|
PLATE LOCK STERNAL 8H X
|
Facility
|
IP
|
$5,066.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.64 |
| Max. Negotiated Rate |
$4,863.84 |
| Rate for Payer: Aetna Commercial |
$3,901.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,951.87
|
| Rate for Payer: Cash Price |
$2,533.25
|
| Rate for Payer: Cigna Commercial |
$4,205.20
|
| Rate for Payer: First Health Commercial |
$4,813.18
|
| Rate for Payer: Humana Commercial |
$4,306.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,154.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,739.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,458.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,799.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,013.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,570.62
|
| Rate for Payer: PHCS Commercial |
$4,863.84
|
| Rate for Payer: United Healthcare All Payer |
$4,458.52
|
|
|
PLATE LOCK STERNAL 8H X
|
Facility
|
OP
|
$5,066.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$658.64 |
| Max. Negotiated Rate |
$4,863.84 |
| Rate for Payer: Aetna Commercial |
$3,901.20
|
| Rate for Payer: Anthem Medicaid |
$1,742.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,951.87
|
| Rate for Payer: Cash Price |
$2,533.25
|
| Rate for Payer: Cigna Commercial |
$4,205.20
|
| Rate for Payer: First Health Commercial |
$4,813.18
|
| Rate for Payer: Humana Commercial |
$4,306.52
|
| Rate for Payer: Humana KY Medicaid |
$1,742.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,760.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,154.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,739.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,519.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,777.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,458.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,799.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,013.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$658.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,570.62
|
| Rate for Payer: PHCS Commercial |
$4,863.84
|
| Rate for Payer: United Healthcare All Payer |
$4,458.52
|
|
|
PLATE LOCK STERNAL 9H Y SHP
|
Facility
|
OP
|
$4,493.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.12 |
| Max. Negotiated Rate |
$4,313.47 |
| Rate for Payer: Aetna Commercial |
$3,459.76
|
| Rate for Payer: Anthem Medicaid |
$1,545.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.70
|
| Rate for Payer: Cash Price |
$2,246.60
|
| Rate for Payer: Cigna Commercial |
$3,729.36
|
| Rate for Payer: First Health Commercial |
$4,268.54
|
| Rate for Payer: Humana Commercial |
$3,819.22
|
| Rate for Payer: Humana KY Medicaid |
$1,545.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,560.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,954.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$898.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,392.89
|
| Rate for Payer: PHCS Commercial |
$4,313.47
|
| Rate for Payer: United Healthcare All Payer |
$3,954.02
|
|
|
PLATE LOCK STERNAL 9H Y SHP
|
Facility
|
IP
|
$4,493.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.12 |
| Max. Negotiated Rate |
$4,313.47 |
| Rate for Payer: Aetna Commercial |
$3,459.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.70
|
| Rate for Payer: Cash Price |
$2,246.60
|
| Rate for Payer: Cigna Commercial |
$3,729.36
|
| Rate for Payer: First Health Commercial |
$4,268.54
|
| Rate for Payer: Humana Commercial |
$3,819.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,954.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$898.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,392.89
|
| Rate for Payer: PHCS Commercial |
$4,313.47
|
| Rate for Payer: United Healthcare All Payer |
$3,954.02
|
|
|
PLATE LOCK THIRD TUB SS 12H
|
Facility
|
OP
|
$3,302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$3,170.40 |
| Rate for Payer: Aetna Commercial |
$2,542.92
|
| Rate for Payer: Anthem Medicaid |
$1,135.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.95
|
| Rate for Payer: Cash Price |
$1,651.25
|
| Rate for Payer: Cigna Commercial |
$2,741.08
|
| Rate for Payer: First Health Commercial |
$3,137.38
|
| Rate for Payer: Humana Commercial |
$2,807.12
|
| Rate for Payer: Humana KY Medicaid |
$1,135.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,147.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,158.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.78
|
| Rate for Payer: PHCS Commercial |
$3,170.40
|
| Rate for Payer: United Healthcare All Payer |
$2,906.20
|
|
|
PLATE LOCK THIRD TUB SS 12H
|
Facility
|
IP
|
$3,302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$3,170.40 |
| Rate for Payer: Aetna Commercial |
$2,542.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.95
|
| Rate for Payer: Cash Price |
$1,651.25
|
| Rate for Payer: Cigna Commercial |
$2,741.08
|
| Rate for Payer: First Health Commercial |
$3,137.38
|
| Rate for Payer: Humana Commercial |
