|
PLATE AXSOS LAT HUM 14H L
|
Facility
|
OP
|
$10,979.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.97 |
| Max. Negotiated Rate |
$10,540.70 |
| Rate for Payer: Aetna Commercial |
$8,454.52
|
| Rate for Payer: Anthem Medicaid |
$3,775.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,564.32
|
| Rate for Payer: Cash Price |
$5,489.95
|
| Rate for Payer: Cigna Commercial |
$9,113.32
|
| Rate for Payer: First Health Commercial |
$10,430.91
|
| Rate for Payer: Humana Commercial |
$9,332.92
|
| Rate for Payer: Humana KY Medicaid |
$3,775.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,814.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,003.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,103.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,851.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,662.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,234.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,783.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,552.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,576.13
|
| Rate for Payer: PHCS Commercial |
$10,540.70
|
| Rate for Payer: United Healthcare All Payer |
$9,662.31
|
|
|
PLATE AXSOS LAT HUM 14H L
|
Facility
|
IP
|
$10,979.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.97 |
| Max. Negotiated Rate |
$10,540.70 |
| Rate for Payer: Aetna Commercial |
$8,454.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,564.32
|
| Rate for Payer: Cash Price |
$5,489.95
|
| Rate for Payer: Cigna Commercial |
$9,113.32
|
| Rate for Payer: First Health Commercial |
$10,430.91
|
| Rate for Payer: Humana Commercial |
$9,332.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,003.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,103.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,662.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,234.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,783.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,552.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,576.13
|
| Rate for Payer: PHCS Commercial |
$10,540.70
|
| Rate for Payer: United Healthcare All Payer |
$9,662.31
|
|
|
PLATE BARBELL 2.7MM
|
Facility
|
OP
|
$4,096.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.04 |
| Max. Negotiated Rate |
$3,932.94 |
| Rate for Payer: Aetna Commercial |
$3,154.54
|
| Rate for Payer: Anthem Medicaid |
$1,408.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.51
|
| Rate for Payer: Cash Price |
$2,048.41
|
| Rate for Payer: Cigna Commercial |
$3,400.35
|
| Rate for Payer: First Health Commercial |
$3,891.97
|
| Rate for Payer: Humana Commercial |
$3,482.29
|
| Rate for Payer: Humana KY Medicaid |
$1,408.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,359.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,605.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,564.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.80
|
| Rate for Payer: PHCS Commercial |
$3,932.94
|
| Rate for Payer: United Healthcare All Payer |
$3,605.19
|
|
|
PLATE BARBELL 2.7MM
|
Facility
|
IP
|
$4,096.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.04 |
| Max. Negotiated Rate |
$3,932.94 |
| Rate for Payer: Aetna Commercial |
$3,154.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.51
|
| Rate for Payer: Cash Price |
$2,048.41
|
| Rate for Payer: Cigna Commercial |
$3,400.35
|
| Rate for Payer: First Health Commercial |
$3,891.97
|
| Rate for Payer: Humana Commercial |
$3,482.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,359.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,605.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,564.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.80
|
| Rate for Payer: PHCS Commercial |
$3,932.94
|
| Rate for Payer: United Healthcare All Payer |
$3,605.19
|
|
|
PLATE BLADE ADOL 3H 90 40/10
|
Facility
|
OP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,409.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Humana KY Medicaid |
$1,409.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 40/10
|
Facility
|
IP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 40/15
|
Facility
|
IP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 40/15
|
Facility
|
OP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,409.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Humana KY Medicaid |
$1,409.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 50/10
|
Facility
|
IP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 50/10
|
Facility
|
OP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,409.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Humana KY Medicaid |
$1,409.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 50/15
|
Facility
|
OP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,409.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Humana KY Medicaid |
$1,409.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 50/15
|
Facility
|
IP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 60/15
|
Facility
|
OP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,409.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Humana KY Medicaid |
$1,409.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE ADOL 3H 90 60/15
|
Facility
|
IP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE BLADE CHILD 3H 100 35/8
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 100 35/8
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 100 45/8
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 100 45/8
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 80 35/8
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 80 35/8
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 80 45/8
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 80 45/8
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE BLADE CHILD 3H 90 35/8
|
Facility
|
OP
|
$3,537.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.25 |
| Max. Negotiated Rate |
$3,396.00 |
| Rate for Payer: Aetna Commercial |
$2,723.88
|
| Rate for Payer: Anthem Medicaid |
$1,216.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,759.25
|
| Rate for Payer: Cash Price |
$1,768.75
|
| Rate for Payer: Cigna Commercial |
$2,936.12
|
| Rate for Payer: First Health Commercial |
$3,360.62
|
| Rate for Payer: Humana Commercial |
$3,006.88
|
| Rate for Payer: Humana KY Medicaid |
$1,216.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,228.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,900.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,610.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,240.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,113.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,653.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,830.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,077.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.88
|
| Rate for Payer: PHCS Commercial |
$3,396.00
|
| Rate for Payer: United Healthcare All Payer |
$3,113.00
|
|
|
PLATE BLADE CHILD 3H 90 35/8
|
Facility
|
IP
|
$3,537.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.25 |
| Max. Negotiated Rate |
$3,396.00 |
| Rate for Payer: Aetna Commercial |
$2,723.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,759.25
|
| Rate for Payer: Cash Price |
$1,768.75
|
| Rate for Payer: Cigna Commercial |
$2,936.12
|
| Rate for Payer: First Health Commercial |
$3,360.62
|
| Rate for Payer: Humana Commercial |
$3,006.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,900.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,610.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,113.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,653.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,830.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,077.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,440.88
|
| Rate for Payer: PHCS Commercial |
$3,396.00
|
| Rate for Payer: United Healthcare All Payer |
$3,113.00
|
|
|
PLATE BLADE CHILD 3H 90 45/8
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
