|
PLATE SHORT CONN 6H 75MM
|
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 7H 85MM
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem Medicaid |
$635.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Humana KY Medicaid |
$635.18
|
| Rate for Payer: Kentucky WC Medicaid |
$641.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE SHORT CONN 7H 85MM
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE SHORT CONN 8H 95MM
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
|
|
PLATE SHORT CONN 8H 95MM
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem Medicaid |
$635.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Humana KY Medicaid |
$635.18
|
| Rate for Payer: Kentucky WC Medicaid |
$641.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE SHORT CONN 9H 105MM
|
Facility
|
IP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE SHORT CONN 9H 105MM
|
Facility
|
OP
|
$1,847.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,773.12 |
| Rate for Payer: Aetna Commercial |
$1,422.19
|
| Rate for Payer: Anthem Medicaid |
$635.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,440.66
|
| Rate for Payer: Cash Price |
$923.50
|
| Rate for Payer: Cigna Commercial |
$1,533.01
|
| Rate for Payer: First Health Commercial |
$1,754.65
|
| Rate for Payer: Humana Commercial |
$1,569.95
|
| Rate for Payer: Humana KY Medicaid |
$635.18
|
| Rate for Payer: Kentucky WC Medicaid |
$641.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,514.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,625.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,385.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.57
|
| Rate for Payer: PHCS Commercial |
$1,773.12
|
| Rate for Payer: United Healthcare All Payer |
$1,625.36
|
|
|
PLATE SM 3.5MM 14X169MM
|
Facility
|
OP
|
$3,541.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$3,400.05 |
| Rate for Payer: Aetna Commercial |
$2,727.12
|
| Rate for Payer: Anthem Medicaid |
$1,218.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,762.54
|
| Rate for Payer: Cash Price |
$1,770.86
|
| Rate for Payer: Cigna Commercial |
$2,939.63
|
| Rate for Payer: First Health Commercial |
$3,364.63
|
| Rate for Payer: Humana Commercial |
$3,010.46
|
| Rate for Payer: Humana KY Medicaid |
$1,218.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,230.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,904.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,242.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,116.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,656.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.93
|
| Rate for Payer: PHCS Commercial |
$3,400.05
|
| Rate for Payer: United Healthcare All Payer |
$3,116.71
|
|
|
PLATE SM 3.5MM 14X169MM
|
Facility
|
IP
|
$3,541.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$3,400.05 |
| Rate for Payer: Aetna Commercial |
$2,727.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,762.54
|
| Rate for Payer: Cash Price |
$1,770.86
|
| Rate for Payer: Cigna Commercial |
$2,939.63
|
| Rate for Payer: First Health Commercial |
$3,364.63
|
| Rate for Payer: Humana Commercial |
$3,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,904.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,116.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,656.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.93
|
| Rate for Payer: PHCS Commercial |
$3,400.05
|
| Rate for Payer: United Healthcare All Payer |
$3,116.71
|
|
|
PLATE SM 3.5MM 16X194MM
|
Facility
|
IP
|
$3,742.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.54 |
| Max. Negotiated Rate |
$3,592.92 |
| Rate for Payer: Aetna Commercial |
$2,881.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.24
|
| Rate for Payer: Cash Price |
$1,871.31
|
| Rate for Payer: Cigna Commercial |
$3,106.37
|
| Rate for Payer: First Health Commercial |
$3,555.49
|
| Rate for Payer: Humana Commercial |
$3,181.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,068.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,293.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,806.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.21
|
| Rate for Payer: PHCS Commercial |
$3,592.92
|
| Rate for Payer: United Healthcare All Payer |
$3,293.51
|
|
|
PLATE SM 3.5MM 16X194MM
|
Facility
|
OP
|
$3,742.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.54 |
| Max. Negotiated Rate |
$3,592.92 |
| Rate for Payer: Aetna Commercial |
$2,881.82
|
| Rate for Payer: Anthem Medicaid |
$1,287.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.24
|
| Rate for Payer: Cash Price |
$1,871.31
|
| Rate for Payer: Cigna Commercial |
$3,106.37
|
| Rate for Payer: First Health Commercial |
$3,555.49
|
| Rate for Payer: Humana Commercial |
$3,181.23
|
| Rate for Payer: Humana KY Medicaid |
$1,287.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,300.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,068.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,312.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,293.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,806.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.21
|
| Rate for Payer: PHCS Commercial |
$3,592.92
|
| Rate for Payer: United Healthcare All Payer |
$3,293.51
|
|
|
PLATE SM 3.5MM 18X217MM
|
Facility
|
OP
|
$4,280.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$4,109.52 |
| Rate for Payer: Humana Commercial |
$3,638.64
|
| Rate for Payer: Humana KY Medicaid |
$1,472.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,510.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,159.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,501.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,767.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,210.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.03
|
| Rate for Payer: PHCS Commercial |
$4,109.52
|
