|
PLATE CORONOID RIGHT
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE CORONOID RIGHT
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE CORONOID RT
|
Facility
|
OP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem Medicaid |
$1,771.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Humana KY Medicaid |
$1,771.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
|
PLATE CORONOID RT
|
Facility
|
IP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
|
PLATE CRVED RECON 3.5 10X118MM
|
Facility
|
OP
|
$3,986.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$3,827.11 |
| Rate for Payer: Aetna Commercial |
$3,069.66
|
| Rate for Payer: Anthem Medicaid |
$1,370.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.52
|
| Rate for Payer: Cash Price |
$1,993.29
|
| Rate for Payer: Cigna Commercial |
$3,308.85
|
| Rate for Payer: First Health Commercial |
$3,787.24
|
| Rate for Payer: Humana Commercial |
$3,388.58
|
| Rate for Payer: Humana KY Medicaid |
$1,370.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,384.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,268.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.84
|
| Rate for Payer: PHCS Commercial |
$3,827.11
|
| Rate for Payer: United Healthcare All Payer |
$3,508.18
|
|
|
PLATE CRVED RECON 3.5 10X118MM
|
Facility
|
IP
|
$3,986.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$3,827.11 |
| Rate for Payer: Aetna Commercial |
$3,069.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.52
|
| Rate for Payer: Cash Price |
$1,993.29
|
| Rate for Payer: Cigna Commercial |
$3,308.85
|
| Rate for Payer: First Health Commercial |
$3,787.24
|
| Rate for Payer: Humana Commercial |
$3,388.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,268.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.84
|
| Rate for Payer: PHCS Commercial |
$3,827.11
|
| Rate for Payer: United Healthcare All Payer |
$3,508.18
|
|
|
PLATE CRVED RECON 3.5 12X142MM
|
Facility
|
IP
|
$4,072.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.45 |
| Max. Negotiated Rate |
$3,909.77 |
| Rate for Payer: Aetna Commercial |
$3,135.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,176.69
|
| Rate for Payer: Cash Price |
$2,036.34
|
| Rate for Payer: Cigna Commercial |
$3,380.32
|
| Rate for Payer: First Health Commercial |
$3,869.05
|
| Rate for Payer: Humana Commercial |
$3,461.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,339.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,005.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,221.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,583.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,054.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$814.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$529.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.53
|
| Rate for Payer: PHCS Commercial |
$3,909.77
|
| Rate for Payer: United Healthcare All Payer |
$3,583.96
|
|
|
PLATE CRVED RECON 3.5 12X142MM
|
Facility
|
OP
|
$4,072.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.45 |
| Max. Negotiated Rate |
$3,909.77 |
| Rate for Payer: Anthem Medicaid |
$1,400.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,176.69
|
| Rate for Payer: Cash Price |
$2,036.34
|
| Rate for Payer: Cigna Commercial |
$3,380.32
|
| Rate for Payer: First Health Commercial |
$3,869.05
|
| Rate for Payer: Humana Commercial |
$3,461.78
|
| Rate for Payer: Humana KY Medicaid |
$1,400.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,414.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,339.60
|
| Rate for Payer: Aetna Commercial |
$3,135.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,005.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,221.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,428.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,583.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,054.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$814.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$529.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.53
|
| Rate for Payer: PHCS Commercial |
$3,909.77
|
| Rate for Payer: United Healthcare All Payer |
$3,583.96
|
|
|
PLATE CRVED RECON 3.5 14X166MM
|
Facility
|
OP
|
$4,309.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.23 |
| Max. Negotiated Rate |
$4,137.07 |
| Rate for Payer: Aetna Commercial |
$3,318.28
|
| Rate for Payer: Anthem Medicaid |
$1,482.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,361.37
|
| Rate for Payer: Cash Price |
$2,154.72
|
| Rate for Payer: Cigna Commercial |
$3,576.84
|
| Rate for Payer: First Health Commercial |
$4,093.98
|
| Rate for Payer: Humana Commercial |
$3,663.03
|
| Rate for Payer: Humana KY Medicaid |
$1,482.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,180.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,292.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,511.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,792.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,335.93
|
| Rate for Payer: PHCS Commercial |
$4,137.07
|
| Rate for Payer: United Healthcare All Payer |
$3,792.32
|
|
|
PLATE CRVED RECON 3.5 14X166MM
|
Facility
|
IP
|
$4,309.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.23 |
| Max. Negotiated Rate |
$4,137.07 |
| Rate for Payer: Aetna Commercial |
$3,318.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,361.37
|
| Rate for Payer: Cash Price |
$2,154.72
|
| Rate for Payer: Cigna Commercial |
$3,576.84
|
| Rate for Payer: First Health Commercial |
$4,093.98
|
| Rate for Payer: Humana Commercial |
$3,663.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,180.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,292.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,792.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$861.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,335.93
