|
PLATE 12 HOLE 2.0 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 12H RECON 3.5 168MM
|
Facility
|
OP
|
$3,806.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.96 |
| Max. Negotiated Rate |
$3,654.26 |
| Rate for Payer: Aetna Commercial |
$2,931.02
|
| Rate for Payer: Anthem Medicaid |
$1,309.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.09
|
| Rate for Payer: Cash Price |
$1,903.26
|
| Rate for Payer: Cigna Commercial |
$3,159.41
|
| Rate for Payer: First Health Commercial |
$3,616.19
|
| Rate for Payer: Humana Commercial |
$3,235.54
|
| Rate for Payer: Humana KY Medicaid |
$1,309.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,045.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,311.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,626.50
|
| Rate for Payer: PHCS Commercial |
$3,654.26
|
| Rate for Payer: United Healthcare All Payer |
$3,349.74
|
|
|
PLATE 12H RECON 3.5 168MM
|
Facility
|
IP
|
$3,806.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.96 |
| Max. Negotiated Rate |
$3,654.26 |
| Rate for Payer: Aetna Commercial |
$2,931.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.09
|
| Rate for Payer: Cash Price |
$1,903.26
|
| Rate for Payer: Cigna Commercial |
$3,159.41
|
| Rate for Payer: First Health Commercial |
$3,616.19
|
| Rate for Payer: Humana Commercial |
$3,235.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,045.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,311.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,626.50
|
| Rate for Payer: PHCS Commercial |
$3,654.26
|
| Rate for Payer: United Healthcare All Payer |
$3,349.74
|
|
|
PLATE 13 HOLE 1.5 T
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem Medicaid |
$636.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Humana KY Medicaid |
$636.56
|
| Rate for Payer: Kentucky WC Medicaid |
$643.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
PLATE 13 HOLE 1.5 T
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
PLATE 13 HOLE 2.0 T
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
PLATE 13 HOLE 2.0 T
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.30 |
| Max. Negotiated Rate |
$1,776.96 |
| Rate for Payer: Aetna Commercial |
$1,425.27
|
| Rate for Payer: Anthem Medicaid |
$636.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,443.78
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$1,536.33
|
| Rate for Payer: First Health Commercial |
$1,758.45
|
| Rate for Payer: Humana Commercial |
$1,573.35
|
| Rate for Payer: Humana KY Medicaid |
$636.56
|
| Rate for Payer: Kentucky WC Medicaid |
$643.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,517.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,628.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,480.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.19
|
| Rate for Payer: PHCS Commercial |
$1,776.96
|
| Rate for Payer: United Healthcare All Payer |
$1,628.88
|
|
|
PLATE 1.3MM METACARPAL NECK L
|
Facility
|
IP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
PLATE 1.3MM METACARPAL NECK L
|
Facility
|
OP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem Medicaid |
$1,204.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Humana KY Medicaid |
$1,204.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
PLATE 1.3MM METACARPAL NECK R
|
Facility
|
IP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
PLATE 1.3MM METACARPAL NECK R
|
Facility
|
OP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem Medicaid |
$1,204.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Humana KY Medicaid |
$1,204.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
PLATE 1.3MM ROLANDO FX HOOK
|
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 1.3MM ROLANDO FX HOOK
|
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 1.3MM ROTATIONAL CORR
|
Facility
|
OP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem Medicaid |
$1,204.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Humana KY Medicaid |
$1,204.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
PLATE 1.3MM ROTATIONAL CORR
|
Facility
|
IP
|
$3,503.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.12 |
| Max. Negotiated Rate |
$3,363.60 |
| Rate for Payer: Aetna Commercial |
$2,697.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,732.93
|
| Rate for Payer: Cash Price |
$1,751.88
|
| Rate for Payer: Cigna Commercial |
$2,908.11
|
| Rate for Payer: First Health Commercial |
$3,328.56
|
| Rate for Payer: Humana Commercial |
$2,978.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,585.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,627.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,417.59
|
| Rate for Payer: PHCS Commercial |
$3,363.60
|
| Rate for Payer: United Healthcare All Payer |
$3,083.30
|
|
|
