|
PLATE LP TB LK 4.5M 16H 309M L
|
Facility
|
IP
|
$9,009.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.92 |
| Max. Negotiated Rate |
$8,649.34 |
| Rate for Payer: Aetna Commercial |
$6,937.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,027.59
|
| Rate for Payer: Cash Price |
$4,504.86
|
| Rate for Payer: Cigna Commercial |
$7,478.08
|
| Rate for Payer: First Health Commercial |
$8,559.24
|
| Rate for Payer: Humana Commercial |
$7,658.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,387.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,649.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,702.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,928.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,757.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,207.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,838.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,216.71
|
| Rate for Payer: PHCS Commercial |
$8,649.34
|
| Rate for Payer: United Healthcare All Payer |
$7,928.56
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M L
|
Facility
|
IP
|
$8,651.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.55 |
| Max. Negotiated Rate |
$8,305.77 |
| Rate for Payer: Aetna Commercial |
$6,661.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,748.44
|
| Rate for Payer: Cash Price |
$4,325.92
|
| Rate for Payer: Cigna Commercial |
$7,181.03
|
| Rate for Payer: First Health Commercial |
$8,219.25
|
| Rate for Payer: Humana Commercial |
$7,354.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,094.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,385.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,595.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,613.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,488.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,921.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,527.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,969.77
|
| Rate for Payer: PHCS Commercial |
$8,305.77
|
| Rate for Payer: United Healthcare All Payer |
$7,613.62
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M L
|
Facility
|
OP
|
$8,651.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.55 |
| Max. Negotiated Rate |
$8,305.77 |
| Rate for Payer: Aetna Commercial |
$6,661.92
|
| Rate for Payer: Anthem Medicaid |
$2,975.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,748.44
|
| Rate for Payer: Cash Price |
$4,325.92
|
| Rate for Payer: Cigna Commercial |
$7,181.03
|
| Rate for Payer: First Health Commercial |
$8,219.25
|
| Rate for Payer: Humana Commercial |
$7,354.06
|
| Rate for Payer: Humana KY Medicaid |
$2,975.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,005.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,094.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,385.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,595.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,035.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,613.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,488.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,921.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,527.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,969.77
|
| Rate for Payer: PHCS Commercial |
$8,305.77
|
| Rate for Payer: United Healthcare All Payer |
$7,613.62
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M R
|
Facility
|
IP
|
$8,651.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.55 |
| Max. Negotiated Rate |
$8,305.77 |
| Rate for Payer: Aetna Commercial |
$6,661.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,748.44
|
| Rate for Payer: Cash Price |
$4,325.92
|
| Rate for Payer: Cigna Commercial |
$7,181.03
|
| Rate for Payer: First Health Commercial |
$8,219.25
|
| Rate for Payer: Humana Commercial |
$7,354.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,094.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,385.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,595.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,613.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,488.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,921.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,527.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,969.77
|
| Rate for Payer: PHCS Commercial |
$8,305.77
|
| Rate for Payer: United Healthcare All Payer |
$7,613.62
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M R
|
Facility
|
OP
|
$8,651.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.55 |
| Max. Negotiated Rate |
$8,305.77 |
| Rate for Payer: Aetna Commercial |
$6,661.92
|
| Rate for Payer: Anthem Medicaid |
$2,975.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,748.44
|
| Rate for Payer: Cash Price |
$4,325.92
|
| Rate for Payer: Cigna Commercial |
$7,181.03
|
| Rate for Payer: First Health Commercial |
$8,219.25
|
| Rate for Payer: Humana Commercial |
$7,354.06
|
| Rate for Payer: Humana KY Medicaid |
$2,975.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,005.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,094.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,385.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,595.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,035.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,613.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,488.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,921.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,527.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,969.77
|
| Rate for Payer: PHCS Commercial |
$8,305.77
|
| Rate for Payer: United Healthcare All Payer |
$7,613.62
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M L
|
Facility
|
OP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem Medicaid |
$3,000.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Humana KY Medicaid |
$3,000.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,031.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,061.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M L
|
Facility
|
IP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M R
|
Facility
|
IP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M R
|
Facility
|
OP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem Medicaid |
$3,000.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Humana KY Medicaid |
$3,000.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,031.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,061.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE LP TIB LK 3.5M 8H 123M R
|
Facility
|
IP
|
$8,786.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.07 |
| Max. Negotiated Rate |
$8,435.41 |
