|
PLATE TUBULAR 1/3 9H*107MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TUBULAR ONE-THIRD 10X121
|
Facility
|
IP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 10X121
|
Facility
|
OP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem Medicaid |
$521.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Humana KY Medicaid |
$521.17
|
| Rate for Payer: Kentucky WC Medicaid |
$526.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 2X25MM
|
Facility
|
OP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem Medicaid |
$398.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Humana KY Medicaid |
$398.42
|
| Rate for Payer: Kentucky WC Medicaid |
$402.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE TUBULAR ONE-THIRD 2X25MM
|
Facility
|
IP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE TUBULAR ONE-THIRD 3X37MM
|
Facility
|
OP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem Medicaid |
$383.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Humana KY Medicaid |
$383.26
|
| Rate for Payer: Kentucky WC Medicaid |
$387.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$390.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE TUBULAR ONE-THIRD 3X37MM
|
Facility
|
IP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
|
|
PLATE TUBULAR ONE-THIRD 4X49MM
|
Facility
|
OP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem Medicaid |
$398.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Humana KY Medicaid |
$398.42
|
| Rate for Payer: Kentucky WC Medicaid |
$402.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE TUBULAR ONE-THIRD 4X49MM
|
Facility
|
IP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE TUBULAR ONE-THIRD 5X61MM
|
Facility
|
IP
|
$1,565.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.07 |
| Rate for Payer: Aetna Commercial |
$1,205.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.25
|
| Rate for Payer: Cash Price |
$782.85
|
| Rate for Payer: Cigna Commercial |
$1,299.53
|
| Rate for Payer: First Health Commercial |
$1,487.42
|
| Rate for Payer: Humana Commercial |
$1,330.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.37
|
| Rate for Payer: PHCS Commercial |
$1,503.07
|
| Rate for Payer: United Healthcare All Payer |
$1,377.82
|
|
|
PLATE TUBULAR ONE-THIRD 5X61MM
|
Facility
|
OP
|
$1,565.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.07 |
| Rate for Payer: Aetna Commercial |
$1,205.59
|
| Rate for Payer: Anthem Medicaid |
$538.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.25
|
| Rate for Payer: Cash Price |
$782.85
|
| Rate for Payer: Cigna Commercial |
$1,299.53
|
| Rate for Payer: First Health Commercial |
$1,487.42
|
| Rate for Payer: Humana Commercial |
$1,330.84
|
| Rate for Payer: Humana KY Medicaid |
$538.44
|
| Rate for Payer: Kentucky WC Medicaid |
$543.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.37
|
| Rate for Payer: PHCS Commercial |
$1,503.07
|
| Rate for Payer: United Healthcare All Payer |
$1,377.82
|
|
|
PLATE TUBULAR ONE-THIRD 6X73MM
|
Facility
|
OP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem Medicaid |
$521.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Humana KY Medicaid |
$521.17
|
| Rate for Payer: Kentucky WC Medicaid |
$526.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 6X73MM
|
Facility
|
IP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 7X85MM
|
Facility
|
IP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 7X85MM
|
Facility
|
OP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Humana KY Medicaid |
$521.17
|
| Rate for Payer: Kentucky WC Medicaid |
$526.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem Medicaid |
$521.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
|
|
PLATE TUBULAR ONE-THIRD 8X97MM
|
Facility
|
OP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem Medicaid |
$521.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Humana KY Medicaid |
$521.17
|
| Rate for Payer: Kentucky WC Medicaid |
$526.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 8X97MM
|
Facility
|
IP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 9X109
|
Facility
|
OP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem Medicaid |
$521.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Humana KY Medicaid |
$521.17
|
| Rate for Payer: Kentucky WC Medicaid |
$526.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$531.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR ONE-THIRD 9X109
|
Facility
|
IP
|
$1,515.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$197.01 |
| Max. Negotiated Rate |
$1,454.85 |
| Rate for Payer: Aetna Commercial |
$1,166.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,182.07
|
| Rate for Payer: Cash Price |
$757.74
|
| Rate for Payer: Cigna Commercial |
$1,257.84
|
| Rate for Payer: First Health Commercial |
$1,439.70
|
| Rate for Payer: Humana Commercial |
$1,288.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,242.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,118.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$454.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,333.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,136.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$303.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$197.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$469.80
|
| Rate for Payer: PHCS Commercial |
$1,454.85
|
| Rate for Payer: United Healthcare All Payer |
$1,333.61
|
|
|
PLATE TUBULAR THRD 10H
|
Facility
|
OP
|
$3,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Aetna Commercial |
$2,448.60
|
| Rate for Payer: Anthem Medicaid |
$1,093.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.40
|
| Rate for Payer: Cash Price |
$1,590.00
|
| Rate for Payer: Cigna Commercial |
$2,639.40
|
| Rate for Payer: First Health Commercial |
$3,021.00
|
| Rate for Payer: Humana Commercial |
$2,703.00
|
| Rate for Payer: Humana KY Medicaid |
$1,093.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,104.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.80
|
| Rate for Payer: PHCS Commercial |
$3,052.80
|
| Rate for Payer: United Healthcare All Payer |
$2,798.40
|
|
|
PLATE TUBULAR THRD 10H
|
Facility
|
IP
|
$3,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.40 |
| Max. Negotiated Rate |
$3,052.80 |
| Rate for Payer: Aetna Commercial |
$2,448.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.40
|
| Rate for Payer: Cash Price |
$1,590.00
|
| Rate for Payer: Cigna Commercial |
$2,639.40
|
| Rate for Payer: First Health Commercial |
$3,021.00
|
| Rate for Payer: Humana Commercial |
$2,703.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$985.80
|
| Rate for Payer: PHCS Commercial |
$3,052.80
|
| Rate for Payer: United Healthcare All Payer |
$2,798.40
|
|
|
PLATE TUBULAR THRD 12H
|
Facility
|
IP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
PLATE TUBULAR THRD 12H
|
Facility
|
OP
|
$3,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.50 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$2,502.50
|
| Rate for Payer: Anthem Medicaid |
$1,117.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,535.00
|
| Rate for Payer: Cash Price |
$1,625.00
|
| Rate for Payer: Cigna Commercial |
$2,697.50
|
| Rate for Payer: First Health Commercial |
$3,087.50
|
| Rate for Payer: Humana Commercial |
$2,762.50
|
| Rate for Payer: Humana KY Medicaid |
$1,117.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,129.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,665.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,140.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,860.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,437.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.50
|
| Rate for Payer: PHCS Commercial |
$3,120.00
|
| Rate for Payer: United Healthcare All Payer |
$2,860.00
|
|
|
PLATE TUBULAR THRD 4H
|
Facility
|
OP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem Medicaid |
$748.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Humana KY Medicaid |
$748.63
|
| Rate for Payer: Kentucky WC Medicaid |
$756.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
|
PLATE TUBULAR THRD 4H
|
Facility
|
IP
|
$2,176.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.99 |
| Max. Negotiated Rate |
$2,089.80 |
| Rate for Payer: Aetna Commercial |
$1,676.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.97
|
| Rate for Payer: Cash Price |
$1,088.44
|
| Rate for Payer: Cigna Commercial |
$1,806.81
|
| Rate for Payer: First Health Commercial |
$2,068.04
|
| Rate for Payer: Humana Commercial |
$1,850.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.83
|
| Rate for Payer: PHCS Commercial |
$2,089.80
|
| Rate for Payer: United Healthcare All Payer |
$1,915.65
|
|