$2,807.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.78
|
| Rate for Payer: PHCS Commercial |
$3,170.40
|
| Rate for Payer: United Healthcare All Payer |
$2,906.20
|
|
|
PLATE LOCK THIRD TUB SS 4H
|
Facility
|
OP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem Medicaid |
$748.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Humana KY Medicaid |
$748.63
|
| Rate for Payer: Kentucky WC Medicaid |
$756.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
PLATE LOCK THIRD TUB SS 4H
|
Facility
|
IP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
PLATE LOCK THIRD TUB SS 5H
|
Facility
|
IP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
|
|
PLATE LOCK THIRD TUB SS 5H
|
Facility
|
OP
|
$2,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.42 |
| Max. Negotiated Rate |
$2,085.60 |
| Rate for Payer: Aetna Commercial |
$1,672.82
|
| Rate for Payer: Anthem Medicaid |
$747.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.55
|
| Rate for Payer: Cash Price |
$1,086.25
|
| Rate for Payer: Cigna Commercial |
$1,803.18
|
| Rate for Payer: First Health Commercial |
$2,063.88
|
| Rate for Payer: Humana Commercial |
$1,846.62
|
| Rate for Payer: Humana KY Medicaid |
$747.12
|
| Rate for Payer: Kentucky WC Medicaid |
$754.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$434.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$673.48
|
| Rate for Payer: PHCS Commercial |
$2,085.60
|
| Rate for Payer: United Healthcare All Payer |
$1,911.80
|
|
|
PLATE LOCK THIRD TUB SS 6H
|
Facility
|
IP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
PLATE LOCK THIRD TUB SS 6H
|
Facility
|
OP
|
$2,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$284.70 |
| Max. Negotiated Rate |
$2,102.40 |
| Rate for Payer: Aetna Commercial |
$1,686.30
|
| Rate for Payer: Anthem Medicaid |
$753.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,708.20
|
| Rate for Payer: Cash Price |
$1,095.00
|
| Rate for Payer: Cigna Commercial |
$1,817.70
|
| Rate for Payer: First Health Commercial |
$2,080.50
|
| Rate for Payer: Humana Commercial |
$1,861.50
|
| Rate for Payer: Humana KY Medicaid |
$753.14
|
| Rate for Payer: Kentucky WC Medicaid |
$760.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,795.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,616.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$768.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,927.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,642.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$284.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$678.90
|
| Rate for Payer: PHCS Commercial |
$2,102.40
|
| Rate for Payer: United Healthcare All Payer |
$1,927.20
|
|
|
PLATE LOCK THIRD TUB SS 7H
|
Facility
|
OP
|
$3,137.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.83 |
| Max. Negotiated Rate |
$3,011.64 |
| Rate for Payer: Aetna Commercial |
$2,415.58
|
| Rate for Payer: Anthem Medicaid |
$1,078.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,446.95
|
| Rate for Payer: Cash Price |
$1,568.56
|
| Rate for Payer: Cigna Commercial |
$2,603.81
|
| Rate for Payer: First Health Commercial |
$2,980.26
|
| Rate for Payer: Humana Commercial |
$2,666.55
|
| Rate for Payer: Humana KY Medicaid |
$1,078.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,089.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,572.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,315.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$941.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,100.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,760.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,352.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.51
|
| Rate for Payer: PHCS Commercial |
$3,011.64
|
| Rate for Payer: United Healthcare All Payer |
$2,760.67
|
|
|
PLATE LOCK THIRD TUB SS 7H
|
Facility
|
IP
|
$3,137.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.83 |
| Max. Negotiated Rate |
$3,011.64 |
| Rate for Payer: Aetna Commercial |
$2,415.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,446.95
|
| Rate for Payer: Cash Price |
$1,568.56
|
| Rate for Payer: Cigna Commercial |
$2,603.81
|
| Rate for Payer: First Health Commercial |
$2,980.26
|
| Rate for Payer: Humana Commercial |
$2,666.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,572.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,315.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$941.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,760.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,352.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$627.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$407.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$972.51
|
| Rate for Payer: PHCS Commercial |
$3,011.64
|
| Rate for Payer: United Healthcare All Payer |
$2,760.67
|
|
|
PLATE LOCK THIRD TUB SS 8H
|
Facility
|
OP
|
$3,173.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.60 |
| Max. Negotiated Rate |
$3,046.92 |
