|
PLATE L-BUTTRESS W/PF LT
|
Facility
|
IP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
|
|
PLATE L-BUTTRESS W/PF RT
|
Facility
|
OP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem Medicaid |
$1,235.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Humana KY Medicaid |
$1,235.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
|
|
PLATE L-BUTTRESS W/PF RT
|
Facility
|
IP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
|
|
PLATE LCK 1/3 TUB 4H L50MM
|
Facility
|
OP
|
$2,114.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.87 |
| Max. Negotiated Rate |
$2,029.82 |
| Rate for Payer: Aetna Commercial |
$1,628.09
|
| Rate for Payer: Anthem Medicaid |
$727.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,649.23
|
| Rate for Payer: Cash Price |
$1,057.20
|
| Rate for Payer: Cigna Commercial |
$1,754.95
|
| Rate for Payer: First Health Commercial |
$2,008.68
|
| Rate for Payer: Humana Commercial |
$1,797.24
|
| Rate for Payer: Humana KY Medicaid |
$727.14
|
| Rate for Payer: Kentucky WC Medicaid |
$734.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$741.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.46
|
| Rate for Payer: PHCS Commercial |
$2,029.82
|
| Rate for Payer: United Healthcare All Payer |
$1,860.67
|
|
|
PLATE LCK 1/3 TUB 4H L50MM
|
Facility
|
IP
|
$2,114.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.87 |
| Max. Negotiated Rate |
$2,029.82 |
| Rate for Payer: Aetna Commercial |
$1,628.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,649.23
|
| Rate for Payer: Cash Price |
$1,057.20
|
| Rate for Payer: Cigna Commercial |
$1,754.95
|
| Rate for Payer: First Health Commercial |
$2,008.68
|
| Rate for Payer: Humana Commercial |
$1,797.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,733.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,560.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$634.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,860.67
|
| Rate for Payer: Ohio Health Group HMO |
$1,585.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$655.46
|
| Rate for Payer: PHCS Commercial |
$2,029.82
|
| Rate for Payer: United Healthcare All Payer |
$1,860.67
|
|
|
PLATE LCK 1/3 TUB 6H L76MM
|
Facility
|
IP
|
$1,921.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.76 |
| Max. Negotiated Rate |
$1,844.35 |
| Rate for Payer: Aetna Commercial |
$1,479.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.54
|
| Rate for Payer: Cash Price |
$960.60
|
| Rate for Payer: Cigna Commercial |
$1,594.60
|
| Rate for Payer: First Health Commercial |
$1,825.14
|
| Rate for Payer: Humana Commercial |
$1,633.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.57
|
| Rate for Payer: PHCS Commercial |
$1,844.35
|
| Rate for Payer: United Healthcare All Payer |
$1,690.66
|
|
|
PLATE LCK 1/3 TUB 6H L76MM
|
Facility
|
OP
|
$1,921.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.76 |
| Max. Negotiated Rate |
$1,844.35 |
| Rate for Payer: Aetna Commercial |
$1,479.32
|
| Rate for Payer: Anthem Medicaid |
$660.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,498.54
|
| Rate for Payer: Cash Price |
$960.60
|
| Rate for Payer: Cigna Commercial |
$1,594.60
|
| Rate for Payer: First Health Commercial |
$1,825.14
|
| Rate for Payer: Humana Commercial |
$1,633.02
|
| Rate for Payer: Humana KY Medicaid |
$660.70
|
| Rate for Payer: Kentucky WC Medicaid |
$667.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,575.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.57
|
| Rate for Payer: PHCS Commercial |
$1,844.35
|
| Rate for Payer: United Healthcare All Payer |
$1,690.66
|
|
|
PLATE LCK 1/3 TUB 8H L102MM
|
Facility
|
OP
|
$1,968.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.94 |
| Max. Negotiated Rate |
$1,890.05 |
| Rate for Payer: Aetna Commercial |
$1,515.98
|
| Rate for Payer: Anthem Medicaid |
$677.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,535.66
|
| Rate for Payer: Cash Price |
$984.40
|
| Rate for Payer: Cigna Commercial |
$1,634.10
|
| Rate for Payer: First Health Commercial |
$1,870.36
|
| Rate for Payer: Humana Commercial |
$1,673.48
|
| Rate for Payer: Humana KY Medicaid |
$677.07
|
| Rate for Payer: Kentucky WC Medicaid |
$683.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,614.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,732.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,476.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.33
|
| Rate for Payer: PHCS Commercial |
$1,890.05
|
| Rate for Payer: United Healthcare All Payer |
$1,732.54
|
|
|
PLATE LCK 1/3 TUB 8H L102MM
|
Facility
|
IP
|
$1,968.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.94 |
| Max. Negotiated Rate |
$1,890.05 |
| Rate for Payer: Aetna Commercial |
$1,515.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,535.66
|
| Rate for Payer: Cash Price |
