|
PLATE S3 6HOLE LEFT
|
Facility
|
IP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Aetna Commercial |
$8,171.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
|
|
PLATE S3 6HOLE RIGHT
|
Facility
|
OP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem Medicaid |
$3,018.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Humana KY Medicaid |
$3,018.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 6HOLE RIGHT
|
Facility
|
IP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 8HOLE LEFT
|
Facility
|
IP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Aetna Commercial |
$8,171.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
|
|
PLATE S3 8HOLE LEFT
|
Facility
|
OP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Aetna Commercial |
$8,171.56
|
| Rate for Payer: Anthem Medicaid |
$3,649.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Humana KY Medicaid |
$3,649.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,686.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,722.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
|
|
PLATE S3 8HOLE RIGHT
|
Facility
|
OP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem Medicaid |
$3,018.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Humana KY Medicaid |
$3,018.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 8HOLE RIGHT
|
Facility
|
IP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE SBF LONG 11 HOLE
|
Facility
|
OP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.78 |
| Max. Negotiated Rate |
$2,021.76 |
| Rate for Payer: Aetna Commercial |
$1,621.62
|
| Rate for Payer: Anthem Medicaid |
$724.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.68
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$1,747.98
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Humana Commercial |
$1,790.10
|
| Rate for Payer: Humana KY Medicaid |
$724.25
|
| Rate for Payer: Kentucky WC Medicaid |
$731.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,853.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.86
|
| Rate for Payer: PHCS Commercial |
$2,021.76
|
| Rate for Payer: United Healthcare All Payer |
$1,853.28
|
|
|
PLATE SBF LONG 11 HOLE
|
Facility
|
IP
|
$2,106.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.78 |
| Max. Negotiated Rate |
$2,021.76 |
| Rate for Payer: Aetna Commercial |
$1,621.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.68
|
| Rate for Payer: Cash Price |
$1,053.00
|
| Rate for Payer: Cigna Commercial |
$1,747.98
|
| Rate for Payer: First Health Commercial |
$2,000.70
|
| Rate for Payer: Humana Commercial |
$1,790.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,554.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,853.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$652.86
|
| Rate for Payer: PHCS Commercial |
$2,021.76
|
| Rate for Payer: United Healthcare All Payer |
$1,853.28
|
|
|
PLATE SBF LONG 5 HOLE
|
Facility
|
OP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$1,997.57 |
| Rate for Payer: Aetna Commercial |
$1,602.22
|
| Rate for Payer: Anthem Medicaid |
$715.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.02
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna Commercial |
$1,727.06
|
| Rate for Payer: First Health Commercial |
$1,976.76
|
| Rate for Payer: Humana Commercial |
$1,768.68
|
| Rate for Payer: Humana KY Medicaid |
$715.59
|
| Rate for Payer: Kentucky WC Medicaid |
$722.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.05
|
| Rate for Payer: PHCS Commercial |
$1,997.57
|
| Rate for Payer: United Healthcare All Payer |
$1,831.10
|
|
|
PLATE SBF LONG 5 HOLE
|
Facility
|
IP
|
$2,080.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$270.50 |
| Max. Negotiated Rate |
$1,997.57 |
| Rate for Payer: Aetna Commercial |
$1,602.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.02
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna Commercial |
$1,727.06
|
| Rate for Payer: First Health Commercial |
$1,976.76
|
| Rate for Payer: Humana Commercial |
$1,768.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$270.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$645.05
|
| Rate for Payer: PHCS Commercial |
$1,997.57
|
| Rate for Payer: United Healthcare All Payer |
$1,831.10
|
|
|
PLATE SBF TWISTED 90 DEG
|
Facility
|
OP
|
$2,087.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.32 |
| Max. Negotiated Rate |
$2,003.62 |
