|
PLATE CLAV SUP MED 8H 97MM R
|
Facility
|
IP
|
$4,546.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.82 |
| Max. Negotiated Rate |
$4,364.22 |
| Rate for Payer: Aetna Commercial |
$3,500.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.93
|
| Rate for Payer: Cash Price |
$2,273.03
|
| Rate for Payer: Cigna Commercial |
$3,773.23
|
| Rate for Payer: First Health Commercial |
$4,318.76
|
| Rate for Payer: Humana Commercial |
$3,864.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,955.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,136.78
|
| Rate for Payer: PHCS Commercial |
$4,364.22
|
| Rate for Payer: United Healthcare All Payer |
$4,000.53
|
|
|
PLATE CLAV SUP MED 8H 97MM R
|
Facility
|
OP
|
$4,546.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.82 |
| Max. Negotiated Rate |
$4,364.22 |
| Rate for Payer: Aetna Commercial |
$3,500.47
|
| Rate for Payer: Anthem Medicaid |
$1,563.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.93
|
| Rate for Payer: Cash Price |
$2,273.03
|
| Rate for Payer: Cigna Commercial |
$3,773.23
|
| Rate for Payer: First Health Commercial |
$4,318.76
|
| Rate for Payer: Humana Commercial |
$3,864.15
|
| Rate for Payer: Humana KY Medicaid |
$1,563.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,579.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,955.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,136.78
|
| Rate for Payer: PHCS Commercial |
$4,364.22
|
| Rate for Payer: United Healthcare All Payer |
$4,000.53
|
|
|
PLATE CLAV SUP MED SH 84MM L
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP MED SH 84MM L
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP MED SH 84MM R
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP MED SH 84MM R
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAW 15MM INTERAXIS
|
Facility
|
IP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE CLAW 15MM INTERAXIS
|
Facility
|
OP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem Medicaid |
$2,531.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Humana KY Medicaid |
$2,531.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE CLAW 20MM INTERAXIS
|
Facility
|
IP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE CLAW 20MM INTERAXIS
|
Facility
|
OP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem Medicaid |
$2,531.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Humana KY Medicaid |
$2,531.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE CLAW 25MM INTERAXIS
|
Facility
|
OP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem Medicaid |
$2,531.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Humana KY Medicaid |
$2,531.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE CLAW 25MM INTERAXIS
|
Facility
|
IP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE CLAW II 3H T 20MM
|
Facility
|
OP
|
$12,197.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,659.37 |
| Max. Negotiated Rate |
$11,709.98 |
| Rate for Payer: Aetna Commercial |
$9,392.38
|
| Rate for Payer: Anthem Medicaid |
$4,194.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,514.36
|
| Rate for Payer: Cash Price |
$6,098.95
|
| Rate for Payer: Cigna Commercial |
$10,124.26
|
| Rate for Payer: First Health Commercial |
$11,588.00
|
| Rate for Payer: Humana Commercial |
$10,368.22
|
| Rate for Payer: Humana KY Medicaid |
$4,194.86
|
| Rate for Payer: Kentucky WC Medicaid |
$4,237.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,002.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,002.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,659.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,279.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,734.15
|
| Rate for Payer: Ohio Health Group HMO |
$9,148.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,758.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,612.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,416.55
|
| Rate for Payer: PHCS Commercial |
$11,709.98
|
| Rate for Payer: United Healthcare All Payer |
$10,734.15
|
|
|
PLATE CLAW II 3H T 20MM
|
Facility
|
IP
|
$12,197.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,659.37 |
| Max. Negotiated Rate |
$11,709.98 |
| Rate for Payer: Aetna Commercial |
$9,392.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,514.36
|
| Rate for Payer: Cash Price |
$6,098.95
|
| Rate for Payer: Cigna Commercial |
$10,124.26
|
| Rate for Payer: First Health Commercial |
$11,588.00
|
| Rate for Payer: Humana Commercial |
$10,368.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,002.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,002.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,659.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,734.15
|
| Rate for Payer: Ohio Health Group HMO |
