|
PLATE-T TI LCP 4H 3.5*56 R ANG
|
Facility
|
IP
|
$3,334.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.42 |
| Max. Negotiated Rate |
$3,200.64 |
| Rate for Payer: Aetna Commercial |
$2,567.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.52
|
| Rate for Payer: Cash Price |
$1,667.00
|
| Rate for Payer: Cigna Commercial |
$2,767.22
|
| Rate for Payer: First Health Commercial |
$3,167.30
|
| Rate for Payer: Humana Commercial |
$2,833.90
|
| 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: Molina Healthcare Benefit Exchange |
$1,000.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,933.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.80
|
| 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: PHCS Commercial |
$3,200.64
|
| Rate for Payer: United Healthcare All Payer |
$2,933.92
|
|
|
PLATE-T TI LCP 4H 3.5*56 R ANG
|
Facility
|
OP
|
$3,334.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.42 |
| Max. Negotiated Rate |
$3,200.64 |
| Rate for Payer: Kentucky WC Medicaid |
$1,158.23
|
| 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: Molina Healthcare Benefit Exchange |
$1,000.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,169.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,933.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.80
|
| 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: PHCS Commercial |
$3,200.64
|
| Rate for Payer: United Healthcare All Payer |
$2,933.92
|
| Rate for Payer: Aetna Commercial |
$2,567.18
|
| Rate for Payer: Anthem Medicaid |
$1,146.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.52
|
| Rate for Payer: Cash Price |
$1,667.00
|
| Rate for Payer: Cigna Commercial |
$2,767.22
|
| Rate for Payer: First Health Commercial |
$3,167.30
|
| Rate for Payer: Humana Commercial |
$2,833.90
|
| Rate for Payer: Humana KY Medicaid |
$1,146.56
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB L
|
Facility
|
OP
|
$3,469.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.01 |
| Max. Negotiated Rate |
$3,330.54 |
| Rate for Payer: Aetna Commercial |
$2,671.37
|
| Rate for Payer: Anthem Medicaid |
$1,193.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.06
|
| Rate for Payer: Cash Price |
$1,734.65
|
| Rate for Payer: Cigna Commercial |
$2,879.53
|
| Rate for Payer: First Health Commercial |
$3,295.84
|
| Rate for Payer: Humana Commercial |
$2,948.91
|
| Rate for Payer: Humana KY Medicaid |
$1,193.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,205.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,217.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$3,330.54
|
| Rate for Payer: United Healthcare All Payer |
$3,052.99
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB L
|
Facility
|
IP
|
$3,469.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.01 |
| Max. Negotiated Rate |
$3,330.54 |
| Rate for Payer: Aetna Commercial |
$2,671.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.06
|
| Rate for Payer: Cash Price |
$1,734.65
|
| Rate for Payer: Cigna Commercial |
$2,879.53
|
| Rate for Payer: First Health Commercial |
$3,295.84
|
| Rate for Payer: Humana Commercial |
$2,948.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$3,330.54
|
| Rate for Payer: United Healthcare All Payer |
$3,052.99
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB R
|
Facility
|
OP
|
$3,469.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.01 |
| Max. Negotiated Rate |
$3,330.54 |
| Rate for Payer: Aetna Commercial |
$2,671.37
|
| Rate for Payer: Anthem Medicaid |
$1,193.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.06
|
| Rate for Payer: Cash Price |
$1,734.65
|
| Rate for Payer: Cigna Commercial |
$2,879.53
|
| Rate for Payer: First Health Commercial |
$3,295.84
|
| Rate for Payer: Humana Commercial |
$2,948.91
|
| Rate for Payer: Humana KY Medicaid |
$1,193.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,205.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,217.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$3,330.54
|
| Rate for Payer: United Healthcare All Payer |
$3,052.99
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB R
|
Facility
|
IP
|
$3,469.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.01 |
| Max. Negotiated Rate |
$3,330.54 |
| Rate for Payer: Aetna Commercial |
$2,671.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,706.06
|
| Rate for Payer: Cash Price |
$1,734.65
|
| Rate for Payer: Cigna Commercial |
$2,879.53
|
| Rate for Payer: First Health Commercial |
$3,295.84
|
| Rate for Payer: Humana Commercial |