| Rate for Payer: Aetna Commercial |
$1,607.07
|
| Rate for Payer: Anthem Medicaid |
$717.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,627.94
|
| Rate for Payer: Cash Price |
$1,043.55
|
| Rate for Payer: Cigna Commercial |
$1,732.29
|
| Rate for Payer: First Health Commercial |
$1,982.74
|
| Rate for Payer: Humana Commercial |
$1,774.04
|
| Rate for Payer: Humana KY Medicaid |
$717.75
|
| Rate for Payer: Kentucky WC Medicaid |
$725.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.00
|
| Rate for Payer: PHCS Commercial |
$2,003.62
|
| Rate for Payer: United Healthcare All Payer |
$1,836.65
|
|
|
PLATE SBF TWISTED 90 DEG
|
Facility
|
IP
|
$2,087.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.32 |
| Max. Negotiated Rate |
$2,003.62 |
| Rate for Payer: Aetna Commercial |
$1,607.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,627.94
|
| Rate for Payer: Cash Price |
$1,043.55
|
| Rate for Payer: Cigna Commercial |
$1,732.29
|
| Rate for Payer: First Health Commercial |
$1,982.74
|
| Rate for Payer: Humana Commercial |
$1,774.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,711.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,836.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,565.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.00
|
| Rate for Payer: PHCS Commercial |
$2,003.62
|
| Rate for Payer: United Healthcare All Payer |
$1,836.65
|
|
|
PLATE SEMI-TUB PF 4H
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
|
|
PLATE SEMI-TUB PF 4H
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
PLATE SEMI-TUB PF 5H
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem Medicaid |
$528.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Humana KY Medicaid |
$528.57
|
| Rate for Payer: Kentucky WC Medicaid |
$533.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$539.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
PLATE SEMI-TUB PF 5H
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$1,475.52 |
| Rate for Payer: Aetna Commercial |
$1,183.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,198.86
|
| Rate for Payer: Cash Price |
$768.50
|
| Rate for Payer: Cigna Commercial |
$1,275.71
|
| Rate for Payer: First Health Commercial |
$1,460.15
|
| Rate for Payer: Humana Commercial |
$1,306.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,260.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,134.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$461.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,352.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,152.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$307.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$199.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$476.47
|
| Rate for Payer: PHCS Commercial |
$1,475.52
|
| Rate for Payer: United Healthcare All Payer |
$1,352.56
|
|
|
PLATE SEMI-TUB PF 7H
|
Facility
|
OP
|
$1,587.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$1,523.73 |
| Rate for Payer: Aetna Commercial |
$1,222.16
|
| Rate for Payer: Anthem Medicaid |
$545.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,238.03
|
| Rate for Payer: Cash Price |
$793.61
|
| Rate for Payer: Cigna Commercial |
$1,317.39
|
| Rate for Payer: First Health Commercial |
$1,507.86
|
| Rate for Payer: Humana Commercial |
$1,349.14
|
| Rate for Payer: Humana KY Medicaid |
$545.84
|
| Rate for Payer: Kentucky WC Medicaid |
$551.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,301.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,171.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$556.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,396.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,190.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.04
|
| Rate for Payer: PHCS Commercial |
$1,523.73
|
| Rate for Payer: United Healthcare All Payer |
$1,396.75
|
|
|
PLATE SEMI-TUB PF 7H
|
Facility
|
IP
|
$1,587.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.34 |
| Max. Negotiated Rate |
$1,523.73 |
| Rate for Payer: Aetna Commercial |
$1,222.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,238.03
|
| Rate for Payer: Cash Price |
$793.61
|
| Rate for Payer: Cigna Commercial |
$1,317.39
|
| Rate for Payer: First Health Commercial |
$1,507.86
|
| Rate for Payer: Humana Commercial |
