|
PLATE OLECRANON TI 3H 65MM L
|
Facility
|
IP
|
$4,732.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$4,543.36 |
| Rate for Payer: Aetna Commercial |
$3,644.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,691.48
|
| Rate for Payer: Cash Price |
$2,366.34
|
| Rate for Payer: Cigna Commercial |
$3,928.12
|
| Rate for Payer: First Health Commercial |
$4,496.04
|
| Rate for Payer: Humana Commercial |
$4,022.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,880.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,492.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,164.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,549.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.13
|
| Rate for Payer: PHCS Commercial |
$4,543.36
|
| Rate for Payer: United Healthcare All Payer |
$4,164.75
|
|
|
PLATE OLECRANON TI 3H 65MM L
|
Facility
|
OP
|
$4,732.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$4,543.36 |
| Rate for Payer: Anthem Medicaid |
$1,627.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,691.48
|
| Rate for Payer: Cash Price |
$2,366.34
|
| Rate for Payer: Cigna Commercial |
$3,928.12
|
| Rate for Payer: First Health Commercial |
$4,496.04
|
| Rate for Payer: Humana Commercial |
$4,022.77
|
| Rate for Payer: Humana KY Medicaid |
$1,627.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,880.79
|
| Rate for Payer: Aetna Commercial |
$3,644.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,492.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,164.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,549.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.13
|
| Rate for Payer: PHCS Commercial |
$4,543.36
|
| Rate for Payer: United Healthcare All Payer |
$4,164.75
|
|
|
PLATE OLECRANON TI 4H 89MM L
|
Facility
|
OP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem Medicaid |
$2,535.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Humana KY Medicaid |
$2,535.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,561.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,586.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE OLECRANON TI 4H 89MM L
|
Facility
|
IP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE OLECRANON TI 6H 113MM L
|
Facility
|
IP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE OLECRANON TI 6H 113MM L
|
Facility
|
OP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem Medicaid |
$2,535.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Humana KY Medicaid |
$2,535.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,561.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,586.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE OLECRANON XLG LEFT
|
Facility
|
IP
|
$6,723.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.09 |
| Max. Negotiated Rate |
$6,454.80 |
| Rate for Payer: Aetna Commercial |
$5,177.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,244.52
|
| Rate for Payer: Cash Price |
$3,361.88
|
| Rate for Payer: Cigna Commercial |
$5,580.71
|
| Rate for Payer: First Health Commercial |
$6,387.56
|
| Rate for Payer: Humana Commercial |
$5,715.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,513.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,962.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,017.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,916.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,042.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,084.36
|
| Rate for Payer: PHCS Commercial |
$6,454.80
|
| Rate for Payer: United Healthcare All Payer |
$5,916.90
|
|
|
PLATE OLECRANON XLG LEFT
|
Facility
|
OP
|
$6,723.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.09 |
| Max. Negotiated Rate |
$6,454.80 |
| Rate for Payer: Aetna Commercial |
$5,177.29
|
| Rate for Payer: Anthem Medicaid |
$2,312.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,244.52
|
| Rate for Payer: Cash Price |
$3,361.88
|
| Rate for Payer: Cigna Commercial |
$5,580.71
|
| Rate for Payer: First Health Commercial |
$6,387.56
|
| Rate for Payer: Humana Commercial |
$5,715.19
|
| Rate for Payer: Humana KY Medicaid |
$2,312.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,335.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,513.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,962.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,017.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,916.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,042.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,084.36
|
| Rate for Payer: PHCS Commercial |
$6,454.80
|
| Rate for Payer: United Healthcare All Payer |
$5,916.90
|
|
|
PLATE ONE-THIRD TUBULAR 10H
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
PLATE ONE-THIRD TUBULAR 10H
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
PLATE ONE-THIRD TUBULAR 12H
|
Facility
|
IP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
PLATE ONE-THIRD TUBULAR 12H
|
Facility
|
OP
|
$1,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.28 |
| Max. Negotiated Rate |
