|
PLATE 2.7MM HOLE RIGHT LARGE
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 2.7MM HOLE RIGHT LARGE
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 2H STR
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
PLATE 2H STR
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
PLATE 2H STR W/COMP
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
PLATE 2H STR W/COMP
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
PLATE 3.5 MED COL LG L
|
Facility
|
OP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem Medicaid |
$2,908.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Humana KY Medicaid |
$2,908.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,937.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL LG L
|
Facility
|
IP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL LG R
|
Facility
|
IP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL LG R
|
Facility
|
OP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem Medicaid |
$2,908.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Humana KY Medicaid |
$2,908.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,937.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL MED L
|
Facility
|
OP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem Medicaid |
$2,908.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Humana KY Medicaid |
$2,908.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,937.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL MED L
|
Facility
|
IP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL MED R
|
Facility
|
IP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL MED R
|
Facility
|
OP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem Medicaid |
$2,908.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Humana KY Medicaid |
$2,908.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,937.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL SM L
|
Facility
|
OP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem Medicaid |
$2,908.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Humana KY Medicaid |
$2,908.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,937.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL SM L
|
Facility
|
IP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL SM R
|
Facility
|
OP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem Medicaid |
$2,908.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Humana KY Medicaid |
$2,908.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,937.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,966.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5 MED COL SM R
|
Facility
|
IP
|
$8,456.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,537.03 |
| Max. Negotiated Rate |
$8,118.48 |
| Rate for Payer: Aetna Commercial |
$6,511.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,596.27
|
| Rate for Payer: Cash Price |
$4,228.38
|
| Rate for Payer: Cigna Commercial |
$7,019.10
|
| Rate for Payer: First Health Commercial |
$8,033.91
|
| Rate for Payer: Humana Commercial |
$7,188.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,934.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,241.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,537.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,441.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,342.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,765.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,357.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,835.16
|
| Rate for Payer: PHCS Commercial |
$8,118.48
|
| Rate for Payer: United Healthcare All Payer |
$7,441.94
|
|
|
PLATE 3.5MM VA-LCP TIB 4H
|
Facility
|
OP
|
$21,477.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,443.25 |
| Max. Negotiated Rate |
$20,618.40 |
| Rate for Payer: Aetna Commercial |
$16,537.67
|
| Rate for Payer: Anthem Medicaid |
$7,386.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,752.45
|
| Rate for Payer: Cash Price |
$10,738.75
|
| Rate for Payer: Cigna Commercial |
$17,826.33
|
| Rate for Payer: First Health Commercial |
$20,403.62
|
| Rate for Payer: Humana Commercial |
$18,255.88
|
| Rate for Payer: Humana KY Medicaid |
$7,386.11
|
| Rate for Payer: Kentucky WC Medicaid |
$7,461.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,611.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,850.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,443.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,534.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,900.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,108.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,685.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,819.48
|
| Rate for Payer: PHCS Commercial |
$20,618.40
|
| Rate for Payer: United Healthcare All Payer |
$18,900.20
|
|
|
PLATE 3.5MM VA-LCP TIB 4H
|
Facility
|
IP
|
$21,477.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,443.25 |
| Max. Negotiated Rate |
$20,618.40 |
| Rate for Payer: Aetna Commercial |
$16,537.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$16,752.45
|
| Rate for Payer: Cash Price |
$10,738.75
|
| Rate for Payer: Cigna Commercial |
$17,826.33
|
| Rate for Payer: First Health Commercial |
$20,403.62
|
| Rate for Payer: Humana Commercial |
$18,255.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$17,611.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$15,850.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6,443.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$18,900.20
|
| Rate for Payer: Ohio Health Group HMO |
$16,108.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17,182.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$18,685.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$14,819.48
|
| Rate for Payer: PHCS Commercial |
$20,618.40
|
| Rate for Payer: United Healthcare All Payer |
$18,900.20
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE L
|
Facility
|
IP
|
$824.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.31 |
| Max. Negotiated Rate |
$791.38 |
| Rate for Payer: Aetna Commercial |
$634.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.99
|
| Rate for Payer: Cash Price |
$412.18
|
| Rate for Payer: Cigna Commercial |
$684.21
|
| Rate for Payer: First Health Commercial |
$783.13
|
| Rate for Payer: Humana Commercial |
$700.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$675.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.43
|
| Rate for Payer: Ohio Health Group HMO |
$618.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.80
|
| Rate for Payer: PHCS Commercial |
$791.38
|
| Rate for Payer: United Healthcare All Payer |
$725.43
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE L
|
Facility
|
OP
|
$824.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.31 |
| Max. Negotiated Rate |
$791.38 |
| Rate for Payer: Aetna Commercial |
$634.75
|
| Rate for Payer: Anthem Medicaid |
$283.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$642.99
|
| Rate for Payer: Cash Price |
$412.18
|
| Rate for Payer: Cigna Commercial |
$684.21
|
| Rate for Payer: First Health Commercial |
$783.13
|
| Rate for Payer: Humana Commercial |
$700.70
|
| Rate for Payer: Humana KY Medicaid |
$283.49
|
| Rate for Payer: Kentucky WC Medicaid |
$286.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$675.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$608.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$247.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$289.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$725.43
|
| Rate for Payer: Ohio Health Group HMO |
$618.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$568.80
|
| Rate for Payer: PHCS Commercial |
$791.38
|
| Rate for Payer: United Healthcare All Payer |
$725.43
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE R
|
Facility
|
OP
|
$787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem Medicaid |
$270.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Humana KY Medicaid |
$270.82
|
| Rate for Payer: Kentucky WC Medicaid |
$273.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE R
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
PLATE 3 HOLE SHAFT T
|
Facility
|
IP
|
$787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
