|
PLATE T 3H HD 7H SHFT 3.5*96OL
|
Facility
|
IP
|
$3,349.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.37 |
| Max. Negotiated Rate |
$3,215.05 |
| Rate for Payer: Aetna Commercial |
$2,578.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,612.23
|
| Rate for Payer: Cash Price |
$1,674.51
|
| Rate for Payer: Cigna Commercial |
$2,779.68
|
| Rate for Payer: First Health Commercial |
$3,181.56
|
| Rate for Payer: Humana Commercial |
$2,846.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,746.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,471.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,947.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.19
|
| Rate for Payer: PHCS Commercial |
$3,215.05
|
| Rate for Payer: United Healthcare All Payer |
$2,947.13
|
|
|
PLATE T 3H HD 7H SHT 3.5*96 OR
|
Facility
|
IP
|
$3,349.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.37 |
| Max. Negotiated Rate |
$3,215.05 |
| Rate for Payer: Aetna Commercial |
$2,578.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,612.23
|
| Rate for Payer: Cash Price |
$1,674.51
|
| Rate for Payer: Cigna Commercial |
$2,779.68
|
| Rate for Payer: First Health Commercial |
$3,181.56
|
| Rate for Payer: Humana Commercial |
$2,846.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,746.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,471.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,947.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.19
|
| Rate for Payer: PHCS Commercial |
$3,215.05
|
| Rate for Payer: United Healthcare All Payer |
$2,947.13
|
|
|
PLATE T 3H HD 7H SHT 3.5*96 OR
|
Facility
|
OP
|
$3,349.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.37 |
| Max. Negotiated Rate |
$3,215.05 |
| Rate for Payer: Aetna Commercial |
$2,578.74
|
| Rate for Payer: Anthem Medicaid |
$1,151.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,612.23
|
| Rate for Payer: Cash Price |
$1,674.51
|
| Rate for Payer: Cigna Commercial |
$2,779.68
|
| Rate for Payer: First Health Commercial |
$3,181.56
|
| Rate for Payer: Humana Commercial |
$2,846.66
|
| Rate for Payer: Humana KY Medicaid |
$1,151.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,746.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,471.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,947.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.19
|
| Rate for Payer: PHCS Commercial |
$3,215.05
|
| Rate for Payer: United Healthcare All Payer |
$2,947.13
|
|
|
PLATE T 3H HED/SHFT 3.5*52 OR
|
Facility
|
IP
|
$3,166.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.68 |
| Max. Negotiated Rate |
$3,040.07 |
| Rate for Payer: Aetna Commercial |
$2,438.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.06
|
| Rate for Payer: Cash Price |
$1,583.37
|
| Rate for Payer: Cigna Commercial |
$2,628.39
|
| Rate for Payer: First Health Commercial |
$3,008.40
|
| Rate for Payer: Humana Commercial |
$2,691.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.69
|
| Rate for Payer: PHCS Commercial |
$3,040.07
|
| Rate for Payer: United Healthcare All Payer |
$2,786.73
|
|
|
PLATE T 3H HED/SHFT 3.5*52 OR
|
Facility
|
OP
|
$3,166.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.68 |
| Max. Negotiated Rate |
$3,040.07 |
| Rate for Payer: Humana Commercial |
$2,691.73
|
| Rate for Payer: Humana KY Medicaid |
$1,089.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.69
|
| Rate for Payer: PHCS Commercial |
$3,040.07
|
| Rate for Payer: United Healthcare All Payer |
$2,786.73
|
| Rate for Payer: Aetna Commercial |
$2,438.39
|
| Rate for Payer: Anthem Medicaid |
$1,089.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.06
|
| Rate for Payer: Cash Price |
$1,583.37
|
| Rate for Payer: Cigna Commercial |
$2,628.39
|
| Rate for Payer: First Health Commercial |
$3,008.40
|
|
|
PLATE T 3 HOLE 68MM
|
Facility
|
OP
|
$3,403.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$3,267.67 |
| Rate for Payer: Aetna Commercial |
$2,620.94
|
| Rate for Payer: Anthem Medicaid |
$1,170.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,654.98
|
| Rate for Payer: Cash Price |
$1,701.91
|
| Rate for Payer: Cigna Commercial |
$2,825.17
|
| Rate for Payer: First Health Commercial |
$3,233.63
|
| Rate for Payer: Humana Commercial |
$2,893.25
|
| Rate for Payer: Humana KY Medicaid |
$1,170.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,552.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.18
|
| Rate for Payer: PHCS Commercial |
$3,267.67
|
| Rate for Payer: United Healthcare All Payer |
$2,995.36
|
|
|
PLATE T 3 HOLE 68MM
|
Facility
|
IP
|
$3,403.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.50 |
| Max. Negotiated Rate |
$3,267.67 |
| Rate for Payer: Aetna Commercial |
$2,620.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,654.98
|
| Rate for Payer: Cash Price |
$1,701.91
|
| Rate for Payer: Cigna Commercial |
$2,825.17
|
| Rate for Payer: First Health Commercial |
$3,233.63
|
| Rate for Payer: Humana Commercial |
$2,893.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,552.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.18
|
| Rate for Payer: PHCS Commercial |
$3,267.67
|
| Rate for Payer: United Healthcare All Payer |
$2,995.36
|
|
|
PLATE T 4.5 LCP 4H 83MM
|
Facility
|
OP
|
$4,394.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.24 |
| Max. Negotiated Rate |
$4,218.38 |
| Rate for Payer: Aetna Commercial |
$3,383.50
|
| Rate for Payer: Anthem Medicaid |
$1,511.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,427.44
|
| Rate for Payer: Cash Price |
