|
PLATE TUB LK 3.5MM 95MM 7H
|
Facility
|
IP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE TUB LK 3.5MM 95MM 7H
|
Facility
|
OP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem Medicaid |
$662.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Humana KY Medicaid |
$662.45
|
| Rate for Payer: Kentucky WC Medicaid |
$669.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE TUBULAR 1/3 10H*119MM
|
Facility
|
IP
|
$3,293.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.11 |
| Max. Negotiated Rate |
$3,161.46 |
| Rate for Payer: Aetna Commercial |
$2,535.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,568.69
|
| Rate for Payer: Cash Price |
$1,646.60
|
| Rate for Payer: Cigna Commercial |
$2,733.35
|
| Rate for Payer: First Health Commercial |
$3,128.53
|
| Rate for Payer: Humana Commercial |
$2,799.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,469.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,020.89
|
| Rate for Payer: PHCS Commercial |
$3,161.46
|
| Rate for Payer: United Healthcare All Payer |
$2,898.01
|
|
|
PLATE TUBULAR 1/3 10H*119MM
|
Facility
|
OP
|
$3,293.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.11 |
| Max. Negotiated Rate |
$3,161.46 |
| Rate for Payer: Aetna Commercial |
$2,535.76
|
| Rate for Payer: Anthem Medicaid |
$1,132.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,568.69
|
| Rate for Payer: Cash Price |
$1,646.60
|
| Rate for Payer: Cigna Commercial |
$2,733.35
|
| Rate for Payer: First Health Commercial |
$3,128.53
|
| Rate for Payer: Humana Commercial |
$2,799.21
|
| Rate for Payer: Humana KY Medicaid |
$1,132.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,144.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,469.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,020.89
|
| Rate for Payer: PHCS Commercial |
$3,161.46
|
| Rate for Payer: United Healthcare All Payer |
$2,898.01
|
|
|
PLATE TUBULAR 1/3 12H*143MM
|
Facility
|
OP
|
$4,758.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.60 |
| Max. Negotiated Rate |
$4,568.16 |
| Rate for Payer: Aetna Commercial |
$3,664.04
|
| Rate for Payer: Anthem Medicaid |
$1,636.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,711.63
|
| Rate for Payer: Cash Price |
$2,379.25
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: First Health Commercial |
$4,520.58
|
| Rate for Payer: Humana Commercial |
$4,044.72
|
| Rate for Payer: Humana KY Medicaid |
$1,636.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,901.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,511.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,427.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,187.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,568.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$951.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,475.14
|
| Rate for Payer: PHCS Commercial |
$4,568.16
|
| Rate for Payer: United Healthcare All Payer |
$4,187.48
|
|
|
PLATE TUBULAR 1/3 12H*143MM
|
Facility
|
IP
|
$4,758.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.60 |
| Max. Negotiated Rate |
$4,568.16 |
| Rate for Payer: Aetna Commercial |
$3,664.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,711.63
|
| Rate for Payer: Cash Price |
$2,379.25
|
| Rate for Payer: Cigna Commercial |
$3,949.56
|
| Rate for Payer: First Health Commercial |
$4,520.58
|
| Rate for Payer: Humana Commercial |
$4,044.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,901.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,511.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,427.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,187.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,568.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$951.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,475.14
|
| Rate for Payer: PHCS Commercial |
$4,568.16
|
| Rate for Payer: United Healthcare All Payer |
$4,187.48
|
|
|
PLATE TUBULAR 1/3 14H*167MM
|
Facility
|
IP
|
$6,490.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.72 |
| Max. Negotiated Rate |
$6,230.54 |
| Rate for Payer: Aetna Commercial |
$4,997.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.32
|
| Rate for Payer: Cash Price |
$3,245.07
|
| Rate for Payer: Cigna Commercial |
$5,386.82
|
| Rate for Payer: First Health Commercial |
$6,165.64
|
| Rate for Payer: Humana Commercial |
$5,516.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,947.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,298.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.95
|
| Rate for Payer: PHCS Commercial |
$6,230.54
|
| Rate for Payer: United Healthcare All Payer |
$5,711.33
|
|
|
PLATE TUBULAR 1/3 14H*167MM
|
Facility
|
OP
|
$6,490.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.72 |
| Max. Negotiated Rate |
$6,230.54 |
| Rate for Payer: Aetna Commercial |
$4,997.42
|
| Rate for Payer: Anthem Medicaid |
$2,231.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.32
|
| Rate for Payer: Cash Price |
$3,245.07
|
| Rate for Payer: Cigna Commercial |
$5,386.82
|
