$635.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.09
|
| Rate for Payer: PHCS Commercial |
$4,695.00
|
| Rate for Payer: United Healthcare All Payer |
$4,303.75
|
|
|
PLATE CABLE 6HOLE 187MM
|
Facility
|
OP
|
$6,641.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.37 |
| Max. Negotiated Rate |
$6,375.65 |
| Rate for Payer: Aetna Commercial |
$5,113.80
|
| Rate for Payer: Anthem Medicaid |
$2,283.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,180.21
|
| Rate for Payer: Cash Price |
$3,320.65
|
| Rate for Payer: Cigna Commercial |
$5,512.28
|
| Rate for Payer: First Health Commercial |
$6,309.24
|
| Rate for Payer: Humana Commercial |
$5,645.10
|
| Rate for Payer: Humana KY Medicaid |
$2,283.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,307.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,445.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,901.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,992.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,329.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,844.34
|
| Rate for Payer: Ohio Health Group HMO |
$4,980.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,058.80
|
| Rate for Payer: PHCS Commercial |
$6,375.65
|
| Rate for Payer: United Healthcare All Payer |
$5,844.34
|
|
|
PLATE CABLE 6HOLE 187MM
|
Facility
|
IP
|
$6,641.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$863.37 |
| Max. Negotiated Rate |
$6,375.65 |
| Rate for Payer: Aetna Commercial |
$5,113.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,180.21
|
| Rate for Payer: Cash Price |
$3,320.65
|
| Rate for Payer: Cigna Commercial |
$5,512.28
|
| Rate for Payer: First Health Commercial |
$6,309.24
|
| Rate for Payer: Humana Commercial |
$5,645.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,445.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,901.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,992.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,844.34
|
| Rate for Payer: Ohio Health Group HMO |
$4,980.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,328.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$863.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,058.80
|
| Rate for Payer: PHCS Commercial |
$6,375.65
|
| Rate for Payer: United Healthcare All Payer |
$5,844.34
|
|
|
PLATE CALCANEAL LARGE
|
Facility
|
OP
|
$4,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.72 |
| Max. Negotiated Rate |
$4,074.24 |
| Rate for Payer: Aetna Commercial |
$3,267.88
|
| Rate for Payer: Anthem Medicaid |
$1,459.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.32
|
| Rate for Payer: Cash Price |
$2,122.00
|
| Rate for Payer: Cigna Commercial |
$3,522.52
|
| Rate for Payer: First Health Commercial |
$4,031.80
|
| Rate for Payer: Humana Commercial |
$3,607.40
|
| Rate for Payer: Humana KY Medicaid |
$1,459.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,474.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,488.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,734.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.64
|
| Rate for Payer: PHCS Commercial |
$4,074.24
|
| Rate for Payer: United Healthcare All Payer |
$3,734.72
|
|
|
PLATE CALCANEAL LARGE
|
Facility
|
IP
|
$4,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.72 |
| Max. Negotiated Rate |
$4,074.24 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,734.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.64
|
| Rate for Payer: PHCS Commercial |
$4,074.24
|
| Rate for Payer: United Healthcare All Payer |
$3,734.72
|
| Rate for Payer: Aetna Commercial |
$3,267.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.32
|
| Rate for Payer: Cash Price |
$2,122.00
|
| Rate for Payer: Cigna Commercial |
$3,522.52
|
| Rate for Payer: First Health Commercial |
$4,031.80
|
| Rate for Payer: Humana Commercial |
$3,607.40
|
|
|
PLATE CALCANEAL X-LARGE
|
Facility
|
OP
|
$4,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.72 |
| Max. Negotiated Rate |
$4,074.24 |
| Rate for Payer: Aetna Commercial |
$3,267.88
|
| Rate for Payer: Anthem Medicaid |
$1,459.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.32
|
| Rate for Payer: Cash Price |
$2,122.00
|
| Rate for Payer: Cigna Commercial |
$3,522.52
|
| Rate for Payer: First Health Commercial |
$4,031.80
|
| Rate for Payer: Humana Commercial |
$3,607.40
|
| Rate for Payer: Humana KY Medicaid |
$1,459.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,474.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,488.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,734.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.64
|
| Rate for Payer: PHCS Commercial |
$4,074.24
|
| Rate for Payer: United Healthcare All Payer |
$3,734.72
|
|
|
PLATE CALCANEAL X-LARGE
|
Facility
|
IP
|
$4,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.72 |
| Max. Negotiated Rate |
$4,074.24 |
| Rate for Payer: Aetna Commercial |
$3,267.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.32
|
| Rate for Payer: Cash Price |
$2,122.00
|
| Rate for Payer: Cigna Commercial |
$3,522.52
|
| Rate for Payer: First Health Commercial |
$4,031.80
|
| Rate for Payer: Humana Commercial |
$3,607.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,734.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.64
|
| Rate for Payer: PHCS Commercial |
$4,074.24
|
| Rate for Payer: United Healthcare All Payer |
$3,734.72
|
|
|
PLATE CALCANEAL X-SMALL
|
Facility
|
IP
|
$3,688.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.49 |
| Max. Negotiated Rate |
$3,540.84 |
| Rate for Payer: Aetna Commercial |
$2,840.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.94
|
| Rate for Payer: Cash Price |
$1,844.19
|
| Rate for Payer: Cigna Commercial |
$3,061.36
|
| Rate for Payer: First Health Commercial |
$3,503.96
|
| Rate for Payer: Humana Commercial |
$3,135.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.40
|
| Rate for Payer: PHCS Commercial |
$3,540.84
|
| Rate for Payer: United Healthcare All Payer |
$3,245.77
|
|
|
PLATE CALCANEAL X-SMALL
|
Facility
|
OP
|
$3,688.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.49 |
| Max. Negotiated Rate |
$3,540.84 |
| Rate for Payer: Aetna Commercial |
$2,840.05
|
| Rate for Payer: Anthem Medicaid |
$1,268.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.94
|
| Rate for Payer: Cash Price |
$1,844.19
|
| Rate for Payer: Cigna Commercial |
$3,061.36
|
| Rate for Payer: First Health Commercial |
$3,503.96
|
| Rate for Payer: Humana Commercial |
$3,135.12
|
| Rate for Payer: Humana KY Medicaid |
$1,268.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.40
|
| Rate for Payer: PHCS Commercial |
$3,540.84
|
| Rate for Payer: United Healthcare All Payer |
$3,245.77
|
|