$2,197.07
|
| Rate for Payer: Cigna Commercial |
$3,647.14
|
| Rate for Payer: First Health Commercial |
$4,174.44
|
| Rate for Payer: Humana Commercial |
$3,735.03
|
| Rate for Payer: Humana KY Medicaid |
$1,511.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,526.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,603.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,242.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,318.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,541.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,866.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,295.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,362.19
|
| Rate for Payer: PHCS Commercial |
$4,218.38
|
| Rate for Payer: United Healthcare All Payer |
$3,866.85
|
|
|
PLATE T 4.5 LCP 4H 83MM
|
Facility
|
IP
|
$4,394.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$571.24 |
| Max. Negotiated Rate |
$4,218.38 |
| Rate for Payer: Aetna Commercial |
$3,383.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,427.44
|
| Rate for Payer: Cash Price |
$2,197.07
|
| Rate for Payer: Cigna Commercial |
$3,647.14
|
| Rate for Payer: First Health Commercial |
$4,174.44
|
| Rate for Payer: Humana Commercial |
$3,735.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,603.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,242.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,318.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,866.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,295.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$878.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$571.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,362.19
|
| Rate for Payer: PHCS Commercial |
$4,218.38
|
| Rate for Payer: United Healthcare All Payer |
$3,866.85
|
|
|
PLATE T 4.5 LCP 6H 115MM
|
Facility
|
IP
|
$4,613.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.75 |
| Max. Negotiated Rate |
$4,428.92 |
| Rate for Payer: Aetna Commercial |
$3,552.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,598.50
|
| Rate for Payer: Cash Price |
$2,306.73
|
| Rate for Payer: Cigna Commercial |
$3,829.17
|
| Rate for Payer: First Health Commercial |
$4,382.79
|
| Rate for Payer: Humana Commercial |
$3,921.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,404.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,059.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.17
|
| Rate for Payer: PHCS Commercial |
$4,428.92
|
| Rate for Payer: United Healthcare All Payer |
$4,059.84
|
|
|
PLATE T 4.5 LCP 6H 115MM
|
Facility
|
OP
|
$4,613.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.75 |
| Max. Negotiated Rate |
$4,428.92 |
| Rate for Payer: Aetna Commercial |
$3,552.36
|
| Rate for Payer: Anthem Medicaid |
$1,586.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,598.50
|
| Rate for Payer: Cash Price |
$2,306.73
|
| Rate for Payer: Cigna Commercial |
$3,829.17
|
| Rate for Payer: First Health Commercial |
$4,382.79
|
| Rate for Payer: Humana Commercial |
$3,921.44
|
| Rate for Payer: Humana KY Medicaid |
$1,586.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,602.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,783.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,404.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,618.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,059.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,460.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$922.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.17
|
| Rate for Payer: PHCS Commercial |
$4,428.92
|
| Rate for Payer: United Healthcare All Payer |
$4,059.84
|
|
|
PLATE T 4.5 LCP 8H 147MM
|
Facility
|
IP
|
$4,367.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.82 |
| Max. Negotiated Rate |
$4,193.12 |
| Rate for Payer: Aetna Commercial |
$3,363.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,406.91
|
| Rate for Payer: Cash Price |
$2,183.92
|
| Rate for Payer: Cigna Commercial |
$3,625.30
|
| Rate for Payer: First Health Commercial |
$4,149.44
|
| Rate for Payer: Humana Commercial |
$3,712.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,581.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,223.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,310.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,843.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,275.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$873.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.03
|
| Rate for Payer: PHCS Commercial |
$4,193.12
|
| Rate for Payer: United Healthcare All Payer |
$3,843.69
|
|
|
PLATE T 4.5 LCP 8H 147MM
|
Facility
|
OP
|
$4,367.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.82 |
| Max. Negotiated Rate |
$4,193.12 |
| Rate for Payer: Aetna Commercial |
$3,363.23
|
| Rate for Payer: Anthem Medicaid |
$1,502.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,406.91
|
| Rate for Payer: Cash Price |
$2,183.92
|
| Rate for Payer: Cigna Commercial |
$3,625.30
|
| Rate for Payer: First Health Commercial |
$4,149.44
|
| Rate for Payer: Humana Commercial |
$3,712.66
|
| Rate for Payer: Humana KY Medicaid |
$1,502.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,517.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,581.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,223.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,310.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,532.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,843.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,275.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$873.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$567.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.03