$984.40
|
| Rate for Payer: Cigna Commercial |
$1,634.10
|
| Rate for Payer: First Health Commercial |
$1,870.36
|
| Rate for Payer: Humana Commercial |
$1,673.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,614.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,732.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,476.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.33
|
| Rate for Payer: PHCS Commercial |
$1,890.05
|
| Rate for Payer: United Healthcare All Payer |
$1,732.54
|
|
|
PLATE LCK CMP 10H 3.5*154
|
Facility
|
IP
|
$3,505.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.72 |
| Max. Negotiated Rate |
$3,365.28 |
| Rate for Payer: Aetna Commercial |
$2,699.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Cash Price |
$1,752.75
|
| Rate for Payer: Cigna Commercial |
$2,909.56
|
| Rate for Payer: First Health Commercial |
$3,330.22
|
| Rate for Payer: Humana Commercial |
$2,979.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.70
|
| Rate for Payer: PHCS Commercial |
$3,365.28
|
| Rate for Payer: United Healthcare All Payer |
$3,084.84
|
|
|
PLATE LCK CMP 10H 3.5*154
|
Facility
|
OP
|
$3,505.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.72 |
| Max. Negotiated Rate |
$3,365.28 |
| Rate for Payer: Anthem Medicaid |
$1,205.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Cash Price |
$1,752.75
|
| Rate for Payer: Cigna Commercial |
$2,909.56
|
| Rate for Payer: First Health Commercial |
$3,330.22
|
| Rate for Payer: Humana Commercial |
$2,979.68
|
| Rate for Payer: Humana KY Medicaid |
$1,205.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.70
|
| Rate for Payer: PHCS Commercial |
$3,365.28
|
| Rate for Payer: United Healthcare All Payer |
$3,084.84
|
| Rate for Payer: Aetna Commercial |
$2,699.24
|
|
|
PLATE LCK CMP 12H 3.5*183
|
Facility
|
IP
|
$3,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.37 |
| Max. Negotiated Rate |
$3,503.04 |
| Rate for Payer: Aetna Commercial |
$2,809.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,846.22
|
| Rate for Payer: Cash Price |
$1,824.50
|
| Rate for Payer: Cigna Commercial |
$3,028.67
|
| Rate for Payer: First Health Commercial |
$3,466.55
|
| Rate for Payer: Humana Commercial |
$3,101.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,992.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,692.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,094.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,211.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,736.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.19
|
| Rate for Payer: PHCS Commercial |
$3,503.04
|
| Rate for Payer: United Healthcare All Payer |
$3,211.12
|
|
|
PLATE LCK CMP 12H 3.5*183
|
Facility
|
OP
|
$3,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.37 |
| Max. Negotiated Rate |
$3,503.04 |
| Rate for Payer: Aetna Commercial |
$2,809.73
|
| Rate for Payer: Anthem Medicaid |
$1,254.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,846.22
|
| Rate for Payer: Cash Price |
$1,824.50
|
| Rate for Payer: Cigna Commercial |
$3,028.67
|
| Rate for Payer: First Health Commercial |
$3,466.55
|
| Rate for Payer: Humana Commercial |
$3,101.65
|
| Rate for Payer: Humana KY Medicaid |
$1,254.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,267.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,992.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,692.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,094.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,211.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,736.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$729.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.19
|
| Rate for Payer: PHCS Commercial |
$3,503.04
|
| Rate for Payer: United Healthcare All Payer |
$3,211.12
|
|
|
PLATE LCK CMP 4H 3.5*67
|
Facility
|
OP
|
$3,187.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.31 |
| Max. Negotiated Rate |
$3,059.52 |
| Rate for Payer: Aetna Commercial |
$2,453.99
|
| Rate for Payer: Anthem Medicaid |
$1,096.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,485.86
|
| Rate for Payer: Cash Price |
$1,593.50
|
| Rate for Payer: Cigna Commercial |
$2,645.21
|
| Rate for Payer: First Health Commercial |
$3,027.65
|
| Rate for Payer: Humana Commercial |
$2,708.95
|
| Rate for Payer: Humana KY Medicaid |
$1,096.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,107.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,118.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,804.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$987.97
|
| Rate for Payer: PHCS Commercial |
$3,059.52
|
| Rate for Payer: United Healthcare All Payer |
$2,804.56
|
|
|
PLATE LCK CMP 4H 3.5*67
|
Facility
|
IP
|
$3,187.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.31 |