| Rate for Payer: First Health Commercial |
$6,165.64
|
| Rate for Payer: Humana Commercial |
$5,516.63
|
| Rate for Payer: Humana KY Medicaid |
$2,231.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,254.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,947.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,276.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,298.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.95
|
| Rate for Payer: PHCS Commercial |
$6,230.54
|
| Rate for Payer: United Healthcare All Payer |
$5,711.33
|
|
|
PLATE TUBULAR 1/3 16H*191MM
|
Facility
|
IP
|
$6,490.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.72 |
| Max. Negotiated Rate |
$6,230.54 |
| Rate for Payer: Aetna Commercial |
$4,997.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.32
|
| Rate for Payer: Cash Price |
$3,245.07
|
| Rate for Payer: Cigna Commercial |
$5,386.82
|
| Rate for Payer: First Health Commercial |
$6,165.64
|
| Rate for Payer: Humana Commercial |
$5,516.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,947.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,298.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.95
|
| Rate for Payer: PHCS Commercial |
$6,230.54
|
| Rate for Payer: United Healthcare All Payer |
$5,711.33
|
|
|
PLATE TUBULAR 1/3 16H*191MM
|
Facility
|
OP
|
$6,490.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.72 |
| Max. Negotiated Rate |
$6,230.54 |
| Rate for Payer: Aetna Commercial |
$4,997.42
|
| Rate for Payer: Anthem Medicaid |
$2,231.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,062.32
|
| Rate for Payer: Cash Price |
$3,245.07
|
| Rate for Payer: Cigna Commercial |
$5,386.82
|
| Rate for Payer: First Health Commercial |
$6,165.64
|
| Rate for Payer: Humana Commercial |
$5,516.63
|
| Rate for Payer: Humana KY Medicaid |
$2,231.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,254.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,321.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,789.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,947.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,276.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,711.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,867.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,298.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,011.95
|
| Rate for Payer: PHCS Commercial |
$6,230.54
|
| Rate for Payer: United Healthcare All Payer |
$5,711.33
|
|
|
PLATE TUBULAR 1/3 2H*23MM
|
Facility
|
IP
|
$2,107.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.92 |
| Max. Negotiated Rate |
$2,022.80 |
| Rate for Payer: Aetna Commercial |
$1,622.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,643.52
|
| Rate for Payer: Cash Price |
$1,053.54
|
| Rate for Payer: Cigna Commercial |
$1,748.88
|
| Rate for Payer: First Health Commercial |
$2,001.73
|
| Rate for Payer: Humana Commercial |
$1,791.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,727.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,555.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,854.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,580.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.19
|
| Rate for Payer: PHCS Commercial |
$2,022.80
|
| Rate for Payer: United Healthcare All Payer |
$1,854.23
|
|
|
PLATE TUBULAR 1/3 2H*23MM
|
Facility
|
OP
|
$2,107.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.92 |
| Max. Negotiated Rate |
$2,022.80 |
| Rate for Payer: Aetna Commercial |
$1,622.45
|
| Rate for Payer: Anthem Medicaid |
$724.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,643.52
|
| Rate for Payer: Cash Price |
$1,053.54
|
| Rate for Payer: Cigna Commercial |
$1,748.88
|
| Rate for Payer: First Health Commercial |
$2,001.73
|
| Rate for Payer: Humana Commercial |
$1,791.02
|
| Rate for Payer: Humana KY Medicaid |
$724.62
|
| Rate for Payer: Kentucky WC Medicaid |
$732.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,727.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,555.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,854.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,580.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.19
|
| Rate for Payer: PHCS Commercial |
$2,022.80
|
| Rate for Payer: United Healthcare All Payer |
$1,854.23
|
|
|
PLATE TUBULAR 1/3 3H*35MM
|
Facility
|
OP
|
$3,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.23 |
| Max. Negotiated Rate |
$3,812.16 |
| Rate for Payer: Aetna Commercial |
$3,057.67
|
| Rate for Payer: Anthem Medicaid |
$1,365.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,097.38
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cigna Commercial |
$3,295.93
|
| Rate for Payer: First Health Commercial |
$3,772.45
|
| Rate for Payer: Humana Commercial |
$3,375.35
|
| Rate for Payer: Humana KY Medicaid |
$1,365.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,379.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,256.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,930.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,494.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,978.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.01