$2,948.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,560.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$693.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.49
|
| Rate for Payer: PHCS Commercial |
$3,330.54
|
| Rate for Payer: United Healthcare All Payer |
$3,052.99
|
|
|
PLATE-T TI LCP 5H 3.5*67 R ANG
|
Facility
|
IP
|
$3,447.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.14 |
| Max. Negotiated Rate |
$3,309.37 |
| Rate for Payer: Aetna Commercial |
$2,654.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,688.86
|
| Rate for Payer: Cash Price |
$1,723.63
|
| Rate for Payer: Cigna Commercial |
$2,861.23
|
| Rate for Payer: First Health Commercial |
$3,274.90
|
| Rate for Payer: Humana Commercial |
$2,930.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,826.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,544.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,033.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,585.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.65
|
| Rate for Payer: PHCS Commercial |
$3,309.37
|
| Rate for Payer: United Healthcare All Payer |
$3,033.59
|
|
|
PLATE-T TI LCP 5H 3.5*67 R ANG
|
Facility
|
OP
|
$3,447.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.14 |
| Max. Negotiated Rate |
$3,309.37 |
| Rate for Payer: Aetna Commercial |
$2,654.39
|
| Rate for Payer: Anthem Medicaid |
$1,185.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,688.86
|
| Rate for Payer: Cash Price |
$1,723.63
|
| Rate for Payer: Cigna Commercial |
$2,861.23
|
| Rate for Payer: First Health Commercial |
$3,274.90
|
| Rate for Payer: Humana Commercial |
$2,930.17
|
| Rate for Payer: Humana KY Medicaid |
$1,185.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,197.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,826.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,544.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,209.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,033.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,585.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,068.65
|
| Rate for Payer: PHCS Commercial |
$3,309.37
|
| Rate for Payer: United Healthcare All Payer |
$3,033.59
|
|
|
PLATE-T TI LCP 5H 3.5*74 OB L
|
Facility
|
OP
|
$3,521.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.85 |
| Max. Negotiated Rate |
$3,381.04 |
| Rate for Payer: Aetna Commercial |
$2,711.88
|
| Rate for Payer: Anthem Medicaid |
$1,211.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,747.10
|
| Rate for Payer: Cash Price |
$1,760.96
|
| Rate for Payer: Cigna Commercial |
$2,923.19
|
| Rate for Payer: First Health Commercial |
$3,345.82
|
| Rate for Payer: Humana Commercial |
$2,993.63
|
| Rate for Payer: Humana KY Medicaid |
$1,211.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,223.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,887.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,599.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,235.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,099.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,641.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.80
|
| Rate for Payer: PHCS Commercial |
$3,381.04
|
| Rate for Payer: United Healthcare All Payer |
$3,099.29
|
|
|
PLATE-T TI LCP 5H 3.5*74 OB L
|
Facility
|
IP
|
$3,521.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.85 |
| Max. Negotiated Rate |
$3,381.04 |
| Rate for Payer: Aetna Commercial |
$2,711.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,747.10
|
| Rate for Payer: Cash Price |
$1,760.96
|
| Rate for Payer: Cigna Commercial |
$2,923.19
|
| Rate for Payer: First Health Commercial |
$3,345.82
|
| Rate for Payer: Humana Commercial |
$2,993.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,887.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,599.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,099.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,641.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.80
|
| Rate for Payer: PHCS Commercial |
$3,381.04
|
| Rate for Payer: United Healthcare All Payer |
$3,099.29
|
|
|
PLATE-T TI LCP 5H 3.5*74 OB R
|
Facility
|
IP
|
$3,643.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.66 |
| Max. Negotiated Rate |
$3,497.83 |
| Rate for Payer: Humana Commercial |
$3,097.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,987.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,688.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,093.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,206.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,732.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,129.51
