|
PLATE MTP FUSION SM LEFT
|
Facility
|
OP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem Medicaid |
$2,594.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Humana KY Medicaid |
$2,594.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,620.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION SM RIGHT
|
Facility
|
IP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION SM RIGHT
|
Facility
|
OP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem Medicaid |
$2,594.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Humana KY Medicaid |
$2,594.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,620.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION STD LEFT
|
Facility
|
OP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem Medicaid |
$2,594.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Humana KY Medicaid |
$2,594.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,620.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION STD LEFT
|
Facility
|
IP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION STD RIGHT
|
Facility
|
OP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem Medicaid |
$2,594.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Humana KY Medicaid |
$2,594.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,620.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION STD RIGHT
|
Facility
|
IP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP STAND 5 VALGUS 5 LT
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
PLATE MTP STAND 5 VALGUS 5 LT
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
PLATE MTP V2 5H L
|
Facility
|
IP
|
$9,615.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,884.75 |
| Max. Negotiated Rate |
$9,231.21 |
| Rate for Payer: Aetna Commercial |
$7,404.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,500.36
|
| Rate for Payer: Cash Price |
$4,807.92
|
| Rate for Payer: Cigna Commercial |
$7,981.15
|
| Rate for Payer: First Health Commercial |
$9,135.05
|
| Rate for Payer: Humana Commercial |
$8,173.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,884.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,096.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,884.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,461.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,692.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,365.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.93
|
| Rate for Payer: PHCS Commercial |
$9,231.21
|
| Rate for Payer: United Healthcare All Payer |
$8,461.94
|
|
|
PLATE MTP V2 5H L
|
Facility
|
OP
|
$9,615.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,884.75 |
| Max. Negotiated Rate |
$9,231.21 |
| Rate for Payer: Aetna Commercial |
$7,404.20
|
| Rate for Payer: Anthem Medicaid |
$3,306.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,500.36
|
| Rate for Payer: Cash Price |
$4,807.92
|
| Rate for Payer: Cigna Commercial |
$7,981.15
|
| Rate for Payer: First Health Commercial |
$9,135.05
|
| Rate for Payer: Humana Commercial |
$8,173.46
|
| Rate for Payer: Humana KY Medicaid |
$3,306.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,340.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,884.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,096.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,884.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,373.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,461.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,692.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,365.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.93
|
| Rate for Payer: PHCS Commercial |
$9,231.21
|
| Rate for Payer: United Healthcare All Payer |
$8,461.94
|
|
|
PLATE MTP VI T8 6H L
|
Facility
|
OP
|
$9,615.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,884.75 |
| Max. Negotiated Rate |
$9,231.21 |
| Rate for Payer: Aetna Commercial |
$7,404.20
|
| Rate for Payer: Anthem Medicaid |
$3,306.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,500.36
|
| Rate for Payer: Cash Price |
$4,807.92
|
| Rate for Payer: Cigna Commercial |
$7,981.15
|
| Rate for Payer: First Health Commercial |
$9,135.05
|
| Rate for Payer: Humana Commercial |
$8,173.46
|
| Rate for Payer: Humana KY Medicaid |
$3,306.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,340.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,884.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,096.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,884.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,373.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,461.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,692.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,365.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.93
|
| Rate for Payer: PHCS Commercial |
$9,231.21
|
| Rate for Payer: United Healthcare All Payer |
$8,461.94
|
|
|
PLATE MTP VI T8 6H L
|
Facility
|
IP
|
$9,615.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,884.75 |
| Max. Negotiated Rate |
$9,231.21 |
| Rate for Payer: Aetna Commercial |
$7,404.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,500.36
|
| Rate for Payer: Cash Price |
$4,807.92
|
| Rate for Payer: Cigna Commercial |
$7,981.15
|
| Rate for Payer: First Health Commercial |
$9,135.05
|
| Rate for Payer: Humana Commercial |
$8,173.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,884.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,096.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,884.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,461.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,692.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,365.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,634.93
|
| Rate for Payer: PHCS Commercial |
$9,231.21
|
| Rate for Payer: United Healthcare All Payer |
$8,461.94
|
|
|
PLATE MULTIFRAG 10 H 3.5MM
|
Facility
|
IP
|
$7,178.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,153.56 |
| Max. Negotiated Rate |
$6,891.38 |
| Rate for Payer: Aetna Commercial |
$5,527.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,599.25
|
| Rate for Payer: Cash Price |
$3,589.26
|
| Rate for Payer: Cigna Commercial |
$5,958.17
|
| Rate for Payer: First Health Commercial |
$6,819.59
|
| Rate for Payer: Humana Commercial |
$6,101.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,886.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,297.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,317.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,383.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,742.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,245.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,953.18