|
| Rate for Payer: PHCS Commercial |
$3,812.16
|
| Rate for Payer: United Healthcare All Payer |
$3,494.48
|
|
|
PLATE TUBULAR 1/3 3H*35MM
|
Facility
|
IP
|
$3,971.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.23 |
| Max. Negotiated Rate |
$3,812.16 |
| Rate for Payer: Aetna Commercial |
$3,057.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,097.38
|
| Rate for Payer: Cash Price |
$1,985.50
|
| Rate for Payer: Cigna Commercial |
$3,295.93
|
| Rate for Payer: First Health Commercial |
$3,772.45
|
| Rate for Payer: Humana Commercial |
$3,375.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,256.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,930.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,494.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,978.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.01
|
| Rate for Payer: PHCS Commercial |
$3,812.16
|
| Rate for Payer: United Healthcare All Payer |
$3,494.48
|
|
|
PLATE TUBULAR 1/3 4H*47MM
|
Facility
|
IP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 4H*47MM
|
Facility
|
OP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem Medicaid |
$744.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Humana KY Medicaid |
$744.47
|
| Rate for Payer: Kentucky WC Medicaid |
$752.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 5H*59MM
|
Facility
|
OP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Anthem Medicaid |
$744.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Humana KY Medicaid |
$744.47
|
| Rate for Payer: Kentucky WC Medicaid |
$752.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
| Rate for Payer: Aetna Commercial |
$1,666.90
|
|
|
PLATE TUBULAR 1/3 5H*59MM
|
Facility
|
IP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 6H*71MM
|
Facility
|
IP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 6H*71MM
|
Facility
|
OP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem Medicaid |
$744.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Humana KY Medicaid |
$744.47
|
| Rate for Payer: Kentucky WC Medicaid |
$752.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 7H*83MM
|
Facility
|
IP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 7H*83MM
|
Facility
|
OP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem Medicaid |
$744.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Humana KY Medicaid |
$744.47
|
| Rate for Payer: Kentucky WC Medicaid |
$752.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 8H*95MM
|
Facility
|
OP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem Medicaid |
$744.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Humana KY Medicaid |
$744.47
|
| Rate for Payer: Kentucky WC Medicaid |
$752.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$759.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 8H*95MM
|
Facility
|
IP
|
$2,164.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.42 |
| Max. Negotiated Rate |
$2,078.21 |
| Rate for Payer: Aetna Commercial |
$1,666.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,688.54
|
| Rate for Payer: Cash Price |
$1,082.40
|
| Rate for Payer: Cigna Commercial |
$1,796.78
|
| Rate for Payer: First Health Commercial |
$2,056.56
|
| Rate for Payer: Humana Commercial |
$1,840.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,775.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,597.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$649.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,905.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,623.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$671.09
|
| Rate for Payer: PHCS Commercial |
$2,078.21
|
| Rate for Payer: United Healthcare All Payer |
$1,905.02
|
|
|
PLATE TUBULAR 1/3 9H*107MM
|
Facility
|
OP
|
$3,760.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$488.86 |
| Max. Negotiated Rate |
$3,610.06 |
| Rate for Payer: Aetna Commercial |
$2,895.57
|
| Rate for Payer: Anthem Medicaid |
$1,293.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,933.17
|
| Rate for Payer: Cash Price |
$1,880.24
|
| Rate for Payer: Cigna Commercial |
$3,121.20
|
| Rate for Payer: First Health Commercial |
$3,572.46
|
| Rate for Payer: Humana Commercial |
$3,196.41
|
| Rate for Payer: Humana KY Medicaid |
$1,293.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,306.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,083.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,775.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,128.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,319.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,309.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,820.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$752.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$488.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,165.75
|
| Rate for Payer: PHCS Commercial |
$3,610.06
|
| Rate for Payer: United Healthcare All Payer |
$3,309.22
|
|