| Max. Negotiated Rate |
$3,059.52 |
| Rate for Payer: Aetna Commercial |
$2,453.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,485.86
|
| Rate for Payer: Cash Price |
$1,593.50
|
| Rate for Payer: Cigna Commercial |
$2,645.21
|
| Rate for Payer: First Health Commercial |
$3,027.65
|
| Rate for Payer: Humana Commercial |
$2,708.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,804.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$637.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$414.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$987.97
|
| Rate for Payer: PHCS Commercial |
$3,059.52
|
| Rate for Payer: United Healthcare All Payer |
$2,804.56
|
|
|
PLATE LCK CMP 6H 3.5*96
|
Facility
|
OP
|
$3,316.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.14 |
| Max. Negotiated Rate |
$3,183.84 |
| Rate for Payer: Aetna Commercial |
$2,553.70
|
| Rate for Payer: Anthem Medicaid |
$1,140.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.87
|
| Rate for Payer: Cash Price |
$1,658.25
|
| Rate for Payer: Cigna Commercial |
$2,752.70
|
| Rate for Payer: First Health Commercial |
$3,150.68
|
| Rate for Payer: Humana Commercial |
$2,819.02
|
| Rate for Payer: Humana KY Medicaid |
$1,140.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,163.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,918.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,487.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.12
|
| Rate for Payer: PHCS Commercial |
$3,183.84
|
| Rate for Payer: United Healthcare All Payer |
$2,918.52
|
|
|
PLATE LCK CMP 6H 3.5*96
|
Facility
|
IP
|
$3,316.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.14 |
| Max. Negotiated Rate |
$3,183.84 |
| Rate for Payer: Aetna Commercial |
$2,553.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.87
|
| Rate for Payer: Cash Price |
$1,658.25
|
| Rate for Payer: Cigna Commercial |
$2,752.70
|
| Rate for Payer: First Health Commercial |
$3,150.68
|
| Rate for Payer: Humana Commercial |
$2,819.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,918.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,487.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.12
|
| Rate for Payer: PHCS Commercial |
$3,183.84
|
| Rate for Payer: United Healthcare All Payer |
$2,918.52
|
|
|
PLATE LCK CMP 8H 3.5*125
|
Facility
|
OP
|
$3,428.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.70 |
| Max. Negotiated Rate |
$3,291.36 |
| Rate for Payer: Aetna Commercial |
$2,639.94
|
| Rate for Payer: Anthem Medicaid |
$1,179.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.23
|
| Rate for Payer: Cash Price |
$1,714.25
|
| Rate for Payer: Cigna Commercial |
$2,845.66
|
| Rate for Payer: First Health Commercial |
$3,257.08
|
| Rate for Payer: Humana Commercial |
$2,914.22
|
| Rate for Payer: Humana KY Medicaid |
$1,179.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,202.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.84
|
| Rate for Payer: PHCS Commercial |
$3,291.36
|
| Rate for Payer: United Healthcare All Payer |
$3,017.08
|
|
|
PLATE LCK CMP 8H 3.5*125
|
Facility
|
IP
|
$3,428.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.70 |
| Max. Negotiated Rate |
$3,291.36 |
| Rate for Payer: Aetna Commercial |
$2,639.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,674.23
|
| Rate for Payer: Cash Price |
$1,714.25
|
| Rate for Payer: Cigna Commercial |
$2,845.66
|
| Rate for Payer: First Health Commercial |
$3,257.08
|
| Rate for Payer: Humana Commercial |
$2,914.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,811.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,530.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,017.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.84
|
| Rate for Payer: PHCS Commercial |
$3,291.36
|
| Rate for Payer: United Healthcare All Payer |
$3,017.08
|
|
|
PLATE LCK COMP BRD 10H 5.0*191
|
Facility
|
OP
|
$3,532.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.26 |
| Max. Negotiated Rate |
$3,391.49 |
| Rate for Payer: Aetna Commercial |
$2,720.26
|
| Rate for Payer: Anthem Medicaid |
$1,214.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,755.58
|
| Rate for Payer: Cash Price |
$1,766.40
|
| Rate for Payer: Cigna Commercial |
$2,932.22
|
| Rate for Payer: First Health Commercial |
$3,356.16
|
| Rate for Payer: Humana Commercial |
$3,002.88
|
| Rate for Payer: Humana KY Medicaid |
$1,214.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,227.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,896.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,607.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,239.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,108.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,649.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.17
|
| Rate for Payer: PHCS Commercial |
