|
PLATE TI RECON 8H 94MM
|
Facility
|
OP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem Medicaid |
$1,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Humana KY Medicaid |
$1,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 9H 106MM
|
Facility
|
OP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem Medicaid |
$1,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Humana KY Medicaid |
$1,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 9H 106MM
|
Facility
|
IP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI SEMI-TUBLAR 4H 71MM
|
Facility
|
IP
|
$1,097.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.73 |
| Max. Negotiated Rate |
$1,054.02 |
| Rate for Payer: Aetna Commercial |
$845.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$856.39
|
| Rate for Payer: Cash Price |
$548.97
|
| Rate for Payer: Cigna Commercial |
$911.29
|
| Rate for Payer: First Health Commercial |
$1,043.04
|
| Rate for Payer: Humana Commercial |
$933.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$900.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$810.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$966.19
|
| Rate for Payer: Ohio Health Group HMO |
$823.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.36
|
| Rate for Payer: PHCS Commercial |
$1,054.02
|
| Rate for Payer: United Healthcare All Payer |
$966.19
|
|
|
PLATE TI SEMI-TUBLAR 4H 71MM
|
Facility
|
OP
|
$1,097.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.73 |
| Max. Negotiated Rate |
$1,054.02 |
| Rate for Payer: Aetna Commercial |
$845.41
|
| Rate for Payer: Anthem Medicaid |
$377.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$856.39
|
| Rate for Payer: Cash Price |
$548.97
|
| Rate for Payer: Cigna Commercial |
$911.29
|
| Rate for Payer: First Health Commercial |
$1,043.04
|
| Rate for Payer: Humana Commercial |
$933.25
|
| Rate for Payer: Humana KY Medicaid |
$377.58
|
| Rate for Payer: Kentucky WC Medicaid |
$381.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$900.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$810.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$385.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$966.19
|
| Rate for Payer: Ohio Health Group HMO |
$823.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.36
|
| Rate for Payer: PHCS Commercial |
$1,054.02
|
| Rate for Payer: United Healthcare All Payer |
$966.19
|
|
|
PLATE TI SEMI-TUBLAR 5H 87MM
|
Facility
|
OP
|
$1,107.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.03 |
| Max. Negotiated Rate |
$1,063.59 |
| Rate for Payer: Aetna Commercial |
$853.09
|
| Rate for Payer: Anthem Medicaid |
$381.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.17
|
| Rate for Payer: Cash Price |
$553.96
|
| Rate for Payer: Cigna Commercial |
$919.57
|
| Rate for Payer: First Health Commercial |
$1,052.51
|
| Rate for Payer: Humana Commercial |
$941.72
|
| Rate for Payer: Humana KY Medicaid |
$381.01
|
| Rate for Payer: Kentucky WC Medicaid |
$384.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$388.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$974.96
|
| Rate for Payer: Ohio Health Group HMO |
$830.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.45
|
| Rate for Payer: PHCS Commercial |
$1,063.59
|
| Rate for Payer: United Healthcare All Payer |
$974.96
|
|
|
PLATE TI SEMI-TUBLAR 5H 87MM
|
Facility
|
IP
|
$1,107.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.03 |
| Max. Negotiated Rate |
$1,063.59 |
| Rate for Payer: Humana Commercial |
$941.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$908.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$817.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$974.96
|
| Rate for Payer: Ohio Health Group HMO |
$830.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$221.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$343.45
|
| Rate for Payer: PHCS Commercial |
$1,063.59
|
| Rate for Payer: United Healthcare All Payer |
$974.96
|
| Rate for Payer: Aetna Commercial |
$853.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$864.17
|
| Rate for Payer: Cash Price |
$553.96
|
| Rate for Payer: Cigna Commercial |
$919.57
|
| Rate for Payer: First Health Commercial |
$1,052.51
|
|
|
PLATE TI SEMI-TUBLAR 6H 103MM
|
Facility
|
IP
|
$1,131.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$1,086.63 |
| Rate for Payer: Aetna Commercial |
$871.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.89
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cigna Commercial |
$939.49
|
| Rate for Payer: First Health Commercial |
$1,075.31
|
| Rate for Payer: Humana Commercial |
