|
PLATE CRVED RECON 3.5 14X166MM
|
Facility
|
IP
|
$4,260.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.04 |
| Max. Negotiated Rate |
$4,089.72 |
| Rate for Payer: Aetna Commercial |
$3,280.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.89
|
| Rate for Payer: Cash Price |
$2,130.06
|
| Rate for Payer: Cigna Commercial |
$3,535.90
|
| Rate for Payer: First Health Commercial |
$4,047.11
|
| Rate for Payer: Humana Commercial |
$3,621.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,408.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,706.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,939.48
|
| Rate for Payer: PHCS Commercial |
$4,089.72
|
| Rate for Payer: United Healthcare All Payer |
$3,748.91
|
|
|
PLATE CRVED RECON 3.5 14X166MM
|
Facility
|
OP
|
$4,260.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.04 |
| Max. Negotiated Rate |
$4,089.72 |
| Rate for Payer: Aetna Commercial |
$3,280.29
|
| Rate for Payer: Anthem Medicaid |
$1,465.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.89
|
| Rate for Payer: Cash Price |
$2,130.06
|
| Rate for Payer: Cigna Commercial |
$3,535.90
|
| Rate for Payer: First Health Commercial |
$4,047.11
|
| Rate for Payer: Humana Commercial |
$3,621.10
|
| Rate for Payer: Humana KY Medicaid |
$1,465.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,493.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,408.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,706.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,939.48
|
| Rate for Payer: PHCS Commercial |
$4,089.72
|
| Rate for Payer: United Healthcare All Payer |
$3,748.91
|
|
|
PLATE CRVED RECON 3.5 16X190MM
|
Facility
|
OP
|
$4,398.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.55 |
| Max. Negotiated Rate |
$4,222.56 |
| Rate for Payer: Aetna Commercial |
$3,386.84
|
| Rate for Payer: Anthem Medicaid |
$1,512.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.83
|
| Rate for Payer: Cash Price |
$2,199.25
|
| Rate for Payer: Cigna Commercial |
$3,650.76
|
| Rate for Payer: First Health Commercial |
$4,178.57
|
| Rate for Payer: Humana Commercial |
$3,738.72
|
| Rate for Payer: Humana KY Medicaid |
$1,512.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,528.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,246.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,542.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,518.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,826.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,034.97
|
| Rate for Payer: PHCS Commercial |
$4,222.56
|
| Rate for Payer: United Healthcare All Payer |
$3,870.68
|
|
|
PLATE CRVED RECON 3.5 16X190MM
|
Facility
|
IP
|
$4,398.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,319.55 |
| Max. Negotiated Rate |
$4,222.56 |
| Rate for Payer: Aetna Commercial |
$3,386.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,430.83
|
| Rate for Payer: Cash Price |
$2,199.25
|
| Rate for Payer: Cigna Commercial |
$3,650.76
|
| Rate for Payer: First Health Commercial |
$4,178.57
|
| Rate for Payer: Humana Commercial |
$3,738.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,606.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,246.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,319.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,870.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,298.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,518.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,826.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,034.97
|
| Rate for Payer: PHCS Commercial |
$4,222.56
|
| Rate for Payer: United Healthcare All Payer |
$3,870.68
|
|
|
PLATE CRVED RECON 3.5 18X214MM
|
Facility
|
OP
|
$4,583.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.90 |
| Max. Negotiated Rate |
$4,399.68 |
| Rate for Payer: Aetna Commercial |
$3,528.91
|
| Rate for Payer: Anthem Medicaid |
$1,576.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,574.74
|
| Rate for Payer: Cash Price |
$2,291.50
|
| Rate for Payer: Cigna Commercial |
$3,803.89
|
| Rate for Payer: First Health Commercial |
$4,353.85
|
| Rate for Payer: Humana Commercial |
$3,895.55
|
| Rate for Payer: Humana KY Medicaid |
$1,576.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,592.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,758.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,607.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,033.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,437.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,987.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.27
|
| Rate for Payer: PHCS Commercial |
$4,399.68
|
| Rate for Payer: United Healthcare All Payer |
$4,033.04
|
|
|
PLATE CRVED RECON 3.5 18X214MM
|
Facility
|
IP
|
$4,583.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,374.90 |
| Max. Negotiated Rate |
$4,399.68 |
| Rate for Payer: Aetna Commercial |
$3,528.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,574.74
|
| Rate for Payer: Cash Price |
$2,291.50
|
| Rate for Payer: Cigna Commercial |
$3,803.89
|
| Rate for Payer: First Health Commercial |
$4,353.85
|
| Rate for Payer: Humana Commercial |
