|
PLATE CLAV SUP MED 6H 73MM R
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
|
|
PLATE CLAV SUP MED 6H 73MM R
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 7H 85MM L
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 7H 85MM L
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 7H 85MM R
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 7H 85MM R
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 8 97MM L
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 8 97MM L
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE CLAV SUP MED 8H 97MM R
|
Facility
|
IP
|
$4,576.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.92 |
| Max. Negotiated Rate |
$4,393.27 |
| Rate for Payer: Aetna Commercial |
$3,523.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,569.53
|
| Rate for Payer: Cash Price |
$2,288.16
|
| Rate for Payer: Cigna Commercial |
$3,798.35
|
| Rate for Payer: First Health Commercial |
$4,347.50
|
| Rate for Payer: Humana Commercial |
$3,889.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,752.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,377.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,027.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,432.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.66
|
| Rate for Payer: PHCS Commercial |
$4,393.27
|
| Rate for Payer: United Healthcare All Payer |
$4,027.16
|
|
|
PLATE CLAV SUP MED 8H 97MM R
|
Facility
|
OP
|
$4,576.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.92 |
| Max. Negotiated Rate |
$4,393.27 |
| Rate for Payer: Kentucky WC Medicaid |
$1,589.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,752.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,377.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,605.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,027.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,432.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$915.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.66
|
| Rate for Payer: PHCS Commercial |
$4,393.27
|
| Rate for Payer: United Healthcare All Payer |
$4,027.16
|
| Rate for Payer: Aetna Commercial |
$3,523.77
|
| Rate for Payer: Anthem Medicaid |
$1,573.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,569.53
|
| Rate for Payer: Cash Price |
$2,288.16
|
| Rate for Payer: Cigna Commercial |
$3,798.35
|
| Rate for Payer: First Health Commercial |
$4,347.50
|
| Rate for Payer: Humana Commercial |
$3,889.87
|
| Rate for Payer: Humana KY Medicaid |
$1,573.80
|
|
|
PLATE CLAV SUP MED SH 84MM L
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP MED SH 84MM L
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP MED SH 84MM R
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAV SUP MED SH 84MM R
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE CLAW 15MM INTERAXIS
|
Facility
|
IP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE CLAW 15MM INTERAXIS
|
Facility
|
OP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem Medicaid |
$2,462.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Humana KY Medicaid |
$2,462.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,512.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE CLAW 20MM INTERAXIS
|
Facility
|
OP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem Medicaid |
$2,462.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Humana KY Medicaid |
$2,462.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,512.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE CLAW 20MM INTERAXIS
|
Facility
|
IP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE CLAW 25MM INTERAXIS
|
Facility
|
IP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
|
|
PLATE CLAW 25MM INTERAXIS
|
Facility
|
OP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem Medicaid |
$2,462.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Humana KY Medicaid |
$2,462.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,512.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE CLAW II 3H T 20MM
|
Facility
|
OP
|
$11,950.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,553.56 |
| Max. Negotiated Rate |
$11,472.48 |
| Rate for Payer: Aetna Commercial |
$9,201.88
|
| Rate for Payer: Anthem Medicaid |
$4,109.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,321.39
|
| Rate for Payer: Cash Price |
$5,975.25
|
| Rate for Payer: Cigna Commercial |
$9,918.92
|
| Rate for Payer: First Health Commercial |
$11,352.98
|
| Rate for Payer: Humana Commercial |
$10,157.92
|
| Rate for Payer: Humana KY Medicaid |
$4,109.78
|
| Rate for Payer: Kentucky WC Medicaid |
$4,151.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,799.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,819.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,585.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,192.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,516.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,962.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,390.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,553.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,704.66
|
| Rate for Payer: PHCS Commercial |
$11,472.48
|
| Rate for Payer: United Healthcare All Payer |
$10,516.44
|
|
|
PLATE CLAW II 3H T 20MM
|
Facility
|
IP
|
$11,950.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,553.56 |
| Max. Negotiated Rate |
$11,472.48 |
| Rate for Payer: Aetna Commercial |
$9,201.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,321.39
|
| Rate for Payer: Cash Price |
$5,975.25
|
| Rate for Payer: Cigna Commercial |
$9,918.92
|
| Rate for Payer: First Health Commercial |
$11,352.98
|
| Rate for Payer: Humana Commercial |
$10,157.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,799.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,819.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,585.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,516.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,962.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,390.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,553.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,704.66
|
| Rate for Payer: PHCS Commercial |
$11,472.48
|
| Rate for Payer: United Healthcare All Payer |
$10,516.44
|
|
|
PLATE CLAW II TACK
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
PLATE CLAW II TACK
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
PLATE CLOVERLEAF 3X88MM
|
Facility
|
OP
|
$3,319.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.51 |
| Max. Negotiated Rate |
$3,186.53 |
| Rate for Payer: Aetna Commercial |
$2,555.86
|
| Rate for Payer: Anthem Medicaid |
$1,141.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.05
|
| Rate for Payer: Cash Price |
$1,659.65
|
| Rate for Payer: Cigna Commercial |
$2,755.02
|
| Rate for Payer: First Health Commercial |
$3,153.34
|
| Rate for Payer: Humana Commercial |
$2,821.40
|
| Rate for Payer: Humana KY Medicaid |
$1,141.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,721.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,449.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,920.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,489.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.98
|
| Rate for Payer: PHCS Commercial |
$3,186.53
|
| Rate for Payer: United Healthcare All Payer |
$2,920.98
|
|