|
| Rate for Payer: PHCS Commercial |
$4,193.12
|
| Rate for Payer: United Healthcare All Payer |
$3,843.69
|
|
|
PLATE T 4H HD 4H SHFT 3.5*56R
|
Facility
|
OP
|
$3,308.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.08 |
| Max. Negotiated Rate |
$3,176.01 |
| Rate for Payer: Aetna Commercial |
$2,547.42
|
| Rate for Payer: Anthem Medicaid |
$1,137.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.51
|
| Rate for Payer: Cash Price |
$1,654.17
|
| Rate for Payer: Cigna Commercial |
$2,745.92
|
| Rate for Payer: First Health Commercial |
$3,142.92
|
| Rate for Payer: Humana Commercial |
$2,812.09
|
| Rate for Payer: Humana KY Medicaid |
$1,137.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,160.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.59
|
| Rate for Payer: PHCS Commercial |
$3,176.01
|
| Rate for Payer: United Healthcare All Payer |
$2,911.34
|
|
|
PLATE T 4H HD 4H SHFT 3.5*56R
|
Facility
|
IP
|
$3,308.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.08 |
| Max. Negotiated Rate |
$3,176.01 |
| Rate for Payer: Aetna Commercial |
$2,547.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.51
|
| Rate for Payer: Cash Price |
$1,654.17
|
| Rate for Payer: Cigna Commercial |
$2,745.92
|
| Rate for Payer: First Health Commercial |
$3,142.92
|
| Rate for Payer: Humana Commercial |
$2,812.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.59
|
| Rate for Payer: PHCS Commercial |
$3,176.01
|
| Rate for Payer: United Healthcare All Payer |
$2,911.34
|
|
|
PLATE T 4H HD 6H SHFT 3.5* 78R
|
Facility
|
IP
|
$3,894.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.29 |
| Max. Negotiated Rate |
$3,738.78 |
| Rate for Payer: Aetna Commercial |
$2,998.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,037.76
|
| Rate for Payer: Cash Price |
$1,947.28
|
| Rate for Payer: Cigna Commercial |
$3,232.48
|
| Rate for Payer: First Health Commercial |
$3,699.83
|
| Rate for Payer: Humana Commercial |
$3,310.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,193.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,168.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,427.21
|
| Rate for Payer: Ohio Health Group HMO |
$2,920.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.31
|
| Rate for Payer: PHCS Commercial |
$3,738.78
|
| Rate for Payer: United Healthcare All Payer |
$3,427.21
|
|
|
PLATE T 4H HD 6H SHFT 3.5* 78R
|
Facility
|
OP
|
$3,894.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.29 |
| Max. Negotiated Rate |
$3,738.78 |
| Rate for Payer: Aetna Commercial |
$2,998.81
|
| Rate for Payer: Anthem Medicaid |
$1,339.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,037.76
|
| Rate for Payer: Cash Price |
$1,947.28
|
| Rate for Payer: Cigna Commercial |
$3,232.48
|
| Rate for Payer: First Health Commercial |
$3,699.83
|
| Rate for Payer: Humana Commercial |
$3,310.38
|
| Rate for Payer: Humana KY Medicaid |
$1,339.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,352.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,193.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,874.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,168.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,366.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,427.21
|
| Rate for Payer: Ohio Health Group HMO |
$2,920.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$778.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$506.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,207.31
|
| Rate for Payer: PHCS Commercial |
$3,738.78
|
| Rate for Payer: United Healthcare All Payer |
$3,427.21
|
|
|
PLATE T 4 HOLE
|
Facility
|
OP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Aetna Commercial |
$2,567.18
|
| Rate for Payer: Anthem Medicaid |
$674.90
|
| Rate for Payer: Anthem Medicaid |
$1,146.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.52
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cash Price |
$1,667.00
|
| Rate for Payer: Cigna Commercial |
$2,767.22
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$3,167.30
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Humana Commercial |
$2,833.90
|
| Rate for Payer: Humana KY Medicaid |
$674.90
|
| Rate for Payer: Humana KY Medicaid |
$1,146.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,158.23
|
| Rate for Payer: Kentucky WC Medicaid |
$681.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,733.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,460.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,169.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,933.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.54
|
| Rate for Payer: PHCS Commercial |
$3,200.64
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$2,933.92
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
PLATE T 4 HOLE
|
Facility
|
IP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Aetna Commercial |
$2,567.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.52
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cash Price |
$1,667.00
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: Cigna Commercial |
$2,767.22
|
| Rate for Payer: First Health Commercial |
$3,167.30
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$2,833.90