| Rate for Payer: United Healthcare All Payer |
$3,767.06
|
| Rate for Payer: Aetna Commercial |
$3,296.18
|
| Rate for Payer: Anthem Medicaid |
$1,472.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,338.98
|
| Rate for Payer: Cash Price |
$2,140.38
|
| Rate for Payer: Cigna Commercial |
$3,553.02
|
| Rate for Payer: First Health Commercial |
$4,066.71
|
|
|
PLATE SM 3.5MM 18X217MM
|
Facility
|
IP
|
$4,280.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$4,109.52 |
| Rate for Payer: Aetna Commercial |
$3,296.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,338.98
|
| Rate for Payer: Cash Price |
$2,140.38
|
| Rate for Payer: Cigna Commercial |
$3,553.02
|
| Rate for Payer: First Health Commercial |
$4,066.71
|
| Rate for Payer: Humana Commercial |
$3,638.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,510.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,159.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,767.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,210.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.03
|
| Rate for Payer: PHCS Commercial |
$4,109.52
|
| Rate for Payer: United Healthcare All Payer |
$3,767.06
|
|
|
PLATE SM 3.5MM 20X242MM
|
Facility
|
OP
|
$4,115.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.04 |
| Max. Negotiated Rate |
$3,951.10 |
| Rate for Payer: Aetna Commercial |
$3,169.11
|
| Rate for Payer: Anthem Medicaid |
$1,415.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,210.27
|
| Rate for Payer: Cash Price |
$2,057.86
|
| Rate for Payer: Cigna Commercial |
$3,416.06
|
| Rate for Payer: First Health Commercial |
$3,909.94
|
| Rate for Payer: Humana Commercial |
$3,498.37
|
| Rate for Payer: Humana KY Medicaid |
$1,415.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,429.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,037.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,443.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.88
|
| Rate for Payer: PHCS Commercial |
$3,951.10
|
| Rate for Payer: United Healthcare All Payer |
$3,621.84
|
|
|
PLATE SM 3.5MM 20X242MM
|
Facility
|
IP
|
$4,115.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.04 |
| Max. Negotiated Rate |
$3,951.10 |
| Rate for Payer: Aetna Commercial |
$3,169.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,210.27
|
| Rate for Payer: Cash Price |
$2,057.86
|
| Rate for Payer: Cigna Commercial |
$3,416.06
|
| Rate for Payer: First Health Commercial |
$3,909.94
|
| Rate for Payer: Humana Commercial |
$3,498.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,374.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,037.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,234.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,621.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,086.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$823.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$535.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.88
|
| Rate for Payer: PHCS Commercial |
$3,951.10
|
| Rate for Payer: United Healthcare All Payer |
$3,621.84
|
|
|
PLATE SM 3.5MM 22X265MM
|
Facility
|
IP
|
$4,761.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.99 |
| Max. Negotiated Rate |
$4,571.02 |
| Rate for Payer: Aetna Commercial |
$3,666.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,713.95
|
| Rate for Payer: Cash Price |
$2,380.74
|
| Rate for Payer: Cigna Commercial |
$3,952.03
|
| Rate for Payer: First Health Commercial |
$4,523.41
|
| Rate for Payer: Humana Commercial |
$4,047.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,904.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,513.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,190.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,571.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.06
|
| Rate for Payer: PHCS Commercial |
$4,571.02
|
| Rate for Payer: United Healthcare All Payer |
$4,190.10
|
|
|
PLATE SM 3.5MM 22X265MM
|
Facility
|
OP
|
$4,761.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.99 |
| Max. Negotiated Rate |
$4,571.02 |
| Rate for Payer: Aetna Commercial |
$3,666.34
|
| Rate for Payer: Anthem Medicaid |
$1,637.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,713.95
|
| Rate for Payer: Cash Price |
$2,380.74
|
| Rate for Payer: Cigna Commercial |
$3,952.03
|
| Rate for Payer: First Health Commercial |
$4,523.41
|
| Rate for Payer: Humana Commercial |
$4,047.26
|
| Rate for Payer: Humana KY Medicaid |
$1,637.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,654.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,904.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,513.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,670.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,190.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,571.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.06
|
| Rate for Payer: PHCS Commercial |
$4,571.02
|
| Rate for Payer: United Healthcare All Payer |
$4,190.10
|
|
|
PLATE SMALL CANCANEAL
|
Facility
|
OP
|
$3,688.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.49 |
| Max. Negotiated Rate |
$3,540.84 |
| Rate for Payer: Aetna Commercial |
$2,840.05
|
| Rate for Payer: Anthem Medicaid |
$1,268.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.94
|
| Rate for Payer: Cash Price |
$1,844.19
|
| Rate for Payer: Cigna Commercial |
$3,061.36
|
| Rate for Payer: First Health Commercial |
$3,503.96
|
| Rate for Payer: Humana Commercial |
$3,135.12
|
| Rate for Payer: Humana KY Medicaid |
$1,268.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.40
|
| Rate for Payer: PHCS Commercial |
$3,540.84
|
| Rate for Payer: United Healthcare All Payer |
$3,245.77
|
|
|
PLATE SMALL CANCANEAL
|
Facility
|
IP
|
$3,688.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.49 |
| Max. Negotiated Rate |
$3,540.84 |
| Rate for Payer: Aetna Commercial |