$962.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$928.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$996.08
|
| Rate for Payer: Ohio Health Group HMO |
$848.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.89
|
| Rate for Payer: PHCS Commercial |
$1,086.63
|
| Rate for Payer: United Healthcare All Payer |
$996.08
|
|
|
PLATE TI SEMI-TUBLAR 6H 103MM
|
Facility
|
OP
|
$1,131.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$1,086.63 |
| Rate for Payer: Aetna Commercial |
$871.57
|
| Rate for Payer: Anthem Medicaid |
$389.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.89
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cigna Commercial |
$939.49
|
| Rate for Payer: First Health Commercial |
$1,075.31
|
| Rate for Payer: Humana Commercial |
$962.12
|
| Rate for Payer: Humana KY Medicaid |
$389.26
|
| Rate for Payer: Kentucky WC Medicaid |
$393.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$928.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$996.08
|
| Rate for Payer: Ohio Health Group HMO |
$848.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.89
|
| Rate for Payer: PHCS Commercial |
$1,086.63
|
| Rate for Payer: United Healthcare All Payer |
$996.08
|
|
|
PLATE TI SEMI-TUBLAR 7H 119MM
|
Facility
|
IP
|
$1,131.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$1,086.63 |
| Rate for Payer: Aetna Commercial |
$871.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.89
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cigna Commercial |
$939.49
|
| Rate for Payer: First Health Commercial |
$1,075.31
|
| Rate for Payer: Humana Commercial |
$962.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$928.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$996.08
|
| Rate for Payer: Ohio Health Group HMO |
$848.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.89
|
| Rate for Payer: PHCS Commercial |
$1,086.63
|
| Rate for Payer: United Healthcare All Payer |
$996.08
|
|
|
PLATE TI SEMI-TUBLAR 7H 119MM
|
Facility
|
OP
|
$1,131.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.15 |
| Max. Negotiated Rate |
$1,086.63 |
| Rate for Payer: Aetna Commercial |
$871.57
|
| Rate for Payer: Anthem Medicaid |
$389.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$882.89
|
| Rate for Payer: Cash Price |
$565.95
|
| Rate for Payer: Cigna Commercial |
$939.49
|
| Rate for Payer: First Health Commercial |
$1,075.31
|
| Rate for Payer: Humana Commercial |
$962.12
|
| Rate for Payer: Humana KY Medicaid |
$389.26
|
| Rate for Payer: Kentucky WC Medicaid |
$393.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$928.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$996.08
|
| Rate for Payer: Ohio Health Group HMO |
$848.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.89
|
| Rate for Payer: PHCS Commercial |
$1,086.63
|
| Rate for Payer: United Healthcare All Payer |
$996.08
|
|
|
PLATE TI SM T-PLATE 3H 50MM RT
|
Facility
|
IP
|
$1,526.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$1,465.60 |
| Rate for Payer: Aetna Commercial |
$1,175.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.80
|
| Rate for Payer: Cash Price |
$763.34
|
| Rate for Payer: Cigna Commercial |
$1,267.14
|
| Rate for Payer: First Health Commercial |
$1,450.34
|
| Rate for Payer: Humana Commercial |
$1,297.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,343.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,145.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.27
|
| Rate for Payer: PHCS Commercial |
$1,465.60
|
| Rate for Payer: United Healthcare All Payer |
$1,343.47
|
|
|
PLATE TI SM T-PLATE 3H 50MM RT
|
Facility
|
OP
|
$1,526.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$1,465.60 |
| Rate for Payer: Aetna Commercial |
$1,175.54
|
| Rate for Payer: Anthem Medicaid |
$525.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.80
|
| Rate for Payer: Cash Price |
$763.34
|
| Rate for Payer: Cigna Commercial |
$1,267.14
|
| Rate for Payer: First Health Commercial |
$1,450.34
|
| Rate for Payer: Humana Commercial |
$1,297.67
|
| Rate for Payer: Humana KY Medicaid |
$525.02
|
| Rate for Payer: Kentucky WC Medicaid |
$530.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$535.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,343.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,145.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.27
|
| Rate for Payer: PHCS Commercial |
$1,465.60
|
| Rate for Payer: United Healthcare All Payer |
$1,343.47
|
|
|
PLATE TI SM T-PLATE 3H 53MM OB
|
Facility
|
OP
|
$1,792.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.05 |