| Rate for Payer: Aetna Commercial |
$2,443.89
|
| Rate for Payer: Anthem Medicaid |
$1,091.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,475.63
|
| Rate for Payer: Cash Price |
$1,586.94
|
| Rate for Payer: Cigna Commercial |
$2,634.32
|
| Rate for Payer: First Health Commercial |
$3,015.19
|
| Rate for Payer: Humana Commercial |
$2,697.80
|
| Rate for Payer: Humana KY Medicaid |
$1,091.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,102.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,602.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,342.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,113.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,793.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,380.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.90
|
| Rate for Payer: PHCS Commercial |
$3,046.92
|
| Rate for Payer: United Healthcare All Payer |
$2,793.01
|
|
|
PLATE LOCK THIRD TUB SS 8H
|
Facility
|
IP
|
$3,173.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.60 |
| Max. Negotiated Rate |
$3,046.92 |
| Rate for Payer: Aetna Commercial |
$2,443.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,475.63
|
| Rate for Payer: Cash Price |
$1,586.94
|
| Rate for Payer: Cigna Commercial |
$2,634.32
|
| Rate for Payer: First Health Commercial |
$3,015.19
|
| Rate for Payer: Humana Commercial |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,602.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,342.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,793.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,380.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.90
|
| Rate for Payer: PHCS Commercial |
$3,046.92
|
| Rate for Payer: United Healthcare All Payer |
$2,793.01
|
|
|
PLATE LOCK THRD TUB SS 10H
|
Facility
|
IP
|
$3,229.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.77 |
| Max. Negotiated Rate |
$3,099.84 |
| Rate for Payer: Aetna Commercial |
$2,486.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,518.62
|
| Rate for Payer: Cash Price |
$1,614.50
|
| Rate for Payer: Cigna Commercial |
$2,680.07
|
| Rate for Payer: First Health Commercial |
$3,067.55
|
| Rate for Payer: Humana Commercial |
$2,744.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,647.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,383.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,841.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,421.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.99
|
| Rate for Payer: PHCS Commercial |
$3,099.84
|
| Rate for Payer: United Healthcare All Payer |
$2,841.52
|
|
|
PLATE LOCK THRD TUB SS 10H
|
Facility
|
OP
|
$3,229.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$419.77 |
| Max. Negotiated Rate |
$3,099.84 |
| Rate for Payer: Kentucky WC Medicaid |
$1,121.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,647.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,383.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$968.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,132.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,841.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,421.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$645.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$419.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,000.99
|
| Rate for Payer: PHCS Commercial |
$3,099.84
|
| Rate for Payer: United Healthcare All Payer |
$2,841.52
|
| Rate for Payer: Aetna Commercial |
$2,486.33
|
| Rate for Payer: Anthem Medicaid |
$1,110.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,518.62
|
| Rate for Payer: Cash Price |
$1,614.50
|
| Rate for Payer: Cigna Commercial |
$2,680.07
|
| Rate for Payer: First Health Commercial |
$3,067.55
|
| Rate for Payer: Humana Commercial |
$2,744.65
|
| Rate for Payer: Humana KY Medicaid |
$1,110.45
|
|
|
PLATE LOPRO COTTON TI 2MM
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE LOPRO COTTON TI 2MM
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE LOPRO COTTON TI 4MM
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE LOPRO COTTON TI 4MM
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE LOPRO COTTON TI 6MM
|
Facility
|
IP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE LOPRO COTTON TI 6MM
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
|
PLATE LOPRO COTTON TI 8MM
|
Facility
|
OP
|
$4,982.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$647.72 |
| Max. Negotiated Rate |
$4,783.20 |
| Rate for Payer: Aetna Commercial |
$3,836.52
|
| Rate for Payer: Anthem Medicaid |
$1,713.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
| Rate for Payer: Cash Price |
$2,491.25
|
| Rate for Payer: Cigna Commercial |
$4,135.48
|
| Rate for Payer: First Health Commercial |
$4,733.38
|
| Rate for Payer: Humana Commercial |
$4,235.12
|
| Rate for Payer: Humana KY Medicaid |
$1,713.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
| Rate for Payer: PHCS Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