|
| Rate for Payer: PHCS Commercial |
$3,497.83
|
| Rate for Payer: United Healthcare All Payer |
$3,206.34
|
| Rate for Payer: Aetna Commercial |
$2,805.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,841.98
|
| Rate for Payer: Cash Price |
$1,821.79
|
| Rate for Payer: Cigna Commercial |
$3,024.16
|
| Rate for Payer: First Health Commercial |
$3,461.39
|
|
|
PLATE-T TI LCP 5H 3.5*74 OB R
|
Facility
|
OP
|
$3,643.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$473.66 |
| Max. Negotiated Rate |
$3,497.83 |
| Rate for Payer: Aetna Commercial |
$2,805.55
|
| Rate for Payer: Anthem Medicaid |
$1,253.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,841.98
|
| Rate for Payer: Cash Price |
$1,821.79
|
| Rate for Payer: Cigna Commercial |
$3,024.16
|
| Rate for Payer: First Health Commercial |
$3,461.39
|
| Rate for Payer: Humana Commercial |
$3,097.03
|
| Rate for Payer: Humana KY Medicaid |
$1,253.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,265.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,987.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,688.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,093.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,278.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,206.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,732.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$728.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$473.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,129.51
|
| Rate for Payer: PHCS Commercial |
$3,497.83
|
| Rate for Payer: United Healthcare All Payer |
$3,206.34
|
|
|
PLATE-T TI LCP 6H 3.5*78 R ANG
|
Facility
|
OP
|
$3,654.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.07 |
| Max. Negotiated Rate |
$3,508.19 |
| Rate for Payer: Aetna Commercial |
$2,813.86
|
| Rate for Payer: Anthem Medicaid |
$1,256.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,850.40
|
| Rate for Payer: Cash Price |
$1,827.18
|
| Rate for Payer: Cigna Commercial |
$3,033.12
|
| Rate for Payer: First Health Commercial |
$3,471.64
|
| Rate for Payer: Humana Commercial |
$3,106.21
|
| Rate for Payer: Humana KY Medicaid |
$1,256.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,269.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,996.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,696.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,740.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.85
|
| Rate for Payer: PHCS Commercial |
$3,508.19
|
| Rate for Payer: United Healthcare All Payer |
$3,215.84
|
|
|
PLATE-T TI LCP 6H 3.5*78 R ANG
|
Facility
|
IP
|
$3,654.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.07 |
| Max. Negotiated Rate |
$3,508.19 |
| Rate for Payer: Aetna Commercial |
$2,813.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,850.40
|
| Rate for Payer: Cash Price |
$1,827.18
|
| Rate for Payer: Cigna Commercial |
$3,033.12
|
| Rate for Payer: First Health Commercial |
$3,471.64
|
| Rate for Payer: Humana Commercial |
$3,106.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,996.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,696.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,215.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,740.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.85
|
| Rate for Payer: PHCS Commercial |
$3,508.19
|
| Rate for Payer: United Healthcare All Payer |
$3,215.84
|
|
|
PLATE-T TI LCP 7H 3.5*87 R ANG
|
Facility
|
OP
|
$4,022.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.86 |
| Max. Negotiated Rate |
$3,861.12 |
| Rate for Payer: Aetna Commercial |
$3,096.94
|
| Rate for Payer: Anthem Medicaid |
$1,383.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,137.16
|
| Rate for Payer: Cash Price |
$2,011.00
|
| Rate for Payer: Cigna Commercial |
$3,338.26
|
| Rate for Payer: First Health Commercial |
$3,820.90
|
| Rate for Payer: Humana Commercial |
$3,418.70
|
| Rate for Payer: Humana KY Medicaid |
$1,383.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,397.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,298.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,968.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,410.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,539.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,016.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.82
|
| Rate for Payer: PHCS Commercial |