| Rate for Payer: Aetna Commercial |
$6,765.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.77
|
| Rate for Payer: Cash Price |
$4,393.45
|
| Rate for Payer: Cigna Commercial |
$7,293.12
|
| Rate for Payer: First Health Commercial |
$8,347.55
|
| Rate for Payer: Humana Commercial |
$7,468.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,205.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,732.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,590.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,029.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,644.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,062.95
|
| Rate for Payer: PHCS Commercial |
$8,435.41
|
| Rate for Payer: United Healthcare All Payer |
$7,732.46
|
|
|
PLATE LP TIB LK 3.5M 8H 123M R
|
Facility
|
OP
|
$8,786.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.07 |
| Max. Negotiated Rate |
$8,435.41 |
| Rate for Payer: Aetna Commercial |
$6,765.91
|
| Rate for Payer: Anthem Medicaid |
$3,021.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.77
|
| Rate for Payer: Cash Price |
$4,393.45
|
| Rate for Payer: Cigna Commercial |
$7,293.12
|
| Rate for Payer: First Health Commercial |
$8,347.55
|
| Rate for Payer: Humana Commercial |
$7,468.86
|
| Rate for Payer: Humana KY Medicaid |
$3,021.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,205.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,732.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,590.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,029.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,644.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,062.95
|
| Rate for Payer: PHCS Commercial |
$8,435.41
|
| Rate for Payer: United Healthcare All Payer |
$7,732.46
|
|
|
PLATE LP TIB LK 4.5M 4H 94M L
|
Facility
|
IP
|
$7,814.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.36 |
| Max. Negotiated Rate |
$7,501.95 |
| Rate for Payer: Aetna Commercial |
$6,017.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,095.33
|
| Rate for Payer: Cash Price |
$3,907.27
|
| Rate for Payer: Cigna Commercial |
$6,486.06
|
| Rate for Payer: First Health Commercial |
$7,423.80
|
| Rate for Payer: Humana Commercial |
$6,642.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,407.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,767.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,344.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,876.79
|
| Rate for Payer: Ohio Health Group HMO |
$5,860.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,251.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,798.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,392.03
|
| Rate for Payer: PHCS Commercial |
$7,501.95
|
| Rate for Payer: United Healthcare All Payer |
$6,876.79
|
|
|
PLATE LP TIB LK 4.5M 4H 94M L
|
Facility
|
OP
|
$7,814.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,344.36 |
| Max. Negotiated Rate |
$7,501.95 |
| Rate for Payer: Aetna Commercial |
$6,017.19
|
| Rate for Payer: Anthem Medicaid |
$2,687.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,095.33
|
| Rate for Payer: Cash Price |
$3,907.27
|
| Rate for Payer: Cigna Commercial |
$6,486.06
|
| Rate for Payer: First Health Commercial |
$7,423.80
|
| Rate for Payer: Humana Commercial |
$6,642.35
|
| Rate for Payer: Humana KY Medicaid |
$2,687.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,714.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,407.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,767.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,344.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,741.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,876.79
|
| Rate for Payer: Ohio Health Group HMO |
$5,860.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,251.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,798.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,392.03
|
| Rate for Payer: PHCS Commercial |
$7,501.95
|
| Rate for Payer: United Healthcare All Payer |
$6,876.79
|
|
|
PLATE LP TIB LK 4.5M 6H 130M L
|
Facility
|
IP
|
$7,922.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.77 |
| Max. Negotiated Rate |
$7,605.67 |
| Rate for Payer: Aetna Commercial |
$6,100.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,179.60
|
| Rate for Payer: Cash Price |
$3,961.29
|
| Rate for Payer: Cigna Commercial |
$6,575.73
|
| Rate for Payer: First Health Commercial |
$7,526.44
|
| Rate for Payer: Humana Commercial |
$6,734.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,496.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,846.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,376.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,971.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,941.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,338.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,892.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,466.57
|
| Rate for Payer: PHCS Commercial |
$7,605.67
|
| Rate for Payer: United Healthcare All Payer |
$6,971.86
|
|
|
PLATE LP TIB LK 4.5M 6H 130M L
|
Facility
|
OP
|
$7,922.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.77 |
| Max. Negotiated Rate |
$7,605.67 |
| Rate for Payer: Aetna Commercial |
$6,100.38
|
| Rate for Payer: Anthem Medicaid |
$2,724.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,179.60
|
| Rate for Payer: Cash Price |
$3,961.29
|
| Rate for Payer: Cigna Commercial |
$6,575.73
|
| Rate for Payer: First Health Commercial |
$7,526.44
|
| Rate for Payer: Humana Commercial |
$6,734.18
|
| Rate for Payer: Humana KY Medicaid |
$2,724.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,752.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,496.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,846.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,376.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,779.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,971.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,941.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,338.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,892.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,466.57
|
| Rate for Payer: PHCS Commercial |
$7,605.67
|
| Rate for Payer: United Healthcare All Payer |
$6,971.86
|
|
|
PLATE LP TIB LK 4.5M 8H 130M L
|
Facility
|
IP
|
$7,922.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.77 |
| Max. Negotiated Rate |
$7,605.67 |
| Rate for Payer: Aetna Commercial |
$6,100.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,179.60
|
| Rate for Payer: Cash Price |
$3,961.29
|
| Rate for Payer: Cigna Commercial |
$6,575.73
|
| Rate for Payer: First Health Commercial |
$7,526.44
|