|
| Rate for Payer: PHCS Commercial |
$4,137.07
|
| Rate for Payer: United Healthcare All Payer |
$3,792.32
|
|
|
PLATE CRVED RECON 3.5 16X190MM
|
Facility
|
OP
|
$4,438.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.02 |
| Max. Negotiated Rate |
$4,261.06 |
| Rate for Payer: Aetna Commercial |
$3,417.72
|
| Rate for Payer: Anthem Medicaid |
$1,526.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,462.11
|
| Rate for Payer: Cash Price |
$2,219.30
|
| Rate for Payer: Cigna Commercial |
$3,684.04
|
| Rate for Payer: First Health Commercial |
$4,216.67
|
| Rate for Payer: Humana Commercial |
$3,772.81
|
| Rate for Payer: Humana KY Medicaid |
$1,526.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,639.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,275.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,557.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.97
|
| Rate for Payer: PHCS Commercial |
$4,261.06
|
| Rate for Payer: United Healthcare All Payer |
$3,905.97
|
|
|
PLATE CRVED RECON 3.5 16X190MM
|
Facility
|
IP
|
$4,438.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.02 |
| Max. Negotiated Rate |
$4,261.06 |
| Rate for Payer: Aetna Commercial |
$3,417.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,462.11
|
| Rate for Payer: Cash Price |
$2,219.30
|
| Rate for Payer: Cigna Commercial |
$3,684.04
|
| Rate for Payer: First Health Commercial |
$4,216.67
|
| Rate for Payer: Humana Commercial |
$3,772.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,639.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,275.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$577.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.97
|
| Rate for Payer: PHCS Commercial |
$4,261.06
|
| Rate for Payer: United Healthcare All Payer |
$3,905.97
|
|
|
PLATE CRVED RECON 3.5 18X214MM
|
Facility
|
IP
|
$4,610.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.40 |
| Max. Negotiated Rate |
$4,426.37 |
| Rate for Payer: Aetna Commercial |
$3,550.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,596.42
|
| Rate for Payer: Cash Price |
$2,305.40
|
| Rate for Payer: Cigna Commercial |
$3,826.96
|
| Rate for Payer: First Health Commercial |
$4,380.26
|
| Rate for Payer: Humana Commercial |
$3,919.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,780.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,402.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,383.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,057.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.35
|
| Rate for Payer: PHCS Commercial |
$4,426.37
|
| Rate for Payer: United Healthcare All Payer |
$4,057.50
|
|
|
PLATE CRVED RECON 3.5 18X214MM
|
Facility
|
OP
|
$4,610.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.40 |
| Max. Negotiated Rate |
$4,426.37 |
| Rate for Payer: Aetna Commercial |
$3,550.32
|
| Rate for Payer: Anthem Medicaid |
$1,585.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,596.42
|
| Rate for Payer: Cash Price |
$2,305.40
|
| Rate for Payer: Cigna Commercial |
$3,826.96
|
| Rate for Payer: First Health Commercial |
$4,380.26
|
| Rate for Payer: Humana Commercial |
$3,919.18
|
| Rate for Payer: Humana KY Medicaid |
$1,585.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,601.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,780.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,402.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,383.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,617.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,057.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,458.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.35
|
| Rate for Payer: PHCS Commercial |
$4,426.37
|
| Rate for Payer: United Healthcare All Payer |
$4,057.50
|
|
|
PLATE CRVED RECON 3.5 6X70MM
|
Facility
|
IP
|
$3,764.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,613.58 |
| Rate for Payer: Aetna Commercial |
$2,898.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.04
|
| Rate for Payer: Cash Price |
$1,882.08
|
| Rate for Payer: Cigna Commercial |
$3,124.24
|
| Rate for Payer: First Health Commercial |
$3,575.94
|
| Rate for Payer: Humana Commercial |
$3,199.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.89
|
| Rate for Payer: PHCS Commercial |
$3,613.58
|
| Rate for Payer: United Healthcare All Payer |
$3,312.45
|
|
|
PLATE CRVED RECON 3.5 6X70MM
|
Facility
|
OP
|
$3,764.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$489.34 |
| Max. Negotiated Rate |
$3,613.58 |
| Rate for Payer: Aetna Commercial |
$2,898.40
|
| Rate for Payer: Anthem Medicaid |
$1,294.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,936.04
|
| Rate for Payer: Cash Price |
$1,882.08
|
| Rate for Payer: Cigna Commercial |
$3,124.24
|
| Rate for Payer: First Health Commercial |
$3,575.94
|
| Rate for Payer: Humana Commercial |
$3,199.53
|
| Rate for Payer: Humana KY Medicaid |
$1,294.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,307.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,086.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,777.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,129.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,320.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,312.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,823.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$489.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.89
|
| Rate for Payer: PHCS Commercial |
$3,613.58
|
| Rate for Payer: United Healthcare All Payer |
$3,312.45
|
|
|
PLATE CRVED RECON 3.5 8X94MM
|
Facility
|
OP
|
$3,907.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.99 |