$9,148.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,758.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,612.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,416.55
|
| Rate for Payer: PHCS Commercial |
$11,709.98
|
| Rate for Payer: United Healthcare All Payer |
$10,734.15
|
|
|
PLATE CLAW II TACK
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
PLATE CLAW II TACK
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem Medicaid |
$517.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Humana KY Medicaid |
$517.23
|
| Rate for Payer: Kentucky WC Medicaid |
$522.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
PLATE CLOVERLEAF 3X88MM
|
Facility
|
IP
|
$3,199.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.77 |
| Max. Negotiated Rate |
$3,071.28 |
| Rate for Payer: Aetna Commercial |
$2,463.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,495.41
|
| Rate for Payer: Cash Price |
$1,599.62
|
| Rate for Payer: Cigna Commercial |
$2,655.38
|
| Rate for Payer: First Health Commercial |
$3,039.29
|
| Rate for Payer: Humana Commercial |
$2,719.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,623.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,815.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,399.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,559.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,783.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,207.48
|
| Rate for Payer: PHCS Commercial |
$3,071.28
|
| Rate for Payer: United Healthcare All Payer |
$2,815.34
|
|
|
PLATE CLOVERLEAF 3X88MM
|
Facility
|
OP
|
$3,199.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.77 |
| Max. Negotiated Rate |
$3,071.28 |
| Rate for Payer: Aetna Commercial |
$2,463.42
|
| Rate for Payer: Anthem Medicaid |
$1,100.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,495.41
|
| Rate for Payer: Cash Price |
$1,599.62
|
| Rate for Payer: Cigna Commercial |
$2,655.38
|
| Rate for Payer: First Health Commercial |
$3,039.29
|
| Rate for Payer: Humana Commercial |
$2,719.36
|
| Rate for Payer: Humana KY Medicaid |
$1,100.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,623.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,815.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,399.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,559.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,783.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,207.48
|
| Rate for Payer: PHCS Commercial |
$3,071.28
|
| Rate for Payer: United Healthcare All Payer |
$2,815.34
|
|
|
PLATE CLOVERLEAF 4X104MM
|
Facility
|
OP
|
$3,291.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.45 |
| Max. Negotiated Rate |
$3,159.84 |
| Rate for Payer: Aetna Commercial |
$2,534.45
|
| Rate for Payer: Anthem Medicaid |
$1,131.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,567.37
|
| Rate for Payer: Cash Price |
$1,645.75
|
| Rate for Payer: Cigna Commercial |
$2,731.95
|
| Rate for Payer: First Health Commercial |
$3,126.93
|
| Rate for Payer: Humana Commercial |
$2,797.78
|
| Rate for Payer: Humana KY Medicaid |
$1,131.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,143.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,699.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,429.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,896.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,633.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.14
|
| Rate for Payer: PHCS Commercial |
$3,159.84
|
| Rate for Payer: United Healthcare All Payer |
$2,896.52
|
|
|
PLATE CLOVERLEAF 4X104MM
|
Facility
|
IP
|
$3,291.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.45 |
| Max. Negotiated Rate |
$3,159.84 |
| Rate for Payer: Aetna Commercial |
$2,534.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,567.37
|
| Rate for Payer: Cash Price |
$1,645.75
|
| Rate for Payer: Cigna Commercial |
$2,731.95
|
| Rate for Payer: First Health Commercial |
$3,126.93
|
| Rate for Payer: Humana Commercial |
$2,797.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,699.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,429.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,896.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,633.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.14
|
| Rate for Payer: PHCS Commercial |
$3,159.84
|
| Rate for Payer: United Healthcare All Payer |
$2,896.52
|
|
|
PLATE CLOVERLEAF 5 H 120MM
|
Facility
|
OP
|
$3,637.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,091.23 |
| Max. Negotiated Rate |
$3,491.94 |
| Rate for Payer: Aetna Commercial |
$2,800.83
|
| Rate for Payer: Anthem Medicaid |
$1,250.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,837.20
|
| Rate for Payer: Cash Price |
$1,818.72
|
| Rate for Payer: Cigna Commercial |
$3,019.08
|
| Rate for Payer: First Health Commercial |