$1,349.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,301.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,171.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$476.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,396.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,190.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$317.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$206.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$492.04
|
| Rate for Payer: PHCS Commercial |
$1,523.73
|
| Rate for Payer: United Healthcare All Payer |
$1,396.75
|
|
|
PLATE SEMI-TUBULAR 10X167MM
|
Facility
|
OP
|
$1,758.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.67 |
| Max. Negotiated Rate |
$1,688.61 |
| Rate for Payer: Aetna Commercial |
$1,354.41
|
| Rate for Payer: Anthem Medicaid |
$604.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.00
|
| Rate for Payer: Cash Price |
$879.49
|
| Rate for Payer: Cigna Commercial |
$1,459.95
|
| Rate for Payer: First Health Commercial |
$1,671.02
|
| Rate for Payer: Humana Commercial |
$1,495.12
|
| Rate for Payer: Humana KY Medicaid |
$604.91
|
| Rate for Payer: Kentucky WC Medicaid |
$611.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.28
|
| Rate for Payer: PHCS Commercial |
$1,688.61
|
| Rate for Payer: United Healthcare All Payer |
$1,547.89
|
|
|
PLATE SEMI-TUBULAR 10X167MM
|
Facility
|
IP
|
$1,758.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.67 |
| Max. Negotiated Rate |
$1,688.61 |
| Rate for Payer: Aetna Commercial |
$1,354.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.00
|
| Rate for Payer: Cash Price |
$879.49
|
| Rate for Payer: Cigna Commercial |
$1,459.95
|
| Rate for Payer: First Health Commercial |
$1,671.02
|
| Rate for Payer: Humana Commercial |
$1,495.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,547.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$351.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$228.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$545.28
|
| Rate for Payer: PHCS Commercial |
$1,688.61
|
| Rate for Payer: United Healthcare All Payer |
$1,547.89
|
|
|
PLATE SEMI-TUBULAR 11X183MM
|
Facility
|
IP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
|
|
PLATE SEMI-TUBULAR 11X183MM
|
Facility
|
OP
|
$1,773.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.53 |
| Max. Negotiated Rate |
$1,702.40 |
| Rate for Payer: Humana Commercial |
$1,507.33
|
| Rate for Payer: Humana KY Medicaid |
$609.85
|
| Rate for Payer: Kentucky WC Medicaid |
$616.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.73
|
| Rate for Payer: PHCS Commercial |
$1,702.40
|
| Rate for Payer: United Healthcare All Payer |
$1,560.53
|
| Rate for Payer: Aetna Commercial |
$1,365.46
|
| Rate for Payer: Anthem Medicaid |
$609.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.20
|
| Rate for Payer: Cash Price |
$886.66
|
| Rate for Payer: Cigna Commercial |
$1,471.86
|
| Rate for Payer: First Health Commercial |
$1,684.66
|
|
|
PLATE SEMI-TUBULAR 12X183MM
|
Facility
|
IP
|
$1,787.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$1,716.16 |
| Rate for Payer: Aetna Commercial |
$1,376.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.38
|
| Rate for Payer: Cash Price |
$893.84
|
| Rate for Payer: Cigna Commercial |
$1,483.77
|
| Rate for Payer: First Health Commercial |
$1,698.29
|
| Rate for Payer: Humana Commercial |
$1,519.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.18
|
| Rate for Payer: PHCS Commercial |
$1,716.16
|
| Rate for Payer: United Healthcare All Payer |
$1,573.15
|
|
|
PLATE SEMI-TUBULAR 12X183MM
|
Facility
|
OP
|
$1,787.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$1,716.16 |
| Rate for Payer: Aetna Commercial |
$1,376.51
|
| Rate for Payer: Anthem Medicaid |
$614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.38
|
| Rate for Payer: Cash Price |
$893.84
|
| Rate for Payer: Cigna Commercial |
$1,483.77
|
| Rate for Payer: First Health Commercial |
$1,698.29
|
| Rate for Payer: Humana Commercial |
$1,519.52
|
| Rate for Payer: Humana KY Medicaid |
$614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$621.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,465.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,340.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$357.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$554.18
|
| Rate for Payer: PHCS Commercial |
$1,716.16
|
| Rate for Payer: United Healthcare All Payer |
$1,573.15
|
|