$1,648.80 |
| Rate for Payer: Anthem Medicaid |
$590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,339.65
|
| Rate for Payer: Cash Price |
$858.75
|
| Rate for Payer: Cigna Commercial |
$1,425.52
|
| Rate for Payer: First Health Commercial |
$1,631.62
|
| Rate for Payer: Humana Commercial |
$1,459.88
|
| Rate for Payer: Humana KY Medicaid |
$590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$596.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,408.35
|
| Rate for Payer: Aetna Commercial |
$1,322.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,267.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$515.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$602.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,511.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,288.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$343.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$532.42
|
| Rate for Payer: PHCS Commercial |
$1,648.80
|
| Rate for Payer: United Healthcare All Payer |
$1,511.40
|
|
|
PLATE ONE-THIRD TUBULAR 3H
|
Facility
|
OP
|
$1,146.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.07 |
| Max. Negotiated Rate |
$1,100.83 |
| Rate for Payer: Aetna Commercial |
$882.96
|
| Rate for Payer: Anthem Medicaid |
$394.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$894.43
|
| Rate for Payer: Cash Price |
$573.35
|
| Rate for Payer: Cigna Commercial |
$951.76
|
| Rate for Payer: First Health Commercial |
$1,089.36
|
| Rate for Payer: Humana Commercial |
$974.70
|
| Rate for Payer: Humana KY Medicaid |
$394.35
|
| Rate for Payer: Kentucky WC Medicaid |
$398.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$940.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$402.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.10
|
| Rate for Payer: Ohio Health Group HMO |
$860.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.48
|
| Rate for Payer: PHCS Commercial |
$1,100.83
|
| Rate for Payer: United Healthcare All Payer |
$1,009.10
|
|
|
PLATE ONE-THIRD TUBULAR 3H
|
Facility
|
IP
|
$1,146.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.07 |
| Max. Negotiated Rate |
$1,100.83 |
| Rate for Payer: Aetna Commercial |
$882.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$894.43
|
| Rate for Payer: Cash Price |
$573.35
|
| Rate for Payer: Cigna Commercial |
$951.76
|
| Rate for Payer: First Health Commercial |
$1,089.36
|
| Rate for Payer: Humana Commercial |
$974.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$940.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.10
|
| Rate for Payer: Ohio Health Group HMO |
$860.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.48
|
| Rate for Payer: PHCS Commercial |
$1,100.83
|
| Rate for Payer: United Healthcare All Payer |
$1,009.10
|
|
|
PLATE ONE-THIRD TUBULAR 4H
|
Facility
|
IP
|
$1,168.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.87 |
| Max. Negotiated Rate |
$1,121.47 |
| Rate for Payer: Aetna Commercial |
$899.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$911.20
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$969.61
|
| Rate for Payer: First Health Commercial |
$1,109.79
|
| Rate for Payer: Humana Commercial |
$992.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$957.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$862.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,028.02
|
| Rate for Payer: Ohio Health Group HMO |
$876.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.14
|
| Rate for Payer: PHCS Commercial |
$1,121.47
|
| Rate for Payer: United Healthcare All Payer |
$1,028.02
|
|
|
PLATE ONE-THIRD TUBULAR 4H
|
Facility
|
OP
|
$1,168.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.87 |
| Max. Negotiated Rate |
$1,121.47 |
| Rate for Payer: Aetna Commercial |
$899.51
|
| Rate for Payer: Anthem Medicaid |
$401.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$911.20
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$969.61
|
| Rate for Payer: First Health Commercial |
$1,109.79
|
| Rate for Payer: Humana Commercial |
$992.97
|
| Rate for Payer: Humana KY Medicaid |
$401.74
|
| Rate for Payer: Kentucky WC Medicaid |
$405.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$957.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$862.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,028.02
|
| Rate for Payer: Ohio Health Group HMO |
$876.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$362.14
|
| Rate for Payer: PHCS Commercial |
$1,121.47
|
| Rate for Payer: United Healthcare All Payer |
$1,028.02
|
|
|
PLATE ONE-THIRD TUBULAR 5H
|
Facility
|
OP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem Medicaid |
$526.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Humana KY Medicaid |
$526.17
|
| Rate for Payer: Kentucky WC Medicaid |
$531.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$536.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
PLATE ONE-THIRD TUBULAR 5H
|
Facility
|
IP
|
$1,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.90 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,193.40