|
| Rate for Payer: PHCS Commercial |
$6,891.38
|
| Rate for Payer: United Healthcare All Payer |
$6,317.10
|
|
|
PLATE MULTIFRAG 10 H 3.5MM
|
Facility
|
OP
|
$7,178.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,153.56 |
| Max. Negotiated Rate |
$6,891.38 |
| Rate for Payer: Aetna Commercial |
$5,527.46
|
| Rate for Payer: Anthem Medicaid |
$2,468.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,599.25
|
| Rate for Payer: Cash Price |
$3,589.26
|
| Rate for Payer: Cigna Commercial |
$5,958.17
|
| Rate for Payer: First Health Commercial |
$6,819.59
|
| Rate for Payer: Humana Commercial |
$6,101.74
|
| Rate for Payer: Humana KY Medicaid |
$2,468.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,886.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,297.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,317.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,383.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,742.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,245.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,953.18
|
| Rate for Payer: PHCS Commercial |
$6,891.38
|
| Rate for Payer: United Healthcare All Payer |
$6,317.10
|
|
|
PLATE MULTIFRAG 14 H 3.5MM
|
Facility
|
IP
|
$7,991.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.30 |
| Max. Negotiated Rate |
$7,671.37 |
| Rate for Payer: Aetna Commercial |
$6,153.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.99
|
| Rate for Payer: Cash Price |
$3,995.50
|
| Rate for Payer: Cigna Commercial |
$6,632.54
|
| Rate for Payer: First Health Commercial |
$7,591.46
|
| Rate for Payer: Humana Commercial |
$6,792.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,552.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,897.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,032.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,993.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,952.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.80
|
| Rate for Payer: PHCS Commercial |
$7,671.37
|
| Rate for Payer: United Healthcare All Payer |
$7,032.09
|
|
|
PLATE MULTIFRAG 14 H 3.5MM
|
Facility
|
OP
|
$7,991.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.30 |
| Max. Negotiated Rate |
$7,671.37 |
| Rate for Payer: Aetna Commercial |
$6,153.08
|
| Rate for Payer: Anthem Medicaid |
$2,748.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.99
|
| Rate for Payer: Cash Price |
$3,995.50
|
| Rate for Payer: Cigna Commercial |
$6,632.54
|
| Rate for Payer: First Health Commercial |
$7,591.46
|
| Rate for Payer: Humana Commercial |
$6,792.36
|
| Rate for Payer: Humana KY Medicaid |
$2,748.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,776.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,552.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,897.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,803.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,032.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,993.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,952.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.80
|
| Rate for Payer: PHCS Commercial |
$7,671.37
|
| Rate for Payer: United Healthcare All Payer |
$7,032.09
|
|
|
PLATE MULTIFRAG 6 H 3.5MM
|
Facility
|
IP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE MULTIFRAG 6 H 3.5MM
|
Facility
|
OP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem Medicaid |
$1,757.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Humana KY Medicaid |
$1,757.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,775.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,792.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE MULTIFRAG H 4 3.5MM
|
Facility
|
OP
|
$4,961.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.41 |
| Max. Negotiated Rate |
$4,762.92 |
| Rate for Payer: Aetna Commercial |
$3,820.26
|
| Rate for Payer: Anthem Medicaid |
$1,706.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,869.88
|
| Rate for Payer: Cash Price |
$2,480.69
|
| Rate for Payer: Cigna Commercial |
$4,117.95
|
| Rate for Payer: First Health Commercial |
$4,713.31
|
| Rate for Payer: Humana Commercial |
$4,217.17
|
| Rate for Payer: Humana KY Medicaid |
$1,706.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,723.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,068.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,661.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,740.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,969.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,316.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,423.35
|
| Rate for Payer: PHCS Commercial |
$4,762.92
|
| Rate for Payer: United Healthcare All Payer |
$4,366.01
|
|
|
PLATE MULTIFRAG H 4 3.5MM
|
Facility
|
IP
|
$4,961.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.41 |
| Max. Negotiated Rate |
$4,762.92 |
| Rate for Payer: Aetna Commercial |
$3,820.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,869.88
|
| Rate for Payer: Cash Price |
$2,480.69
|
| Rate for Payer: Cigna Commercial |
$4,117.95
|
| Rate for Payer: First Health Commercial |
$4,713.31
|
| Rate for Payer: Humana Commercial |
$4,217.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,068.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,661.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,969.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,316.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,423.35
|
| Rate for Payer: PHCS Commercial |
$4,762.92
|
| Rate for Payer: United Healthcare All Payer |
$4,366.01
|
|
|
PLATE MULTI FRAGMENT
|
Facility
|
IP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE MULTI FRAGMENT
|
Facility
|
OP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem Medicaid |
$415.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Humana KY Medicaid |
$415.69
|
| Rate for Payer: Kentucky WC Medicaid |
$419.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$424.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE NARROW 4.5*106 5H
|
Facility
|
OP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem Medicaid |
$625.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Humana KY Medicaid |
$625.97
|
| Rate for Payer: Kentucky WC Medicaid |
$632.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE NARROW 4.5*106 5H
|
Facility
|
IP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