PLATE 1.3MM 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 1.3MM 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 1.3MM 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 1.3MM 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 1/3 TUB 10H 122 71829440
|
Facility
|
IP
|
$1,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.88
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.24
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
PLATE 1/3 TUB 10H 122 71829440
|
Facility
|
OP
|
$1,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem Medicaid |
$411.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.88
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| Rate for Payer: Humana KY Medicaid |
$411.30
|
| Rate for Payer: Kentucky WC Medicaid |
$415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.24
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
PLATE 1/3 TUB 3.5MM 3H
|
Facility
|
OP
|
$2,196.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.87 |
| Max. Negotiated Rate |
$2,108.38 |
| Rate for Payer: Aetna Commercial |
$1,691.10
|
| Rate for Payer: Anthem Medicaid |
$755.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.06
|
| Rate for Payer: Cash Price |
$1,098.12
|
| Rate for Payer: Cigna Commercial |
$1,822.87
|
| Rate for Payer: First Health Commercial |
$2,086.42
|
| Rate for Payer: Humana Commercial |
$1,866.80
|
| Rate for Payer: Humana KY Medicaid |
$755.28
|
| Rate for Payer: Kentucky WC Medicaid |
$762.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,800.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,620.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,932.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,756.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,910.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.40
|
| Rate for Payer: PHCS Commercial |
$2,108.38
|
| Rate for Payer: United Healthcare All Payer |
$1,932.68
|
|
|
PLATE 1/3 TUB 3.5MM 3H
|
Facility
|
IP
|
$2,196.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.87 |
| Max. Negotiated Rate |
$2,108.38 |
| Rate for Payer: Aetna Commercial |
$1,691.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.06
|
| Rate for Payer: Cash Price |
$1,098.12
|
| Rate for Payer: Cigna Commercial |
$1,822.87
|
| Rate for Payer: First Health Commercial |
$2,086.42
|
| Rate for Payer: Humana Commercial |
$1,866.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,800.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,620.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,932.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,756.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,910.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.40
|
| Rate for Payer: PHCS Commercial |
$2,108.38
|
| Rate for Payer: United Healthcare All Payer |
$1,932.68
|
|
|
PLATE 1/3 TUB 3.5MM 4H
|
Facility
|
OP
|
$2,196.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.87 |
| Max. Negotiated Rate |
$2,108.38 |
| Rate for Payer: Aetna Commercial |
$1,691.10
|
| Rate for Payer: Anthem Medicaid |
$755.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.06
|
| Rate for Payer: Cash Price |
$1,098.12
|
| Rate for Payer: Cigna Commercial |
$1,822.87
|
| Rate for Payer: First Health Commercial |
$2,086.42
|
| Rate for Payer: Humana Commercial |
$1,866.80
|
| Rate for Payer: Humana KY Medicaid |
$755.28
|
| Rate for Payer: Kentucky WC Medicaid |
$762.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,800.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,620.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,932.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,756.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,910.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.40
|
| Rate for Payer: PHCS Commercial |
$2,108.38
|
| Rate for Payer: United Healthcare All Payer |
$1,932.68
|
|
|
PLATE 1/3 TUB 3.5MM 4H
|
Facility
|
IP
|
$2,196.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.87 |
| Max. Negotiated Rate |
$2,108.38 |
| Rate for Payer: Aetna Commercial |
$1,691.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.06
|
| Rate for Payer: Cash Price |
$1,098.12
|
| Rate for Payer: Cigna Commercial |
$1,822.87
|
| Rate for Payer: First Health Commercial |
$2,086.42
|
| Rate for Payer: Humana Commercial |
$1,866.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,800.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,620.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,932.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,756.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,910.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.40
|
| Rate for Payer: PHCS Commercial |
$2,108.38
|
| Rate for Payer: United Healthcare All Payer |
$1,932.68
|
|