$3,861.12
|
| Rate for Payer: United Healthcare All Payer |
$3,539.36
|
|
|
PLATE-T TI LCP 7H 3.5*87 R ANG
|
Facility
|
IP
|
$4,022.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.86 |
| Max. Negotiated Rate |
$3,861.12 |
| Rate for Payer: Aetna Commercial |
$3,096.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,137.16
|
| Rate for Payer: Cash Price |
$2,011.00
|
| Rate for Payer: Cigna Commercial |
$3,338.26
|
| Rate for Payer: First Health Commercial |
$3,820.90
|
| Rate for Payer: Humana Commercial |
$3,418.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,298.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,968.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,539.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,016.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$804.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.82
|
| Rate for Payer: PHCS Commercial |
$3,861.12
|
| Rate for Payer: United Healthcare All Payer |
$3,539.36
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB L
|
Facility
|
IP
|
$3,636.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.74 |
| Max. Negotiated Rate |
$3,491.01 |
| Rate for Payer: Aetna Commercial |
$2,800.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,836.45
|
| Rate for Payer: Cash Price |
$1,818.23
|
| Rate for Payer: Cigna Commercial |
$3,018.27
|
| Rate for Payer: First Health Commercial |
$3,454.65
|
| Rate for Payer: Humana Commercial |
$3,091.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,981.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,683.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,200.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,727.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,127.31
|
| Rate for Payer: PHCS Commercial |
$3,491.01
|
| Rate for Payer: United Healthcare All Payer |
$3,200.09
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB L
|
Facility
|
OP
|
$3,636.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.74 |
| Max. Negotiated Rate |
$3,491.01 |
| Rate for Payer: Aetna Commercial |
$2,800.08
|
| Rate for Payer: Anthem Medicaid |
$1,250.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,836.45
|
| Rate for Payer: Cash Price |
$1,818.23
|
| Rate for Payer: Cigna Commercial |
$3,018.27
|
| Rate for Payer: First Health Commercial |
$3,454.65
|
| Rate for Payer: Humana Commercial |
$3,091.00
|
| Rate for Payer: Humana KY Medicaid |
$1,250.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,263.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,981.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,683.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,090.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,275.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,200.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,727.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,127.31
|
| Rate for Payer: PHCS Commercial |
$3,491.01
|
| Rate for Payer: United Healthcare All Payer |
$3,200.09
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB R
|
Facility
|
IP
|
$3,637.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.83 |
| Max. Negotiated Rate |
$3,491.68 |
| Rate for Payer: Aetna Commercial |
$2,800.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,836.99
|
| Rate for Payer: Cash Price |
$1,818.59
|
| Rate for Payer: Cigna Commercial |
$3,018.85
|
| Rate for Payer: First Health Commercial |
$3,455.31
|
| Rate for Payer: Humana Commercial |
$3,091.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,982.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,684.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,091.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,200.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,727.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,127.52
|
| Rate for Payer: PHCS Commercial |
$3,491.68
|
| Rate for Payer: United Healthcare All Payer |
$3,200.71
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB R
|
Facility
|
OP
|
$3,637.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.83 |
| Max. Negotiated Rate |
$3,491.68 |
| Rate for Payer: Humana Commercial |
$3,091.59
|
| Rate for Payer: Humana KY Medicaid |
$1,250.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,263.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,982.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,684.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,091.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,275.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,200.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,727.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$727.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$472.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,127.52