$3,391.49
|
| Rate for Payer: United Healthcare All Payer |
$3,108.86
|
|
|
PLATE LCK COMP BRD 10H 5.0*191
|
Facility
|
IP
|
$3,532.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.26 |
| Max. Negotiated Rate |
$3,391.49 |
| Rate for Payer: Aetna Commercial |
$2,720.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,755.58
|
| Rate for Payer: Cash Price |
$1,766.40
|
| Rate for Payer: Cigna Commercial |
$2,932.22
|
| Rate for Payer: First Health Commercial |
$3,356.16
|
| Rate for Payer: Humana Commercial |
$3,002.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,896.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,607.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,108.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,649.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.17
|
| Rate for Payer: PHCS Commercial |
$3,391.49
|
| Rate for Payer: United Healthcare All Payer |
$3,108.86
|
|
|
PLATE LCK COMP NAR 8H 5.0*151M
|
Facility
|
OP
|
$2,214.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.89 |
| Max. Negotiated Rate |
$2,125.99 |
| Rate for Payer: Aetna Commercial |
$1,705.22
|
| Rate for Payer: Anthem Medicaid |
$761.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.36
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cigna Commercial |
$1,838.09
|
| Rate for Payer: First Health Commercial |
$2,103.84
|
| Rate for Payer: Humana Commercial |
$1,882.38
|
| Rate for Payer: Humana KY Medicaid |
$761.59
|
| Rate for Payer: Kentucky WC Medicaid |
$769.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,815.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$776.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,948.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,660.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.52
|
| Rate for Payer: PHCS Commercial |
$2,125.99
|
| Rate for Payer: United Healthcare All Payer |
$1,948.82
|
|
|
PLATE LCK COMP NAR 8H 5.0*151M
|
Facility
|
IP
|
$2,214.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.89 |
| Max. Negotiated Rate |
$2,125.99 |
| Rate for Payer: Aetna Commercial |
$1,705.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,727.36
|
| Rate for Payer: Cash Price |
$1,107.29
|
| Rate for Payer: Cigna Commercial |
$1,838.09
|
| Rate for Payer: First Health Commercial |
$2,103.84
|
| Rate for Payer: Humana Commercial |
$1,882.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,815.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,634.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,948.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,660.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$686.52
|
| Rate for Payer: PHCS Commercial |
$2,125.99
|
| Rate for Payer: United Healthcare All Payer |
$1,948.82
|
|
|
PLATE LCK DIST FIB RT 5 HOLE
|
Facility
|
OP
|
$4,864.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.37 |
| Max. Negotiated Rate |
$4,669.80 |
| Rate for Payer: Aetna Commercial |
$3,745.57
|
| Rate for Payer: Anthem Medicaid |
$1,672.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,794.22
|
| Rate for Payer: Cash Price |
$2,432.19
|
| Rate for Payer: Cigna Commercial |
$4,037.44
|
| Rate for Payer: First Health Commercial |
$4,621.16
|
| Rate for Payer: Humana Commercial |
$4,134.72
|
| Rate for Payer: Humana KY Medicaid |
$1,672.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,689.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,988.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,589.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,459.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,706.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,280.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.96
|
| Rate for Payer: PHCS Commercial |
$4,669.80
|
| Rate for Payer: United Healthcare All Payer |
$4,280.65
|
|
|
PLATE LCK DIST FIB RT 5 HOLE
|
Facility
|
IP
|
$4,864.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.37 |
| Max. Negotiated Rate |
$4,669.80 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,988.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,589.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,459.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,280.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$972.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$632.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.96
|
| Rate for Payer: PHCS Commercial |
$4,669.80
|
| Rate for Payer: United Healthcare All Payer |
$4,280.65
|
| Rate for Payer: Aetna Commercial |
$3,745.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,794.22
|
| Rate for Payer: Cash Price |
$2,432.19
|
| Rate for Payer: Cigna Commercial |
$4,037.44
|
| Rate for Payer: First Health Commercial |
$4,621.16
|
| Rate for Payer: Humana Commercial |
$4,134.72
|
|