$3,455.57
|
| Rate for Payer: Humana Commercial |
$3,091.82
|
| Rate for Payer: Humana KY Medicaid |
$1,250.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,263.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,684.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,091.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,276.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,200.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,728.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,909.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,164.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,509.83
|
| Rate for Payer: PHCS Commercial |
$3,491.94
|
| Rate for Payer: United Healthcare All Payer |
$3,200.95
|
|
|
PLATE CLOVERLEAF 5 H 120MM
|
Facility
|
IP
|
$3,637.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,091.23 |
| Max. Negotiated Rate |
$3,491.94 |
| Rate for Payer: Aetna Commercial |
$2,800.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,837.20
|
| Rate for Payer: Cash Price |
$1,818.72
|
| Rate for Payer: Cigna Commercial |
$3,019.08
|
| Rate for Payer: First Health Commercial |
$3,455.57
|
| Rate for Payer: Humana Commercial |
$3,091.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,982.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,684.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,091.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,200.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,728.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,909.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,164.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,509.83
|
| Rate for Payer: PHCS Commercial |
$3,491.94
|
| Rate for Payer: United Healthcare All Payer |
$3,200.95
|
|
|
PLATE CLOVERLEAF 6 H 136MM
|
Facility
|
IP
|
$3,798.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.66 |
| Max. Negotiated Rate |
$3,646.92 |
| Rate for Payer: Aetna Commercial |
$2,925.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,963.13
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cigna Commercial |
$3,153.07
|
| Rate for Payer: First Health Commercial |
$3,608.94
|
| Rate for Payer: Humana Commercial |
$3,229.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,115.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,803.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,343.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,849.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,305.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.23
|
| Rate for Payer: PHCS Commercial |
$3,646.92
|
| Rate for Payer: United Healthcare All Payer |
$3,343.01
|
|
|
PLATE CLOVERLEAF 6 H 136MM
|
Facility
|
OP
|
$3,798.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.66 |
| Max. Negotiated Rate |
$3,646.92 |
| Rate for Payer: Aetna Commercial |
$2,925.14
|
| Rate for Payer: Anthem Medicaid |
$1,306.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,963.13
|
| Rate for Payer: Cash Price |
$1,899.44
|
| Rate for Payer: Cigna Commercial |
$3,153.07
|
| Rate for Payer: First Health Commercial |
$3,608.94
|
| Rate for Payer: Humana Commercial |
$3,229.05
|
| Rate for Payer: Humana KY Medicaid |
$1,306.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,319.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,115.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,803.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,332.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,343.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,849.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,039.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,305.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,621.23
|
| Rate for Payer: PHCS Commercial |
$3,646.92
|
| Rate for Payer: United Healthcare All Payer |
$3,343.01
|
|
|
PLATE CLOVERLEAF 7 H 152MM
|
Facility
|
IP
|
$3,914.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.26 |
| Max. Negotiated Rate |
$3,757.62 |
| Rate for Payer: Aetna Commercial |
$3,013.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.07
|
| Rate for Payer: Cash Price |
$1,957.09
|
| Rate for Payer: Cigna Commercial |
$3,248.78
|
| Rate for Payer: First Health Commercial |
$3,718.48
|
| Rate for Payer: Humana Commercial |
$3,327.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,209.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,888.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,444.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,935.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,131.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,405.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.79
|
| Rate for Payer: PHCS Commercial |
$3,757.62
|
| Rate for Payer: United Healthcare All Payer |
$3,444.49
|
|
