|
PLATE 0.8 AVULSION HOOK
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE 0.8 AVULSION HOOK
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE 0.8 COMPRESSION 6H
|
Facility
|
OP
|
$3,038.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.62 |
| Max. Negotiated Rate |
$2,917.20 |
| Rate for Payer: Aetna Commercial |
$2,339.84
|
| Rate for Payer: Anthem Medicaid |
$1,045.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,370.22
|
| Rate for Payer: Cash Price |
$1,519.38
|
| Rate for Payer: Cigna Commercial |
$2,522.16
|
| Rate for Payer: First Health Commercial |
$2,886.81
|
| Rate for Payer: Humana Commercial |
$2,582.94
|
| Rate for Payer: Humana KY Medicaid |
$1,045.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,055.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,065.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,674.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,279.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.74
|
| Rate for Payer: PHCS Commercial |
$2,917.20
|
| Rate for Payer: United Healthcare All Payer |
$2,674.10
|
|
|
PLATE 0.8 COMPRESSION 6H
|
Facility
|
IP
|
$3,038.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.62 |
| Max. Negotiated Rate |
$2,917.20 |
| Rate for Payer: Aetna Commercial |
$2,339.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,370.22
|
| Rate for Payer: Cash Price |
$1,519.38
|
| Rate for Payer: Cigna Commercial |
$2,522.16
|
| Rate for Payer: First Health Commercial |
$2,886.81
|
| Rate for Payer: Humana Commercial |
$2,582.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,491.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,242.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$911.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,674.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,279.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,643.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,096.74
|
| Rate for Payer: PHCS Commercial |
$2,917.20
|
| Rate for Payer: United Healthcare All Payer |
$2,674.10
|
|
|
PLATE 0.8 CVD MED/LAT
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE 0.8 CVD MED/LAT
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE 0.8 OFFSET
|
Facility
|
OP
|
$3,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$3,043.20 |
| Rate for Payer: Aetna Commercial |
$2,440.90
|
| Rate for Payer: Anthem Medicaid |
$1,090.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,472.60
|
| Rate for Payer: Cash Price |
$1,585.00
|
| Rate for Payer: Cigna Commercial |
$2,631.10
|
| Rate for Payer: First Health Commercial |
$3,011.50
|
| Rate for Payer: Humana Commercial |
$2,694.50
|
| Rate for Payer: Humana KY Medicaid |
$1,090.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,101.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,599.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,339.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,112.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,789.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,377.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,757.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,187.30
|
| Rate for Payer: PHCS Commercial |
$3,043.20
|
| Rate for Payer: United Healthcare All Payer |
$2,789.60
|
|
|
PLATE 0.8 OFFSET
|
Facility
|
IP
|
$3,170.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.00 |
| Max. Negotiated Rate |
$3,043.20 |
| Rate for Payer: Aetna Commercial |
$2,440.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,472.60
|
| Rate for Payer: Cash Price |
$1,585.00
|
| Rate for Payer: Cigna Commercial |
$2,631.10
|
| Rate for Payer: First Health Commercial |
$3,011.50
|
| Rate for Payer: Humana Commercial |
$2,694.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,599.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,339.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,789.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,377.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,536.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,757.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,187.30
|
| Rate for Payer: PHCS Commercial |
$3,043.20
|
| Rate for Payer: United Healthcare All Payer |
$2,789.60
|
|
|
PLATE 0.8 STR 10H
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE 0.8 STR 10H
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE 0.8 T
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE 0.8 T
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE 10H 1/3TUB W/COLLR 117MM
|
Facility
|
OP
|
$2,030.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.13 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,563.44
|
| Rate for Payer: Anthem Medicaid |
$698.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.74
|
| Rate for Payer: Cash Price |
$1,015.22
|
| Rate for Payer: Cigna Commercial |
$1,685.27
|
| Rate for Payer: First Health Commercial |
$1,928.92
|
| Rate for Payer: Humana Commercial |
$1,725.87
|
| Rate for Payer: Humana KY Medicaid |
$698.27
|
| Rate for Payer: Kentucky WC Medicaid |
$705.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,766.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.00
|
| Rate for Payer: PHCS Commercial |
$1,949.22
|
| Rate for Payer: United Healthcare All Payer |
$1,786.79
|
|
|
PLATE 10H 1/3TUB W/COLLR 117MM
|
Facility
|
IP
|
$2,030.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.13 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,563.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.74