| Rate for Payer: Humana Commercial |
$6,734.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,496.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,846.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,376.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,971.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,941.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,338.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,892.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,466.57
|
| Rate for Payer: PHCS Commercial |
$7,605.67
|
| Rate for Payer: United Healthcare All Payer |
$6,971.86
|
|
|
PLATE LP TIB LK 4.5M 8H 130M L
|
Facility
|
OP
|
$7,922.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.77 |
| Max. Negotiated Rate |
$7,605.67 |
| Rate for Payer: Aetna Commercial |
$6,100.38
|
| Rate for Payer: Anthem Medicaid |
$2,724.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,179.60
|
| Rate for Payer: Cash Price |
$3,961.29
|
| Rate for Payer: Cigna Commercial |
$6,575.73
|
| Rate for Payer: First Health Commercial |
$7,526.44
|
| Rate for Payer: Humana Commercial |
$6,734.18
|
| Rate for Payer: Humana KY Medicaid |
$2,724.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,752.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,496.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,846.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,376.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,779.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,971.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,941.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,338.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,892.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,466.57
|
| Rate for Payer: PHCS Commercial |
$7,605.67
|
| Rate for Payer: United Healthcare All Payer |
$6,971.86
|
|
|
PLATE L RT 2.7MM
|
Facility
|
OP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem Medicaid |
$398.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Humana KY Medicaid |
$398.06
|
| Rate for Payer: Kentucky WC Medicaid |
$402.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE L RT 2.7MM
|
Facility
|
IP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE L TI BUTTRESS 4H 86MM LT
|
Facility
|
IP
|
$3,521.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.41 |
| Max. Negotiated Rate |
$3,380.52 |
| Rate for Payer: Aetna Commercial |
$2,711.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.68
|
| Rate for Payer: Cash Price |
$1,760.69
|
| Rate for Payer: Cigna Commercial |
$2,922.75
|
| Rate for Payer: First Health Commercial |
$3,345.31
|
| Rate for Payer: Humana Commercial |
$2,993.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,887.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,641.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,817.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,063.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.75
|
| Rate for Payer: PHCS Commercial |
$3,380.52
|
| Rate for Payer: United Healthcare All Payer |
$3,098.81
|
|
|
PLATE L TI BUTTRESS 4H 86MM LT
|
Facility
|
OP
|
$3,521.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,056.41 |
| Max. Negotiated Rate |
$3,380.52 |
| Rate for Payer: Aetna Commercial |
$2,711.46
|
| Rate for Payer: Anthem Medicaid |
$1,211.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,746.68
|
| Rate for Payer: Cash Price |
$1,760.69
|
| Rate for Payer: Cigna Commercial |
$2,922.75
|
| Rate for Payer: First Health Commercial |
$3,345.31
|
| Rate for Payer: Humana Commercial |
$2,993.17
|
| Rate for Payer: Humana KY Medicaid |
$1,211.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,223.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,887.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,598.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,235.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,098.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,641.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,817.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,063.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,429.75
|
| Rate for Payer: PHCS Commercial |
$3,380.52
|
| Rate for Payer: United Healthcare All Payer |
$3,098.81
|
|
|
PLATE L TI BUTTRESS 4 H 86MM R
|
Facility
|
OP
|
$10,113.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,034.00 |
| Max. Negotiated Rate |
$9,708.81 |
| Rate for Payer: Aetna Commercial |
$7,787.27
|
| Rate for Payer: Anthem Medicaid |
$3,477.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,888.41
|
| Rate for Payer: Cash Price |
$5,056.67
|
| Rate for Payer: Cigna Commercial |
$8,394.07
|
| Rate for Payer: First Health Commercial |
$9,607.67
|
| Rate for Payer: Humana Commercial |
$8,596.34
|
| Rate for Payer: Humana KY Medicaid |
$3,477.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,513.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,292.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,463.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,034.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,547.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,899.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,585.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,090.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,798.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,978.20
|
| Rate for Payer: PHCS Commercial |
$9,708.81
|
| Rate for Payer: United Healthcare All Payer |
$8,899.74
|
|
|
PLATE L TI BUTTRESS 4 H 86MM R
|
Facility
|
IP
|
$10,113.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,034.00 |
| Max. Negotiated Rate |
$9,708.81 |
| Rate for Payer: Aetna Commercial |
$7,787.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,888.41
|
| Rate for Payer: Cash Price |
$5,056.67
|
| Rate for Payer: Cigna Commercial |
$8,394.07
|
| Rate for Payer: First Health Commercial |
$9,607.67
|
| Rate for Payer: Humana Commercial |
$8,596.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,292.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,463.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,034.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,899.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,585.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,090.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,798.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,978.20
|
| Rate for Payer: PHCS Commercial |
$9,708.81
|
| Rate for Payer: United Healthcare All Payer |
$8,899.74
|
|
|
PLATE MALLEOLAR 3 HOLE
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MALLEOLAR 3 HOLE
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
