|
PLATE QUART TUB COMP 5 H 2.7MM
|
Facility
|
IP
|
$4,961.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.41 |
| Max. Negotiated Rate |
$4,762.92 |
| Rate for Payer: Aetna Commercial |
$3,820.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,869.88
|
| Rate for Payer: Cash Price |
$2,480.69
|
| Rate for Payer: Cigna Commercial |
$4,117.95
|
| Rate for Payer: First Health Commercial |
$4,713.31
|
| Rate for Payer: Humana Commercial |
$4,217.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,068.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,661.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,969.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,316.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,423.35
|
| Rate for Payer: PHCS Commercial |
$4,762.92
|
| Rate for Payer: United Healthcare All Payer |
$4,366.01
|
|
|
PLATE QUART TUB COMP 5 H 2.7MM
|
Facility
|
OP
|
$4,961.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,488.41 |
| Max. Negotiated Rate |
$4,762.92 |
| Rate for Payer: Aetna Commercial |
$3,820.26
|
| Rate for Payer: Anthem Medicaid |
$1,706.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,869.88
|
| Rate for Payer: Cash Price |
$2,480.69
|
| Rate for Payer: Cigna Commercial |
$4,117.95
|
| Rate for Payer: First Health Commercial |
$4,713.31
|
| Rate for Payer: Humana Commercial |
$4,217.17
|
| Rate for Payer: Humana KY Medicaid |
$1,706.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,723.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,068.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,661.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,488.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,740.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,366.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,721.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,969.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,316.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,423.35
|
| Rate for Payer: PHCS Commercial |
$4,762.92
|
| Rate for Payer: United Healthcare All Payer |
$4,366.01
|
|
|
PLATE QUART TUB COMP 7 H 2.7MM
|
Facility
|
OP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem Medicaid |
$1,757.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Humana KY Medicaid |
$1,757.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,775.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,792.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE QUART TUB COMP 7 H 2.7MM
|
Facility
|
IP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE RAD COL SMARTLOCK LONG
|
Facility
|
IP
|
$5,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.00 |
| Max. Negotiated Rate |
$5,404.80 |
| Rate for Payer: Aetna Commercial |
$4,335.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,391.40
|
| Rate for Payer: Cash Price |
$2,815.00
|
| Rate for Payer: Cigna Commercial |
$4,672.90
|
| Rate for Payer: First Health Commercial |
$5,348.50
|
| Rate for Payer: Humana Commercial |
$4,785.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,616.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,954.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,898.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,884.70
|
| Rate for Payer: PHCS Commercial |
$5,404.80
|
| Rate for Payer: United Healthcare All Payer |
$4,954.40
|
|
|
PLATE RAD COL SMARTLOCK LONG
|
Facility
|
OP
|
$5,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.00 |
| Max. Negotiated Rate |
$5,404.80 |
| Rate for Payer: Aetna Commercial |
$4,335.10
|
| Rate for Payer: Anthem Medicaid |
$1,936.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,391.40
|
| Rate for Payer: Cash Price |
$2,815.00
|
| Rate for Payer: Cigna Commercial |
$4,672.90
|
| Rate for Payer: First Health Commercial |
$5,348.50
|
| Rate for Payer: Humana Commercial |
$4,785.50
|
| Rate for Payer: Humana KY Medicaid |
$1,936.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,955.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,616.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,954.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,898.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,884.70
|
| Rate for Payer: PHCS Commercial |
$5,404.80
|
| Rate for Payer: United Healthcare All Payer |
$4,954.40
|
|
|
PLATE RAD COL SMARTLOCK SHORT
|
Facility
|
OP
|
$5,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.00 |
| Max. Negotiated Rate |
$5,404.80 |
| Rate for Payer: Aetna Commercial |
$4,335.10
|
| Rate for Payer: Anthem Medicaid |
$1,936.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,391.40
|
| Rate for Payer: Cash Price |
$2,815.00
|
| Rate for Payer: Cigna Commercial |
$4,672.90
|
| Rate for Payer: First Health Commercial |
$5,348.50
|
| Rate for Payer: Humana Commercial |
$4,785.50
|
| Rate for Payer: Humana KY Medicaid |
$1,936.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,955.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,616.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,975.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,954.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,898.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,884.70
|
| Rate for Payer: PHCS Commercial |
$5,404.80
|
| Rate for Payer: United Healthcare All Payer |
$4,954.40
|
|
|
PLATE RAD COL SMARTLOCK SHORT
|
Facility
|
IP
|
$5,630.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.00 |
| Max. Negotiated Rate |
$5,404.80 |
| Rate for Payer: Aetna Commercial |
$4,335.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,391.40
|
| Rate for Payer: Cash Price |
$2,815.00
|
| Rate for Payer: Cigna Commercial |
$4,672.90
|
| Rate for Payer: First Health Commercial |
$5,348.50
|
| Rate for Payer: Humana Commercial |
$4,785.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,616.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,154.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,954.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,222.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,504.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,898.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,884.70
|
| Rate for Payer: PHCS Commercial |