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,733.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,460.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,933.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: PHCS Commercial |
$3,200.64
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
| Rate for Payer: United Healthcare All Payer |
$2,933.92
|
|
|
PLATE T 4 HOLE 84MM
|
Facility
|
OP
|
$3,154.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.06 |
| Max. Negotiated Rate |
$3,028.11 |
| Rate for Payer: Aetna Commercial |
$2,428.80
|
| Rate for Payer: Anthem Medicaid |
$1,084.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,460.34
|
| Rate for Payer: Cash Price |
$1,577.14
|
| Rate for Payer: Cigna Commercial |
$2,618.05
|
| Rate for Payer: First Health Commercial |
$2,996.57
|
| Rate for Payer: Humana Commercial |
$2,681.14
|
| Rate for Payer: Humana KY Medicaid |
$1,084.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,095.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,586.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,327.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$946.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,106.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,775.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,365.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.83
|
| Rate for Payer: PHCS Commercial |
$3,028.11
|
| Rate for Payer: United Healthcare All Payer |
$2,775.77
|
|
|
PLATE T 4 HOLE 84MM
|
Facility
|
IP
|
$3,154.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.06 |
| Max. Negotiated Rate |
$3,028.11 |
| Rate for Payer: Aetna Commercial |
$2,428.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,460.34
|
| Rate for Payer: Cash Price |
$1,577.14
|
| Rate for Payer: Cigna Commercial |
$2,618.05
|
| Rate for Payer: First Health Commercial |
$2,996.57
|
| Rate for Payer: Humana Commercial |
$2,681.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,586.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,327.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$946.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,775.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,365.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$977.83
|
| Rate for Payer: PHCS Commercial |
$3,028.11
|
| Rate for Payer: United Healthcare All Payer |
$2,775.77
|
|
|
PLATE T 5 HOLE 100MM
|
Facility
|
IP
|
$3,211.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.52 |
| Max. Negotiated Rate |
$3,083.21 |
| Rate for Payer: Aetna Commercial |
$2,472.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,505.11
|
| Rate for Payer: Cash Price |
$1,605.84
|
| Rate for Payer: Cigna Commercial |
$2,665.69
|
| Rate for Payer: First Health Commercial |
$3,051.10
|
| Rate for Payer: Humana Commercial |
$2,729.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,633.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,370.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,826.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,408.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.62
|
| Rate for Payer: PHCS Commercial |
$3,083.21
|
| Rate for Payer: United Healthcare All Payer |
$2,826.28
|
|
|
PLATE T 5 HOLE 100MM
|
Facility
|
OP
|
$3,211.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.52 |
| Max. Negotiated Rate |
$3,083.21 |
| Rate for Payer: Aetna Commercial |
$2,472.99
|
| Rate for Payer: Anthem Medicaid |
$1,104.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,505.11
|
| Rate for Payer: Cash Price |
$1,605.84
|
| Rate for Payer: Cigna Commercial |
$2,665.69
|
| Rate for Payer: First Health Commercial |
$3,051.10
|
| Rate for Payer: Humana Commercial |
$2,729.93
|
| Rate for Payer: Humana KY Medicaid |
$1,104.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,115.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,633.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,370.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$963.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,126.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,826.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,408.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$995.62
|
| Rate for Payer: PHCS Commercial |
$3,083.21
|
| Rate for Payer: United Healthcare All Payer |
$2,826.28
|
|
|
PLATE T 6H 4.5MM
|
Facility
|
IP
|
$3,404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.52 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$2,621.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.12
|
| Rate for Payer: Cash Price |
$1,702.00
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: First Health Commercial |
$3,233.80
|
| Rate for Payer: Humana Commercial |
$2,893.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.24
|
| Rate for Payer: PHCS Commercial |
$3,267.84
|
| Rate for Payer: United Healthcare All Payer |
$2,995.52
|
|
|
PLATE T 6H 4.5MM
|
Facility
|
OP
|
$3,404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.52 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Kentucky WC Medicaid |
$1,182.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.24
|
| Rate for Payer: PHCS Commercial |
$3,267.84
|
| Rate for Payer: United Healthcare All Payer |
$2,995.52
|
| Rate for Payer: Aetna Commercial |
$2,621.08
|
| Rate for Payer: Anthem Medicaid |
$1,170.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.12
|
| Rate for Payer: Cash Price |
$1,702.00
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: First Health Commercial |
$3,233.80
|
| Rate for Payer: Humana Commercial |
$2,893.40
|
| Rate for Payer: Humana KY Medicaid |
$1,170.64
|
|