| Max. Negotiated Rate |
$3,751.34 |
| Rate for Payer: Anthem Medicaid |
$1,343.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.97
|
| Rate for Payer: Cash Price |
$1,953.83
|
| Rate for Payer: Cigna Commercial |
$3,243.35
|
| Rate for Payer: First Health Commercial |
$3,712.27
|
| Rate for Payer: Humana Commercial |
$3,321.50
|
| Rate for Payer: Humana KY Medicaid |
$1,343.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.27
|
| Rate for Payer: Aetna Commercial |
$3,008.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.37
|
| Rate for Payer: PHCS Commercial |
$3,751.34
|
| Rate for Payer: United Healthcare All Payer |
$3,438.73
|
|
|
PLATE CRVED RECON 3.5 8X94MM
|
Facility
|
IP
|
$3,907.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.99 |
| Max. Negotiated Rate |
$3,751.34 |
| Rate for Payer: Aetna Commercial |
$3,008.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.97
|
| Rate for Payer: Cash Price |
$1,953.83
|
| Rate for Payer: Cigna Commercial |
$3,243.35
|
| Rate for Payer: First Health Commercial |
$3,712.27
|
| Rate for Payer: Humana Commercial |
$3,321.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$781.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,211.37
|
| Rate for Payer: PHCS Commercial |
$3,751.34
|
| Rate for Payer: United Healthcare All Payer |
$3,438.73
|
|
|
PLATE CURVED
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
|
PLATE CURVED
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem Medicaid |
$661.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Humana KY Medicaid |
$661.66
|
| Rate for Payer: Kentucky WC Medicaid |
$668.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
|
PLATE CUST MAND RECON 2.8 HEMI
|
Facility
|
IP
|
$40,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,297.82 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$31,379.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,786.95
|
| Rate for Payer: Cash Price |
$20,376.25
|
| Rate for Payer: Cigna Commercial |
$33,824.58
|
| Rate for Payer: First Health Commercial |
$38,714.88
|
| Rate for Payer: Humana Commercial |
$34,639.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,417.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,075.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,225.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,862.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,150.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,633.28
|
| Rate for Payer: PHCS Commercial |
$39,122.40
|
| Rate for Payer: United Healthcare All Payer |
$35,862.20
|
|
|
PLATE CUST MAND RECON 2.8 HEMI
|
Facility
|
OP
|
$40,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,297.82 |
| Max. Negotiated Rate |
$39,122.40 |
| Rate for Payer: Aetna Commercial |
$31,379.42
|
| Rate for Payer: Anthem Medicaid |
$14,014.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$31,786.95
|
| Rate for Payer: Cash Price |
$20,376.25
|
| Rate for Payer: Cigna Commercial |
$33,824.58
|
| Rate for Payer: First Health Commercial |
$38,714.88
|
| Rate for Payer: Humana Commercial |
$34,639.62
|
| Rate for Payer: Humana KY Medicaid |
$14,014.78
|
| Rate for Payer: Kentucky WC Medicaid |
$14,157.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$33,417.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,075.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,225.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,295.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$35,862.20
|
| Rate for Payer: Ohio Health Group HMO |
$30,564.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,150.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,633.28
|
| Rate for Payer: PHCS Commercial |
$39,122.40
|
| Rate for Payer: United Healthcare All Payer |
$35,862.20
|
|
|
PLATE CVD BROAD 14 HOLE
|
Facility
|
OP
|
$4,192.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.96 |
| Max. Negotiated Rate |
$4,024.34 |
| Rate for Payer: Aetna Commercial |
$3,227.86
|
| Rate for Payer: Anthem Medicaid |
$1,441.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,269.78
|
| Rate for Payer: Cash Price |
$2,096.01
|
| Rate for Payer: Cigna Commercial |
$3,479.38
|
| Rate for Payer: First Health Commercial |
$3,982.42
|
| Rate for Payer: Humana Commercial |
$3,563.22
|
| Rate for Payer: Humana KY Medicaid |
$1,441.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,456.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,437.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,093.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,470.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,688.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,144.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.53
|
| Rate for Payer: PHCS Commercial |
$4,024.34
|
| Rate for Payer: United Healthcare All Payer |
$3,688.98
|
|
|
PLATE CVD BROAD 14 HOLE
|
Facility
|
IP
|
$4,192.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.96 |
| Max. Negotiated Rate |
$4,024.34 |
| Rate for Payer: Aetna Commercial |
$3,227.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,269.78
|
| Rate for Payer: Cash Price |
$2,096.01
|
| Rate for Payer: Cigna Commercial |
$3,479.38
|
| Rate for Payer: First Health Commercial |
$3,982.42
|
| Rate for Payer: Humana Commercial |
$3,563.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,437.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,093.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,688.98
|
| Rate for Payer: Ohio Health Group HMO |
$3,144.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.53
|
| Rate for Payer: PHCS Commercial |
$4,024.34
|
| Rate for Payer: United Healthcare All Payer |
$3,688.98
|
|
|
PLATE DHS 135*4H 78MM
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