|
| Rate for Payer: Cash Price |
$1,015.22
|
| Rate for Payer: Cigna Commercial |
$1,685.27
|
| Rate for Payer: First Health Commercial |
$1,928.92
|
| Rate for Payer: Humana Commercial |
$1,725.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,766.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.00
|
| Rate for Payer: PHCS Commercial |
$1,949.22
|
| Rate for Payer: United Healthcare All Payer |
$1,786.79
|
|
|
PLATE 10H 3.5*137MM SM FRAG
|
Facility
|
OP
|
$3,529.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,058.78 |
| Max. Negotiated Rate |
$3,388.08 |
| Rate for Payer: Aetna Commercial |
$2,717.52
|
| Rate for Payer: Anthem Medicaid |
$1,213.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,752.82
|
| Rate for Payer: Cash Price |
$1,764.62
|
| Rate for Payer: Cigna Commercial |
$2,929.28
|
| Rate for Payer: First Health Commercial |
$3,352.79
|
| Rate for Payer: Humana Commercial |
$2,999.86
|
| Rate for Payer: Humana KY Medicaid |
$1,213.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,893.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,604.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,058.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,105.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,823.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,070.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.18
|
| Rate for Payer: PHCS Commercial |
$3,388.08
|
| Rate for Payer: United Healthcare All Payer |
$3,105.74
|
|
|
PLATE 10H 3.5*137MM SM FRAG
|
Facility
|
IP
|
$3,529.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,058.78 |
| Max. Negotiated Rate |
$3,388.08 |
| Rate for Payer: Aetna Commercial |
$2,717.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,752.82
|
| Rate for Payer: Cash Price |
$1,764.62
|
| Rate for Payer: Cigna Commercial |
$2,929.28
|
| Rate for Payer: First Health Commercial |
$3,352.79
|
| Rate for Payer: Humana Commercial |
$2,999.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,893.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,604.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,058.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,105.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,646.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,823.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,070.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.18
|
| Rate for Payer: PHCS Commercial |
$3,388.08
|
| Rate for Payer: United Healthcare All Payer |
$3,105.74
|
|
|
PLATE 10H RECON 3.5*140MM
|
Facility
|
IP
|
$3,656.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.97 |
| Max. Negotiated Rate |
$3,510.30 |
| Rate for Payer: Aetna Commercial |
$2,815.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,852.12
|
| Rate for Payer: Cash Price |
$1,828.28
|
| Rate for Payer: Cigna Commercial |
$3,034.94
|
| Rate for Payer: First Health Commercial |
$3,473.73
|
| Rate for Payer: Humana Commercial |
$3,108.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,998.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,698.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,217.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,742.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,925.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,181.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,523.03
|
| Rate for Payer: PHCS Commercial |
$3,510.30
|
| Rate for Payer: United Healthcare All Payer |
$3,217.77
|
|
|
PLATE 10H RECON 3.5*140MM
|
Facility
|
OP
|
$3,656.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.97 |
| Max. Negotiated Rate |
$3,510.30 |
| Rate for Payer: Aetna Commercial |
$2,815.55
|
| Rate for Payer: Anthem Medicaid |
$1,257.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,852.12
|
| Rate for Payer: Cash Price |
$1,828.28
|
| Rate for Payer: Cigna Commercial |
$3,034.94
|
| Rate for Payer: First Health Commercial |
$3,473.73
|
| Rate for Payer: Humana Commercial |
$3,108.08
|
| Rate for Payer: Humana KY Medicaid |
$1,257.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,270.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,998.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,698.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,282.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,217.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,742.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,925.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,181.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,523.03
|
| Rate for Payer: PHCS Commercial |
$3,510.30
|
| Rate for Payer: United Healthcare All Payer |
$3,217.77
|
|
|
PLATE 12H 1/3TUB W/COLLR 141MM
|
Facility
|
OP
|
$2,059.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.94 |
| Max. Negotiated Rate |
$1,977.42 |
| Rate for Payer: Aetna Commercial |
$1,586.05
|
| Rate for Payer: Anthem Medicaid |
$708.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.65
|
| Rate for Payer: Cash Price |
$1,029.90
|
| Rate for Payer: Cigna Commercial |
$1,709.64
|
| Rate for Payer: First Health Commercial |
$1,956.82
|
| Rate for Payer: Humana Commercial |
$1,750.84
|
| Rate for Payer: Humana KY Medicaid |
$708.37
|
| Rate for Payer: Kentucky WC Medicaid |
$715.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.27
|
| Rate for Payer: PHCS Commercial |
$1,977.42
|
| Rate for Payer: United Healthcare All Payer |
