|
PLATE TALUS MDL 2.5 11X20M L R
|
Facility
|
IP
|
$5,098.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.74 |
| Max. Negotiated Rate |
$4,894.08 |
| Rate for Payer: Aetna Commercial |
$3,925.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,976.44
|
| Rate for Payer: Cash Price |
$2,549.00
|
| Rate for Payer: Cigna Commercial |
$4,231.34
|
| Rate for Payer: First Health Commercial |
$4,843.10
|
| Rate for Payer: Humana Commercial |
$4,333.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,180.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,762.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,529.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,486.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,823.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,019.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$662.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,580.38
|
| Rate for Payer: PHCS Commercial |
$4,894.08
|
| Rate for Payer: United Healthcare All Payer |
$4,486.24
|
|
|
PLATE TB L-K 3.5M 1/3 10H 122M
|
Facility
|
IP
|
$3,214.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.86 |
| Max. Negotiated Rate |
$3,085.73 |
| Rate for Payer: Aetna Commercial |
$2,475.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.15
|
| Rate for Payer: Cash Price |
$1,607.15
|
| Rate for Payer: Cigna Commercial |
$2,667.87
|
| Rate for Payer: First Health Commercial |
$3,053.58
|
| Rate for Payer: Humana Commercial |
$2,732.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.43
|
| Rate for Payer: PHCS Commercial |
$3,085.73
|
| Rate for Payer: United Healthcare All Payer |
$2,828.58
|
|
|
PLATE TB L-K 3.5M 1/3 10H 122M
|
Facility
|
OP
|
$3,214.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$417.86 |
| Max. Negotiated Rate |
$3,085.73 |
| Rate for Payer: Aetna Commercial |
$2,475.01
|
| Rate for Payer: Anthem Medicaid |
$1,105.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.15
|
| Rate for Payer: Cash Price |
$1,607.15
|
| Rate for Payer: Cigna Commercial |
$2,667.87
|
| Rate for Payer: First Health Commercial |
$3,053.58
|
| Rate for Payer: Humana Commercial |
$2,732.16
|
| Rate for Payer: Humana KY Medicaid |
$1,105.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$642.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$417.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.43
|
| Rate for Payer: PHCS Commercial |
$3,085.73
|
| Rate for Payer: United Healthcare All Payer |
$2,828.58
|
|
|
PLATE TB L-K 3.5M 1/3 12H 146M
|
Facility
|
OP
|
$3,302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$3,170.40 |
| Rate for Payer: Aetna Commercial |
$2,542.92
|
| Rate for Payer: Anthem Medicaid |
$1,135.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.95
|
| Rate for Payer: Cash Price |
$1,651.25
|
| Rate for Payer: Cigna Commercial |
$2,741.08
|
| Rate for Payer: First Health Commercial |
$3,137.38
|
| Rate for Payer: Humana Commercial |
$2,807.12
|
| Rate for Payer: Humana KY Medicaid |
$1,135.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,147.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,158.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.78
|
| Rate for Payer: PHCS Commercial |
$3,170.40
|
| Rate for Payer: United Healthcare All Payer |
$2,906.20
|
|
|
PLATE TB L-K 3.5M 1/3 12H 146M
|
Facility
|
IP
|
$3,302.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.32 |
| Max. Negotiated Rate |
$3,170.40 |
| Rate for Payer: Aetna Commercial |
$2,542.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.95
|
| Rate for Payer: Cash Price |
$1,651.25
|
| Rate for Payer: Cigna Commercial |
$2,741.08
|
| Rate for Payer: First Health Commercial |
$3,137.38
|
| Rate for Payer: Humana Commercial |
$2,807.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,708.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,437.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,906.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.78
|
| Rate for Payer: PHCS Commercial |
$3,170.40
|
| Rate for Payer: United Healthcare All Payer |
$2,906.20
|
|
|
PLATE TBLK 3.5M148M 10 L A-L-D
|
Facility
|
IP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
|
|
PLATE TBLK 3.5M148M 10 L A-L-D
|
Facility
|
OP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem Medicaid |
$3,236.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Humana KY Medicaid |
$3,236.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,269.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,301.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
|
|
PLATE TBLK 3.5M148M10 R A-L-D
|
Facility
|
IP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
|
|
PLATE TBLK 3.5M148M10 R A-L-D
|
Facility
|
OP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem Medicaid |
$3,236.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Humana KY Medicaid |
$3,236.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,269.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,301.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
|
|
PLATE TBLK 3.5M 186M13 L A-L-D
|
Facility
|
OP
|
$9,464.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.41 |
| Max. Negotiated Rate |
$9,086.13 |
| Rate for Payer: Anthem Medicaid |
$3,254.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.48
|
| Rate for Payer: Cash Price |
$4,732.36
|
| Rate for Payer: Cigna Commercial |
$7,855.72
|
| Rate for Payer: First Health Commercial |
$8,991.48
|
| Rate for Payer: Humana Commercial |
$8,045.01
|
| Rate for Payer: Humana KY Medicaid |
$3,254.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,288.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,984.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,320.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,328.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.06
|
| Rate for Payer: PHCS Commercial |
$9,086.13
|
| Rate for Payer: United Healthcare All Payer |
$8,328.95
|
| Rate for Payer: Aetna Commercial |
$7,287.83
|
|
|
PLATE TBLK 3.5M 186M13 L A-L-D
|
Facility
|
IP
|
$9,464.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.41 |
| Max. Negotiated Rate |
$9,086.13 |
| Rate for Payer: Aetna Commercial |
$7,287.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.48
|
| Rate for Payer: Cash Price |
$4,732.36
|
| Rate for Payer: Cigna Commercial |
$7,855.72
|
| Rate for Payer: First Health Commercial |
$8,991.48
|
| Rate for Payer: Humana Commercial |
$8,045.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,984.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,328.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.06
|
| Rate for Payer: PHCS Commercial |