$3,895.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,758.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,382.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,374.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,033.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,437.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,666.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,987.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,162.27
|
| Rate for Payer: PHCS Commercial |
$4,399.68
|
| Rate for Payer: United Healthcare All Payer |
$4,033.04
|
|
|
PLATE CRVED RECON 3.5 6X70MM
|
Facility
|
IP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
PLATE CRVED RECON 3.5 6X70MM
|
Facility
|
OP
|
$3,675.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.76 |
| Max. Negotiated Rate |
$3,528.84 |
| Rate for Payer: Aetna Commercial |
$2,830.43
|
| Rate for Payer: Anthem Medicaid |
$1,264.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,867.19
|
| Rate for Payer: Cash Price |
$1,837.94
|
| Rate for Payer: Cigna Commercial |
$3,050.98
|
| Rate for Payer: First Health Commercial |
$3,492.09
|
| Rate for Payer: Humana Commercial |
$3,124.50
|
| Rate for Payer: Humana KY Medicaid |
$1,264.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,277.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,014.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,712.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,102.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,289.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,234.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,756.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,940.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,198.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,536.36
|
| Rate for Payer: PHCS Commercial |
$3,528.84
|
| Rate for Payer: United Healthcare All Payer |
$3,234.77
|
|
|
PLATE CRVED RECON 3.5 8X94MM
|
Facility
|
OP
|
$3,829.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.89 |
| Max. Negotiated Rate |
$3,676.44 |
| Rate for Payer: Aetna Commercial |
$2,948.81
|
| Rate for Payer: Anthem Medicaid |
$1,317.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,987.10
|
| Rate for Payer: Cash Price |
$1,914.81
|
| Rate for Payer: Cigna Commercial |
$3,178.58
|
| Rate for Payer: First Health Commercial |
$3,638.14
|
| Rate for Payer: Humana Commercial |
$3,255.18
|
| Rate for Payer: Humana KY Medicaid |
$1,317.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,330.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,140.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,826.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,148.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,343.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,370.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,872.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,331.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.44
|
| Rate for Payer: PHCS Commercial |
$3,676.44
|
| Rate for Payer: United Healthcare All Payer |
$3,370.07
|
|
|
PLATE CRVED RECON 3.5 8X94MM
|
Facility
|
IP
|
$3,829.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.89 |
| Max. Negotiated Rate |
$3,676.44 |
| Rate for Payer: Aetna Commercial |
$2,948.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,987.10
|
| Rate for Payer: Cash Price |
$1,914.81
|
| Rate for Payer: Cigna Commercial |
$3,178.58
|
| Rate for Payer: First Health Commercial |
$3,638.14
|
| Rate for Payer: Humana Commercial |
$3,255.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,140.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,826.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,148.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,370.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,872.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,063.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,331.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,642.44
|
| Rate for Payer: PHCS Commercial |
$3,676.44
|
| Rate for Payer: United Healthcare All Payer |
$3,370.07
|
|
|
PLATE CURVED
|
Facility
|
IP
|
$1,923.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$1,846.27 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.10
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cigna Commercial |
$1,596.26
|
| Rate for Payer: First Health Commercial |
$1,827.04
|
| Rate for Payer: Humana Commercial |
$1,634.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.01
|
| Rate for Payer: PHCS Commercial |
$1,846.27
|
| Rate for Payer: United Healthcare All Payer |
$1,692.42
|
|
|
PLATE CURVED
|
Facility
|
OP
|
$1,923.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$1,846.27 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Anthem Medicaid |
$661.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.10
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cigna Commercial |
$1,596.26
|
| Rate for Payer: First Health Commercial |
$1,827.04
|
| Rate for Payer: Humana Commercial |
$1,634.72
|
| Rate for Payer: Humana KY Medicaid |
$661.39
|
| Rate for Payer: Kentucky WC Medicaid |