$1,812.63
|
|
|
PLATE 12H 1/3TUB W/COLLR 141MM
|
Facility
|
IP
|
$2,059.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.94 |
| Max. Negotiated Rate |
$1,977.42 |
| Rate for Payer: Aetna Commercial |
$1,586.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,606.65
|
| Rate for Payer: Cash Price |
$1,029.90
|
| Rate for Payer: Cigna Commercial |
$1,709.64
|
| Rate for Payer: First Health Commercial |
$1,956.82
|
| Rate for Payer: Humana Commercial |
$1,750.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$617.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,812.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,544.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,647.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,792.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.27
|
| Rate for Payer: PHCS Commercial |
$1,977.42
|
| Rate for Payer: United Healthcare All Payer |
$1,812.63
|
|
|
PLATE 12H 3.5*163MM SM FRAG
|
Facility
|
OP
|
$3,647.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.10 |
| Max. Negotiated Rate |
$3,501.12 |
| Rate for Payer: Aetna Commercial |
$2,808.19
|
| Rate for Payer: Anthem Medicaid |
$1,254.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,844.66
|
| Rate for Payer: Cash Price |
$1,823.50
|
| Rate for Payer: Cigna Commercial |
$3,027.01
|
| Rate for Payer: First Health Commercial |
$3,464.65
|
| Rate for Payer: Humana Commercial |
$3,099.95
|
| Rate for Payer: Humana KY Medicaid |
$1,254.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,266.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,990.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,691.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,094.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,279.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,209.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,735.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,917.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,172.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.43
|
| Rate for Payer: PHCS Commercial |
$3,501.12
|
| Rate for Payer: United Healthcare All Payer |
$3,209.36
|
|
|
PLATE 12H 3.5*163MM SM FRAG
|
Facility
|
IP
|
$3,647.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.10 |
| Max. Negotiated Rate |
$3,501.12 |
| Rate for Payer: Aetna Commercial |
$2,808.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,844.66
|
| Rate for Payer: Cash Price |
$1,823.50
|
| Rate for Payer: Cigna Commercial |
$3,027.01
|
| Rate for Payer: First Health Commercial |
$3,464.65
|
| Rate for Payer: Humana Commercial |
$3,099.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,990.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,691.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,094.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,209.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,735.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,917.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,172.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,516.43
|
| Rate for Payer: PHCS Commercial |
$3,501.12
|
| Rate for Payer: United Healthcare All Payer |
$3,209.36
|
|
|
PLATE 12 HOLE 1.5 T
|
Facility
|
IP
|
$1,805.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.62 |
| Max. Negotiated Rate |
$1,733.18 |
| Rate for Payer: Aetna Commercial |
$1,390.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.21
|
| Rate for Payer: Cash Price |
$902.70
|
| Rate for Payer: Cigna Commercial |
$1,498.48
|
| Rate for Payer: First Health Commercial |
$1,715.13
|
| Rate for Payer: Humana Commercial |
$1,534.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,570.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.73
|
| Rate for Payer: PHCS Commercial |
$1,733.18
|
| Rate for Payer: United Healthcare All Payer |
$1,588.75
|
|
|
PLATE 12 HOLE 1.5 T
|
Facility
|
OP
|
$1,805.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.62 |
| Max. Negotiated Rate |
$1,733.18 |
| Rate for Payer: Aetna Commercial |
$1,390.16
|
| Rate for Payer: Anthem Medicaid |
$620.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.21
|
| Rate for Payer: Cash Price |
$902.70
|
| Rate for Payer: Cigna Commercial |
$1,498.48
|
| Rate for Payer: First Health Commercial |
$1,715.13
|
| Rate for Payer: Humana Commercial |
$1,534.59
|
| Rate for Payer: Humana KY Medicaid |
$620.88
|
| Rate for Payer: Kentucky WC Medicaid |
$627.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,570.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.73
|
| Rate for Payer: PHCS Commercial |
$1,733.18
|
| Rate for Payer: United Healthcare All Payer |
$1,588.75
|
|
|
PLATE 12 HOLE 2.0 T
|
Facility
|
IP
|
$1,805.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.62 |
| Max. Negotiated Rate |
$1,733.18 |
| Rate for Payer: Aetna Commercial |
$1,390.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.21
|
| Rate for Payer: Cash Price |
$902.70
|
| Rate for Payer: Cigna Commercial |
$1,498.48
|
| Rate for Payer: First Health Commercial |
$1,715.13
|
| Rate for Payer: Humana Commercial |
$1,534.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,480.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,588.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,570.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.73
|
| Rate for Payer: PHCS Commercial |
$1,733.18
|
| Rate for Payer: United Healthcare All Payer |
$1,588.75
|
|