| Max. Negotiated Rate |
$1,720.97 |
| Rate for Payer: Humana Commercial |
$1,523.78
|
| Rate for Payer: Humana KY Medicaid |
$616.50
|
| Rate for Payer: Kentucky WC Medicaid |
$622.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,470.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$628.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,577.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,344.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.73
|
| Rate for Payer: PHCS Commercial |
$1,720.97
|
| Rate for Payer: United Healthcare All Payer |
$1,577.56
|
| Rate for Payer: Aetna Commercial |
$1,380.36
|
| Rate for Payer: Anthem Medicaid |
$616.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.29
|
| Rate for Payer: Cash Price |
$896.34
|
| Rate for Payer: Cigna Commercial |
$1,487.92
|
| Rate for Payer: First Health Commercial |
$1,703.05
|
|
|
PLATE TI SM T-PLATE 3H 53MM OB
|
Facility
|
IP
|
$1,792.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.05 |
| Max. Negotiated Rate |
$1,720.97 |
| Rate for Payer: Aetna Commercial |
$1,380.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.29
|
| Rate for Payer: Cash Price |
$896.34
|
| Rate for Payer: Cigna Commercial |
$1,487.92
|
| Rate for Payer: First Health Commercial |
$1,703.05
|
| Rate for Payer: Humana Commercial |
$1,523.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,470.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,577.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,344.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.73
|
| Rate for Payer: PHCS Commercial |
$1,720.97
|
| Rate for Payer: United Healthcare All Payer |
$1,577.56
|
|
|
PLATE TI SM T-PLATE 3H 63MM OB
|
Facility
|
OP
|
$1,792.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.05 |
| Max. Negotiated Rate |
$1,720.97 |
| Rate for Payer: Aetna Commercial |
$1,380.36
|
| Rate for Payer: Anthem Medicaid |
$616.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.29
|
| Rate for Payer: Cash Price |
$896.34
|
| Rate for Payer: Cigna Commercial |
$1,487.92
|
| Rate for Payer: First Health Commercial |
$1,703.05
|
| Rate for Payer: Humana Commercial |
$1,523.78
|
| Rate for Payer: Humana KY Medicaid |
$616.50
|
| Rate for Payer: Kentucky WC Medicaid |
$622.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,470.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$628.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,577.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,344.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.73
|
| Rate for Payer: PHCS Commercial |
$1,720.97
|
| Rate for Payer: United Healthcare All Payer |
$1,577.56
|
|
|
PLATE TI SM T-PLATE 3H 63MM OB
|
Facility
|
IP
|
$1,792.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.05 |
| Max. Negotiated Rate |
$1,720.97 |
| Rate for Payer: Aetna Commercial |
$1,380.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,398.29
|
| Rate for Payer: Cash Price |
$896.34
|
| Rate for Payer: Cigna Commercial |
$1,487.92
|
| Rate for Payer: First Health Commercial |
$1,703.05
|
| Rate for Payer: Humana Commercial |
$1,523.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,470.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,323.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,577.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,344.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.73
|
| Rate for Payer: PHCS Commercial |
$1,720.97
|
| Rate for Payer: United Healthcare All Payer |
$1,577.56
|
|
|
PLATE TI SM T-PLATE 3H 67MM RT
|
Facility
|
OP
|
$1,526.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$1,465.60 |
| Rate for Payer: Aetna Commercial |
$1,175.54
|
| Rate for Payer: Anthem Medicaid |
$525.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.80
|
| Rate for Payer: Cash Price |
$763.34
|
| Rate for Payer: Cigna Commercial |
$1,267.14
|
| Rate for Payer: First Health Commercial |
$1,450.34
|
| Rate for Payer: Humana Commercial |
$1,297.67
|
| Rate for Payer: Humana KY Medicaid |
$525.02
|
| Rate for Payer: Kentucky WC Medicaid |
$530.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$458.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$535.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,343.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,145.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.27
|
| Rate for Payer: PHCS Commercial |
$1,465.60
|
| Rate for Payer: United Healthcare All Payer |
$1,343.47
|
|
|
PLATE TI SM T-PLATE 3H 67MM RT
|
Facility
|
IP
|
$1,526.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.47 |
| Max. Negotiated Rate |