|
| Rate for Payer: PHCS Commercial |
$3,491.68
|
| Rate for Payer: United Healthcare All Payer |
$3,200.71
|
| Rate for Payer: Aetna Commercial |
$2,800.62
|
| Rate for Payer: Anthem Medicaid |
$1,250.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,836.99
|
| Rate for Payer: Cash Price |
$1,818.59
|
| Rate for Payer: Cigna Commercial |
$3,018.85
|
| Rate for Payer: First Health Commercial |
$3,455.31
|
|
|
PLATE TUB 1/3 10H 122MM
|
Facility
|
OP
|
$1,144.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$881.14
|
| Rate for Payer: Anthem Medicaid |
$393.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.59
|
| Rate for Payer: Cash Price |
$572.17
|
| Rate for Payer: Cigna Commercial |
$949.80
|
| Rate for Payer: First Health Commercial |
$1,087.12
|
| Rate for Payer: Humana Commercial |
$972.69
|
| Rate for Payer: Humana KY Medicaid |
$393.54
|
| Rate for Payer: Kentucky WC Medicaid |
$397.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$401.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,007.02
|
| Rate for Payer: Ohio Health Group HMO |
$858.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.75
|
| Rate for Payer: PHCS Commercial |
$1,098.57
|
| Rate for Payer: United Healthcare All Payer |
$1,007.02
|
|
|
PLATE TUB 1/3 10H 122MM
|
Facility
|
IP
|
$1,144.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$881.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.59
|
| Rate for Payer: Cash Price |
$572.17
|
| Rate for Payer: Cigna Commercial |
$949.80
|
| Rate for Payer: First Health Commercial |
$1,087.12
|
| Rate for Payer: Humana Commercial |
$972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,007.02
|
| Rate for Payer: Ohio Health Group HMO |
$858.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.75
|
| Rate for Payer: PHCS Commercial |
$1,098.57
|
| Rate for Payer: United Healthcare All Payer |
$1,007.02
|
|
|
PLATE TUB 1/3*122 10HL
|
Facility
|
IP
|
$1,144.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$881.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.59
|
| Rate for Payer: Cash Price |
$572.17
|
| Rate for Payer: Cigna Commercial |
$949.80
|
| Rate for Payer: First Health Commercial |
$1,087.12
|
| Rate for Payer: Humana Commercial |
$972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,007.02
|
| Rate for Payer: Ohio Health Group HMO |
$858.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.75
|
| Rate for Payer: PHCS Commercial |
$1,098.57
|
| Rate for Payer: United Healthcare All Payer |
$1,007.02
|
|
|
PLATE TUB 1/3*122 10HL
|
Facility
|
OP
|
$1,144.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$881.14
|
| Rate for Payer: Anthem Medicaid |
$393.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.59
|
| Rate for Payer: Cash Price |
$572.17
|
| Rate for Payer: Cigna Commercial |
$949.80
|
| Rate for Payer: First Health Commercial |
$1,087.12
|
| Rate for Payer: Humana Commercial |
$972.69
|
| Rate for Payer: Humana KY Medicaid |
$393.54
|
| Rate for Payer: Kentucky WC Medicaid |
$397.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$401.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,007.02
|
| Rate for Payer: Ohio Health Group HMO |
$858.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.75
|
| Rate for Payer: PHCS Commercial |
$1,098.57
|
| Rate for Payer: United Healthcare All Payer |
$1,007.02
|
|
|
PLATE TUB 1/3*26M 2HL
|
Facility
|
OP
|
$1,072.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$1,029.83 |
| Rate for Payer: Aetna Commercial |
$826.01
|
| Rate for Payer: Anthem Medicaid |
$368.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$836.74
|
| Rate for Payer: Cash Price |
$536.37
|
| Rate for Payer: Cigna Commercial |
$890.37
|
| Rate for Payer: First Health Commercial |
$1,019.10
|
| Rate for Payer: Humana Commercial |
$911.83
|
| Rate for Payer: Humana KY Medicaid |
$368.92
|
| Rate for Payer: Kentucky WC Medicaid |
$372.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$879.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$791.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.01
|
| Rate for Payer: Ohio Health Group HMO |
$804.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.55
|
| Rate for Payer: PHCS Commercial |
$1,029.83
|
| Rate for Payer: United Healthcare All Payer |
$944.01
|
|
