|
PLATE SEMI-TUBULAR 4X71MM
|
Facility
|
OP
|
$1,149.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.46 |
| Max. Negotiated Rate |
$1,103.72 |
| Rate for Payer: Aetna Commercial |
$885.28
|
| Rate for Payer: Anthem Medicaid |
$395.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.77
|
| Rate for Payer: Cash Price |
$574.86
|
| Rate for Payer: Cigna Commercial |
$954.26
|
| Rate for Payer: First Health Commercial |
$1,092.22
|
| Rate for Payer: Humana Commercial |
$977.25
|
| Rate for Payer: Humana KY Medicaid |
$395.39
|
| Rate for Payer: Kentucky WC Medicaid |
$399.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.74
|
| Rate for Payer: Ohio Health Group HMO |
$862.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.41
|
| Rate for Payer: PHCS Commercial |
$1,103.72
|
| Rate for Payer: United Healthcare All Payer |
$1,011.74
|
|
|
PLATE SEMI-TUBULAR 4X71MM
|
Facility
|
IP
|
$1,149.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.46 |
| Max. Negotiated Rate |
$1,103.72 |
| Rate for Payer: Aetna Commercial |
$885.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.77
|
| Rate for Payer: Cash Price |
$574.86
|
| Rate for Payer: Cigna Commercial |
$954.26
|
| Rate for Payer: First Health Commercial |
$1,092.22
|
| Rate for Payer: Humana Commercial |
$977.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.74
|
| Rate for Payer: Ohio Health Group HMO |
$862.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.41
|
| Rate for Payer: PHCS Commercial |
$1,103.72
|
| Rate for Payer: United Healthcare All Payer |
$1,011.74
|
|
|
PLATE SEMI-TUBULAR 5X87MM
|
Facility
|
IP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE SEMI-TUBULAR 5X87MM
|
Facility
|
OP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem Medicaid |
$398.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Humana KY Medicaid |
$398.42
|
| Rate for Payer: Kentucky WC Medicaid |
$402.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE SEMI-TUBULAR 6X103MM
|
Facility
|
IP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE SEMI-TUBULAR 6X103MM
|
Facility
|
OP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem Medicaid |
$521.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Humana KY Medicaid |
$521.17
|
| Rate for Payer: Kentucky WC Medicaid |
$526.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE SEMI-TUBULAR 7X119MM
|
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-TUBULAR 7X119MM
|
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-TUBULAR 8X135MM
|
Facility
|
OP
|
$1,723.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,654.18 |
| Rate for Payer: Aetna Commercial |
$1,326.79
|
| Rate for Payer: Anthem Medicaid |
$592.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Cash Price |
$861.55
|
| Rate for Payer: Cigna Commercial |
$1,430.17
|
| Rate for Payer: First Health Commercial |
$1,636.94
|
| Rate for Payer: Humana Commercial |
$1,464.64
|
| Rate for Payer: Humana KY Medicaid |
$592.57
|
| Rate for Payer: Kentucky WC Medicaid |
$598.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.16
|
| Rate for Payer: PHCS Commercial |
$1,654.18
|
| Rate for Payer: United Healthcare All Payer |
$1,516.33
|
|
|
PLATE SEMI-TUBULAR 8X135MM
|
Facility
|
IP
|
$1,723.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,654.18 |
| Rate for Payer: Aetna Commercial |
$1,326.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Cash Price |
$861.55
|
| Rate for Payer: Cigna Commercial |
$1,430.17
|
| Rate for Payer: First Health Commercial |
$1,636.94
|
| Rate for Payer: Humana Commercial |
$1,464.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.16
|
| Rate for Payer: PHCS Commercial |
$1,654.18
|
| Rate for Payer: United Healthcare All Payer |
$1,516.33
|
|
|
PLATE SEMI-TUBULAR 9X151MM
|
Facility
|
OP
|
$1,580.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.41 |
| Max. Negotiated Rate |
$1,516.85 |
| Rate for Payer: Aetna Commercial |
$1,216.64
|
| Rate for Payer: Anthem Medicaid |
$543.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.44
|
| Rate for Payer: Cash Price |
$790.02
|
| Rate for Payer: Cigna Commercial |
$1,311.44
|
| Rate for Payer: First Health Commercial |
$1,501.05
|
| Rate for Payer: Humana Commercial |
$1,343.04
|
| Rate for Payer: Humana KY Medicaid |
$543.38
|
| Rate for Payer: Kentucky WC Medicaid |
$548.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.82
|
| Rate for Payer: PHCS Commercial |
$1,516.85
|
| Rate for Payer: United Healthcare All Payer |
$1,390.44
|
|
|
PLATE SEMI-TUBULAR 9X151MM
|
Facility
|
IP
|
$1,580.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.41 |
| Max. Negotiated Rate |
$1,516.85 |
| Rate for Payer: Aetna Commercial |
$1,216.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.44
|
| Rate for Payer: Cash Price |
$790.02
|
| Rate for Payer: Cigna Commercial |
$1,311.44
|
| Rate for Payer: First Health Commercial |
$1,501.05
|
| Rate for Payer: Humana Commercial |
$1,343.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.82