$5,404.80
|
| Rate for Payer: United Healthcare All Payer |
$4,954.40
|
|
|
PLATE RAD HD LCKG CURV 3H SM
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RAD HD LCKG CURV 3H SM
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RAD HD LCKG CURV 3H STD
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RAD HD LCKG CURV 3H STD
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RAD HD LCKG CURV 5H SM
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RAD HD LCKG CURV 5H SM
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RAD HD LCKG CURV 5H STD
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RAD HD LCKG CURV 5H STD
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE RADIAL STYLD DIS RAD 5H
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE RADIAL STYLD DIS RAD 5H
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE RB LK TI 2.3M 32H T 1.5M
|
Facility
|
OP
|
$7,781.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,334.34 |
| Max. Negotiated Rate |
$7,469.89 |
| Rate for Payer: Aetna Commercial |
$5,991.48
|
| Rate for Payer: Anthem Medicaid |
$2,675.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,069.29
|
| Rate for Payer: Cash Price |
$3,890.57
|
| Rate for Payer: Cigna Commercial |
$6,458.35
|
| Rate for Payer: First Health Commercial |
$7,392.08
|
| Rate for Payer: Humana Commercial |
$6,613.97
|
| Rate for Payer: Humana KY Medicaid |
$2,675.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,380.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,742.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,729.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,847.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,835.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,224.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,769.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,368.99
|
| Rate for Payer: PHCS Commercial |
$7,469.89
|
| Rate for Payer: United Healthcare All Payer |
$6,847.40
|
|
|
PLATE RB LK TI 2.3M 32H T 1.5M
|
Facility
|
IP
|
$7,781.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,334.34 |
| Max. Negotiated Rate |
$7,469.89 |
| Rate for Payer: Aetna Commercial |
$5,991.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,069.29
|
| Rate for Payer: Cash Price |
$3,890.57
|
| Rate for Payer: Cigna Commercial |
$6,458.35
|
| Rate for Payer: First Health Commercial |
$7,392.08
|
| Rate for Payer: Humana Commercial |
$6,613.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,380.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,742.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,847.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,835.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,224.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,769.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,368.99
|
| Rate for Payer: PHCS Commercial |
$7,469.89
|
| Rate for Payer: United Healthcare All Payer |
$6,847.40
|
|
|
PLATE RD WR W/SM STP 1.25*150
|
Facility
|
IP
|
$1,915.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.68 |
| Max. Negotiated Rate |
$1,838.98 |
| Rate for Payer: Aetna Commercial |
$1,475.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,494.17
|
| Rate for Payer: Cash Price |
$957.80
|
| Rate for Payer: Cigna Commercial |
$1,589.95
|
| Rate for Payer: First Health Commercial |
$1,819.82
|
| Rate for Payer: Humana Commercial |
$1,628.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.76
|
| Rate for Payer: PHCS Commercial |
$1,838.98
|
| Rate for Payer: United Healthcare All Payer |
$1,685.73
|
|
|
PLATE RD WR W/SM STP 1.25*150
|
Facility
|
OP
|
$1,915.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.68 |
| Max. Negotiated Rate |
$1,838.98 |
| Rate for Payer: Aetna Commercial |
$1,475.01
|
| Rate for Payer: Anthem Medicaid |
$658.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,494.17
|
| Rate for Payer: Cash Price |
$957.80
|
| Rate for Payer: Cigna Commercial |
$1,589.95
|
| Rate for Payer: First Health Commercial |
$1,819.82
|
| Rate for Payer: Humana Commercial |
$1,628.26
|
| Rate for Payer: Humana KY Medicaid |
$658.77
|
| Rate for Payer: Kentucky WC Medicaid |
$665.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$671.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.76
|
| Rate for Payer: PHCS Commercial |
$1,838.98
|
| Rate for Payer: United Healthcare All Payer |
$1,685.73
|
|
|
PLATE REC 10H 3.5*118
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,074.75 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.47
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,866.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,116.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.93
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE REC 10H 3.5*118
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,074.75 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.53
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.47
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,866.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,116.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,471.93
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE RECON 11 HOLE
|
Facility
|
OP
|
$12,873.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,861.95 |
| Max. Negotiated Rate |
$12,358.25 |
| Rate for Payer: Aetna Commercial |
$9,912.35
|
| Rate for Payer: Anthem Medicaid |
$4,427.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,041.08
|
| Rate for Payer: Cash Price |
$6,436.59
|
| Rate for Payer: Cigna Commercial |
$10,684.74
|
| Rate for Payer: First Health Commercial |
$12,229.52
|
| Rate for Payer: Humana Commercial |
$10,942.20
|
| Rate for Payer: Humana KY Medicaid |
$4,427.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,472.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,556.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,515.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,298.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,199.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,882.49
|
| Rate for Payer: PHCS Commercial |
$12,358.25
|
| Rate for Payer: United Healthcare All Payer |
$11,328.40
|
|