$668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.01
|
| Rate for Payer: PHCS Commercial |
$1,846.27
|
| Rate for Payer: United Healthcare All Payer |
$1,692.42
|
|
|
PLATE CUST MAND RECON 2.8 HEMI
|
Facility
|
OP
|
$41,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,581.25 |
| Max. Negotiated Rate |
$40,260.00 |
| Rate for Payer: Aetna Commercial |
$32,291.88
|
| Rate for Payer: Anthem Medicaid |
$14,422.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,711.25
|
| Rate for Payer: Cash Price |
$20,968.75
|
| Rate for Payer: Cigna Commercial |
$34,808.12
|
| Rate for Payer: First Health Commercial |
$39,840.62
|
| Rate for Payer: Humana Commercial |
$35,646.88
|
| Rate for Payer: Humana KY Medicaid |
$14,422.31
|
| Rate for Payer: Kentucky WC Medicaid |
$14,569.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,388.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,949.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,581.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,711.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,453.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,485.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,936.88
|
| Rate for Payer: PHCS Commercial |
$40,260.00
|
| Rate for Payer: United Healthcare All Payer |
$36,905.00
|
|
|
PLATE CUST MAND RECON 2.8 HEMI
|
Facility
|
IP
|
$41,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,581.25 |
| Max. Negotiated Rate |
$40,260.00 |
| Rate for Payer: Aetna Commercial |
$32,291.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$32,711.25
|
| Rate for Payer: Cash Price |
$20,968.75
|
| Rate for Payer: Cigna Commercial |
$34,808.12
|
| Rate for Payer: First Health Commercial |
$39,840.62
|
| Rate for Payer: Humana Commercial |
$35,646.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$34,388.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$30,949.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$12,581.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$36,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$31,453.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$33,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$36,485.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$28,936.88
|
| Rate for Payer: PHCS Commercial |
$40,260.00
|
| Rate for Payer: United Healthcare All Payer |
$36,905.00
|
|
|
PLATE CVD BROAD 14 HOLE
|
Facility
|
OP
|
$4,134.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.29 |
| Max. Negotiated Rate |
$3,968.94 |
| Rate for Payer: Aetna Commercial |
$3,183.42
|
| Rate for Payer: Anthem Medicaid |
$1,421.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,224.76
|
| Rate for Payer: Cash Price |
$2,067.16
|
| Rate for Payer: Cigna Commercial |
$3,431.48
|
| Rate for Payer: First Health Commercial |
$3,927.59
|
| Rate for Payer: Humana Commercial |
$3,514.16
|
| Rate for Payer: Humana KY Medicaid |
$1,421.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,436.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,390.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,051.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,240.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,450.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,638.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,100.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,596.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,852.67
|
| Rate for Payer: PHCS Commercial |
$3,968.94
|
| Rate for Payer: United Healthcare All Payer |
$3,638.19
|
|
|
PLATE CVD BROAD 14 HOLE
|
Facility
|
IP
|
$4,134.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,240.29 |
| Max. Negotiated Rate |
$3,968.94 |
| Rate for Payer: Aetna Commercial |
$3,183.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,224.76
|
| Rate for Payer: Cash Price |
$2,067.16
|
| Rate for Payer: Cigna Commercial |
$3,431.48
|
| Rate for Payer: First Health Commercial |
$3,927.59
|
| Rate for Payer: Humana Commercial |
$3,514.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,390.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,051.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,240.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,638.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,100.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,307.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,596.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,852.67
|
| Rate for Payer: PHCS Commercial |
$3,968.94
|
| Rate for Payer: United Healthcare All Payer |
$3,638.19
|
|
|
PLATE DHS 135*4H 78MM
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 135*4H 78MM
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 140*5H 94MM
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 140*5H 94MM
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 140* 6H 110MM
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 140* 6H 110MM
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 145*5H 94MM
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 145*5H 94MM
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DHS 145*6H 110MM
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