$9,086.13
|
| Rate for Payer: United Healthcare All Payer |
$8,328.95
|
|
|
PLATE TBLK 3.5M 186M13 R A-L-D
|
Facility
|
OP
|
$9,464.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.41 |
| Max. Negotiated Rate |
$9,086.13 |
| Rate for Payer: Aetna Commercial |
$7,287.83
|
| Rate for Payer: Anthem Medicaid |
$3,254.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.48
|
| Rate for Payer: Cash Price |
$4,732.36
|
| Rate for Payer: Cigna Commercial |
$7,855.72
|
| Rate for Payer: First Health Commercial |
$8,991.48
|
| Rate for Payer: Humana Commercial |
$8,045.01
|
| Rate for Payer: Humana KY Medicaid |
$3,254.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,288.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,984.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,320.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,328.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.06
|
| Rate for Payer: PHCS Commercial |
$9,086.13
|
| Rate for Payer: United Healthcare All Payer |
$8,328.95
|
|
|
PLATE TBLK 3.5M 186M13 R A-L-D
|
Facility
|
IP
|
$9,464.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,230.41 |
| Max. Negotiated Rate |
$9,086.13 |
| Rate for Payer: Aetna Commercial |
$7,287.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,382.48
|
| Rate for Payer: Cash Price |
$4,732.36
|
| Rate for Payer: Cigna Commercial |
$7,855.72
|
| Rate for Payer: First Health Commercial |
$8,991.48
|
| Rate for Payer: Humana Commercial |
$8,045.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,761.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,984.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,839.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,328.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,098.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,892.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,230.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,934.06
|
| Rate for Payer: PHCS Commercial |
$9,086.13
|
| Rate for Payer: United Healthcare All Payer |
$8,328.95
|
|
|
PLATE TB LK 3.5M M-D 6H 127M L
|
Facility
|
OP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Aetna Commercial |
$4,328.09
|
| Rate for Payer: Anthem Medicaid |
$1,933.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Humana KY Medicaid |
$1,933.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,952.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,971.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
|
|
PLATE TB LK 3.5M M-D 6H 127M L
|
Facility
|
IP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Aetna Commercial |
$4,328.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
|
|
PLATE TB LK 3.5M M-D 6H 127M R
|
Facility
|
OP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Aetna Commercial |
$4,328.09
|
| Rate for Payer: Anthem Medicaid |
$1,933.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Humana KY Medicaid |
$1,933.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,952.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,971.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
|
|
PLATE TB LK 3.5M M-D 6H 127M R
|
Facility
|
IP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Aetna Commercial |
$4,328.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
|
|
PLATE TB LK 3.5M PM-P 4H 64M L
|
Facility
|
IP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TB LK 3.5M PM-P 4H 64M L
|
Facility
|
OP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem Medicaid |
$1,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Humana KY Medicaid |
$1,889.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,927.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TB LK 3.5M PM-P 7H 98M L
|
Facility
|
IP
|
$5,627.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.54 |
| Max. Negotiated Rate |
$5,402.11 |
| Rate for Payer: Aetna Commercial |
$4,332.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,389.22
|
| Rate for Payer: Cash Price |
$2,813.60
|
| Rate for Payer: Cigna Commercial |
$4,670.58
|
| Rate for Payer: First Health Commercial |
$5,345.84
|
| Rate for Payer: Humana Commercial |
$4,783.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,614.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,152.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,688.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,951.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,220.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,125.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,744.43
|
| Rate for Payer: PHCS Commercial |
$5,402.11
|
| Rate for Payer: United Healthcare All Payer |
$4,951.94
|
|
|
PLATE TB LK 3.5M PM-P 7H 98M L
|
Facility
|
OP
|
$5,627.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$731.54 |
| Max. Negotiated Rate |
$5,402.11 |
| Rate for Payer: Aetna Commercial |
$4,332.94
|
| Rate for Payer: Anthem Medicaid |
$1,935.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,389.22
|
| Rate for Payer: Cash Price |
$2,813.60
|
| Rate for Payer: Cigna Commercial |
$4,670.58
|
| Rate for Payer: First Health Commercial |
$5,345.84
|
| Rate for Payer: Humana Commercial |
$4,783.12
|
| Rate for Payer: Humana KY Medicaid |
$1,935.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,954.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,614.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,152.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,688.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,974.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,951.94
|
| Rate for Payer: Ohio Health Group HMO |
$4,220.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,125.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$731.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,744.43
|
| Rate for Payer: PHCS Commercial |
$5,402.11
|
| Rate for Payer: United Healthcare All Payer |
$4,951.94
|
|
|
PLATE TB LK PL-D 3.5M 155M 11L
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem Medicaid |
$1,601.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Humana KY Medicaid |
$1,601.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,633.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE TB LK PL-D 3.5M 155M 11L
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE T BUTTRESS 4X80MM
|
Facility
|
IP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
|
|
PLATE T BUTTRESS 4X80MM
|
Facility
|
OP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem Medicaid |
$1,235.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Humana KY Medicaid |
$1,235.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
|