|
| Rate for Payer: PHCS Commercial |
$1,516.85
|
| Rate for Payer: United Healthcare All Payer |
$1,390.44
|
|
|
PLATE SH FUSION TMT 2.7MM
|
Facility
|
OP
|
$5,103.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$4,898.96 |
| Rate for Payer: Aetna Commercial |
$3,929.37
|
| Rate for Payer: Anthem Medicaid |
$1,754.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,980.40
|
| Rate for Payer: Cash Price |
$2,551.54
|
| Rate for Payer: Cigna Commercial |
$4,235.56
|
| Rate for Payer: First Health Commercial |
$4,847.93
|
| Rate for Payer: Humana Commercial |
$4,337.62
|
| Rate for Payer: Humana KY Medicaid |
$1,754.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,772.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,184.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,790.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,490.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,827.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.95
|
| Rate for Payer: PHCS Commercial |
$4,898.96
|
| Rate for Payer: United Healthcare All Payer |
$4,490.71
|
|
|
PLATE SH FUSION TMT 2.7MM
|
Facility
|
IP
|
$5,103.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$4,898.96 |
| Rate for Payer: Aetna Commercial |
$3,929.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,980.40
|
| Rate for Payer: Cash Price |
$2,551.54
|
| Rate for Payer: Cigna Commercial |
$4,235.56
|
| Rate for Payer: First Health Commercial |
$4,847.93
|
| Rate for Payer: Humana Commercial |
$4,337.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,184.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,490.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,827.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.95
|
| Rate for Payer: PHCS Commercial |
$4,898.96
|
| Rate for Payer: United Healthcare All Payer |
$4,490.71
|
|
|
PLATE SHORT CONN 10H 115MM
|
Facility
|
IP
|
$1,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.85 |
| Max. Negotiated Rate |
$1,867.20 |
| Rate for Payer: Aetna Commercial |
$1,497.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.10
|
| Rate for Payer: Cash Price |
$972.50
|
| Rate for Payer: Cigna Commercial |
$1,614.35
|
| Rate for Payer: First Health Commercial |
$1,847.75
|
| Rate for Payer: Humana Commercial |
$1,653.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,594.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,711.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,458.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.95
|
| Rate for Payer: PHCS Commercial |
$1,867.20
|
| Rate for Payer: United Healthcare All Payer |
$1,711.60
|
|
|
PLATE SHORT CONN 10H 115MM
|
Facility
|
OP
|
$1,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.85 |
| Max. Negotiated Rate |
$1,867.20 |
| Rate for Payer: Anthem Medicaid |
$668.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.10
|
| Rate for Payer: Cash Price |
$972.50
|
| Rate for Payer: Cigna Commercial |
$1,614.35
|
| Rate for Payer: First Health Commercial |
$1,847.75
|
| Rate for Payer: Humana Commercial |
$1,653.25
|
| Rate for Payer: Humana KY Medicaid |
$668.89
|
| Rate for Payer: Kentucky WC Medicaid |
$675.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,594.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,711.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,458.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.95
|
| Rate for Payer: PHCS Commercial |
$1,867.20
|
| Rate for Payer: United Healthcare All Payer |
$1,711.60
|
| Rate for Payer: Aetna Commercial |
$1,497.65
|
|
|
PLATE SHORT CONN 2H 35MM
|
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 SHORT CONN 2H 35MM
|
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: Aetna Commercial |
$1,205.05
|
| 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: 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 SHORT CONN 3H 45MM
|
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: Aetna Commercial |
$1,205.05
|
| 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: 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 SHORT CONN 3H 45MM
|
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 SHORT CONN 4H 55MM
|
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 SHORT CONN 4H 55MM
|
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: Aetna Commercial |
$1,205.05
|
| 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: 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 SHORT CONN 5H 65MM
|
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 SHORT CONN 5H 65MM
|
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: Aetna Commercial |
$1,205.05
|
| 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: 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 SHORT CONN 6H 75MM
|
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: Aetna Commercial |
$1,205.05
|
| 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: 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
|
|