$1,465.60 |
| Rate for Payer: Aetna Commercial |
$1,175.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,190.80
|
| Rate for Payer: Cash Price |
$763.34
|
| Rate for Payer: Cigna Commercial |
$1,267.14
|
| Rate for Payer: First Health Commercial |
$1,450.34
|
| Rate for Payer: Humana Commercial |
$1,297.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,251.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,126.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$458.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,343.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,145.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$305.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$198.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$473.27
|
| Rate for Payer: PHCS Commercial |
$1,465.60
|
| Rate for Payer: United Healthcare All Payer |
$1,343.47
|
|
|
PLATE TI SM T-PLATE 3H 75MM OB
|
Facility
|
OP
|
$2,157.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.54 |
| Max. Negotiated Rate |
$2,071.66 |
| Rate for Payer: Aetna Commercial |
$1,661.64
|
| Rate for Payer: Anthem Medicaid |
$742.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.22
|
| Rate for Payer: Cash Price |
$1,078.99
|
| Rate for Payer: Cigna Commercial |
$1,791.12
|
| Rate for Payer: First Health Commercial |
$2,050.08
|
| Rate for Payer: Humana Commercial |
$1,834.28
|
| Rate for Payer: Humana KY Medicaid |
$742.13
|
| Rate for Payer: Kentucky WC Medicaid |
$749.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$757.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.97
|
| Rate for Payer: PHCS Commercial |
$2,071.66
|
| Rate for Payer: United Healthcare All Payer |
$1,899.02
|
|
|
PLATE TI SM T-PLATE 3H 75MM OB
|
Facility
|
IP
|
$2,157.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.54 |
| Max. Negotiated Rate |
$2,071.66 |
| Rate for Payer: Aetna Commercial |
$1,661.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,683.22
|
| Rate for Payer: Cash Price |
$1,078.99
|
| Rate for Payer: Cigna Commercial |
$1,791.12
|
| Rate for Payer: First Health Commercial |
$2,050.08
|
| Rate for Payer: Humana Commercial |
$1,834.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,769.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,592.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,899.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,618.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.97
|
| Rate for Payer: PHCS Commercial |
$2,071.66
|
| Rate for Payer: United Healthcare All Payer |
$1,899.02
|
|
|
PLATE TITANIUM 2 HOLE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE TITANIUM 2 HOLE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE TITANIUM ACCORD 320MM
|
Facility
|
OP
|
$8,422.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.97 |
| Max. Negotiated Rate |
$8,085.92 |
| Rate for Payer: Aetna Commercial |
$6,485.58
|
| Rate for Payer: Anthem Medicaid |
$2,896.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,569.81
|
| Rate for Payer: Cash Price |
$4,211.41
|
| Rate for Payer: Cigna Commercial |
$6,990.95
|
| Rate for Payer: First Health Commercial |
$8,001.69
|
| Rate for Payer: Humana Commercial |
$7,159.41
|
| Rate for Payer: Humana KY Medicaid |
$2,896.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,926.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,906.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,954.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,412.09
|
| Rate for Payer: Ohio Health Group HMO |
$6,317.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.08
|
| Rate for Payer: PHCS Commercial |
$8,085.92
|
| Rate for Payer: United Healthcare All Payer |
$7,412.09
|
|
|
PLATE TITANIUM ACCORD 320MM
|
Facility
|
IP
|
$8,422.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,094.97 |
| Max. Negotiated Rate |
$8,085.92 |
| Rate for Payer: Aetna Commercial |
$6,485.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,569.81
|
| Rate for Payer: Cash Price |
$4,211.41
|
| Rate for Payer: Cigna Commercial |
$6,990.95
|
| Rate for Payer: First Health Commercial |
$8,001.69
|
| Rate for Payer: Humana Commercial |
$7,159.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,906.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,216.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,412.09
|
| Rate for Payer: Ohio Health Group HMO |
$6,317.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,094.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.08
|
| Rate for Payer: PHCS Commercial |
$8,085.92
|
| Rate for Payer: United Healthcare All Payer |
$7,412.09
|
|