|
| Rate for Payer: Cash Price |
$765.00
|
| Rate for Payer: Cigna Commercial |
$1,269.90
|
| Rate for Payer: First Health Commercial |
$1,453.50
|
| Rate for Payer: Humana Commercial |
$1,300.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,254.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,129.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$459.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,346.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,147.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$306.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$474.30
|
| Rate for Payer: PHCS Commercial |
$1,468.80
|
| Rate for Payer: United Healthcare All Payer |
$1,346.40
|
|
|
PLATE ONE-THIRD TUBULAR 6H
|
Facility
|
IP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
PLATE ONE-THIRD TUBULAR 6H
|
Facility
|
OP
|
$1,547.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$201.18 |
| Max. Negotiated Rate |
$1,485.60 |
| Rate for Payer: Aetna Commercial |
$1,191.58
|
| Rate for Payer: Anthem Medicaid |
$532.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,207.05
|
| Rate for Payer: Cash Price |
$773.75
|
| Rate for Payer: Cigna Commercial |
$1,284.42
|
| Rate for Payer: First Health Commercial |
$1,470.12
|
| Rate for Payer: Humana Commercial |
$1,315.38
|
| Rate for Payer: Humana KY Medicaid |
$532.19
|
| Rate for Payer: Kentucky WC Medicaid |
$537.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,268.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,142.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$464.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,361.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,160.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$201.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.72
|
| Rate for Payer: PHCS Commercial |
$1,485.60
|
| Rate for Payer: United Healthcare All Payer |
$1,361.80
|
|
|
PLATE ONE-THIRD TUBULAR 7H
|
Facility
|
OP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Anthem Medicaid |
$538.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Humana KY Medicaid |
$538.20
|
| Rate for Payer: Kentucky WC Medicaid |
$543.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
PLATE ONE-THIRD TUBULAR 7H
|
Facility
|
IP
|
$1,565.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.45 |
| Max. Negotiated Rate |
$1,502.40 |
| Rate for Payer: Aetna Commercial |
$1,205.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.70
|
| Rate for Payer: Cash Price |
$782.50
|
| Rate for Payer: Cigna Commercial |
$1,298.95
|
| Rate for Payer: First Health Commercial |
$1,486.75
|
| Rate for Payer: Humana Commercial |
$1,330.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,154.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.15
|
| Rate for Payer: PHCS Commercial |
$1,502.40
|
| Rate for Payer: United Healthcare All Payer |
$1,377.20
|
|
|
PLATE ONE-THIRD TUBULAR 8H
|
Facility
|
OP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem Medicaid |
$544.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Humana KY Medicaid |
$544.22
|
| Rate for Payer: Kentucky WC Medicaid |
$549.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$555.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
PLATE ONE-THIRD TUBULAR 8H
|
Facility
|
IP
|
$1,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.72 |
| Max. Negotiated Rate |
$1,519.20 |
| Rate for Payer: Aetna Commercial |
$1,218.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,234.35
|
| Rate for Payer: Cash Price |
$791.25
|
| Rate for Payer: Cigna Commercial |
$1,313.48
|
| Rate for Payer: First Health Commercial |
$1,503.38
|
| Rate for Payer: Humana Commercial |
$1,345.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.58
|
| Rate for Payer: PHCS Commercial |
$1,519.20
|
| Rate for Payer: United Healthcare All Payer |
$1,392.60
|
|
|
PLATE PERC CALC MD 2.7M 58M L
|
Facility
|
OP
|
$6,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.89 |
| Max. Negotiated Rate |
$6,615.81 |
| Rate for Payer: Aetna Commercial |
$5,306.43
|
| Rate for Payer: Anthem Medicaid |
$2,369.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,375.35
|
| Rate for Payer: Cash Price |
$3,445.73
|
| Rate for Payer: Cigna Commercial |
$5,719.92
|
| Rate for Payer: First Health Commercial |
$6,546.90
|
| Rate for Payer: Humana Commercial |
$5,857.75
|
| Rate for Payer: Humana KY Medicaid |
$2,369.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,394.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,651.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,085.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,067.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,417.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,064.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,168.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.36
|
| Rate for Payer: PHCS Commercial |
$6,615.81
|
| Rate for Payer: United Healthcare All Payer |
$6,064.49
|
|