$2,840.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.94
|
| Rate for Payer: Cash Price |
$1,844.19
|
| Rate for Payer: Cigna Commercial |
$3,061.36
|
| Rate for Payer: First Health Commercial |
$3,503.96
|
| Rate for Payer: Humana Commercial |
$3,135.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,024.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,722.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,766.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$737.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$479.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,143.40
|
| Rate for Payer: PHCS Commercial |
$3,540.84
|
| Rate for Payer: United Healthcare All Payer |
$3,245.77
|
|
|
PLATE SMARTLOCK HYBRID MMF
|
Facility
|
IP
|
$3,280.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.48 |
| Max. Negotiated Rate |
$3,149.40 |
| Rate for Payer: Aetna Commercial |
$2,526.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.88
|
| Rate for Payer: Cash Price |
$1,640.31
|
| Rate for Payer: Cigna Commercial |
$2,722.91
|
| Rate for Payer: First Health Commercial |
$3,116.59
|
| Rate for Payer: Humana Commercial |
$2,788.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,690.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,421.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,016.99
|
| Rate for Payer: PHCS Commercial |
$3,149.40
|
| Rate for Payer: United Healthcare All Payer |
$2,886.95
|
|
|
PLATE SMARTLOCK HYBRID MMF
|
Facility
|
OP
|
$3,280.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.48 |
| Max. Negotiated Rate |
$3,149.40 |
| Rate for Payer: Aetna Commercial |
$2,526.08
|
| Rate for Payer: Anthem Medicaid |
$1,128.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,558.88
|
| Rate for Payer: Cash Price |
$1,640.31
|
| Rate for Payer: Cigna Commercial |
$2,722.91
|
| Rate for Payer: First Health Commercial |
$3,116.59
|
| Rate for Payer: Humana Commercial |
$2,788.53
|
| Rate for Payer: Humana KY Medicaid |
$1,128.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,139.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,690.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,421.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$984.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,150.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,886.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,460.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,016.99
|
| Rate for Payer: PHCS Commercial |
$3,149.40
|
| Rate for Payer: United Healthcare All Payer |
$2,886.95
|
|
|
PLATE SMARTLOCK HYBRID MMF SM
|
Facility
|
OP
|
$3,372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.42 |
| Max. Negotiated Rate |
$3,237.60 |
| Rate for Payer: Aetna Commercial |
$2,596.82
|
| Rate for Payer: Anthem Medicaid |
$1,159.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,630.55
|
| Rate for Payer: Cash Price |
$1,686.25
|
| Rate for Payer: Cigna Commercial |
$2,799.18
|
| Rate for Payer: First Health Commercial |
$3,203.88
|
| Rate for Payer: Humana Commercial |
$2,866.62
|
| Rate for Payer: Humana KY Medicaid |
$1,159.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,171.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,765.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,488.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,011.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,967.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,529.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.48
|
| Rate for Payer: PHCS Commercial |
$3,237.60
|
| Rate for Payer: United Healthcare All Payer |
$2,967.80
|
|
|
PLATE SMARTLOCK HYBRID MMF SM
|
Facility
|
IP
|
$3,372.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.42 |
| Max. Negotiated Rate |
$3,237.60 |
| Rate for Payer: Aetna Commercial |
$2,596.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,630.55
|
| Rate for Payer: Cash Price |
$1,686.25
|
| Rate for Payer: Cigna Commercial |
$2,799.18
|
| Rate for Payer: First Health Commercial |
$3,203.88
|
| Rate for Payer: Humana Commercial |
$2,866.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,765.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,488.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,011.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,967.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,529.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$674.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,045.48
|
| Rate for Payer: PHCS Commercial |
$3,237.60
|
| Rate for Payer: United Healthcare All Payer |
$2,967.80
|
|
|
PLATE SM CP 3.5MM 10X130MM
|
Facility
|
IP
|
$2,060.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,977.91 |
| Rate for Payer: Aetna Commercial |
$1,586.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.05
|
| Rate for Payer: Cash Price |
$1,030.16
|
| Rate for Payer: Cigna Commercial |
$1,710.07
|
| Rate for Payer: First Health Commercial |
$1,957.30
|
| Rate for Payer: Humana Commercial |
$1,751.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.70
|
| Rate for Payer: PHCS Commercial |
$1,977.91
|
| Rate for Payer: United Healthcare All Payer |
$1,813.08
|
|
|
PLATE SM CP 3.5MM 10X130MM
|
Facility
|
OP
|
$2,060.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,977.91 |
| Rate for Payer: Aetna Commercial |
$1,586.45
|
| Rate for Payer: Anthem Medicaid |
$708.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.05
|
| Rate for Payer: Cash Price |
$1,030.16
|
| Rate for Payer: Cigna Commercial |
$1,710.07
|
| Rate for Payer: First Health Commercial |
$1,957.30
|
| Rate for Payer: Humana Commercial |
$1,751.27
|
| Rate for Payer: Humana KY Medicaid |
$708.54
|
| Rate for Payer: Kentucky WC Medicaid |
$715.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.70
|
| Rate for Payer: PHCS Commercial |
$1,977.91
|
| Rate for Payer: United Healthcare All Payer |
$1,813.08
|
|
