|
PLATE SEMI-TUB PF 4H
|
Facility
|
OP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem Medicaid |
$519.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Humana KY Medicaid |
$519.84
|
| Rate for Payer: Kentucky WC Medicaid |
$525.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
PLATE SEMI-TUB PF 4H
|
Facility
|
IP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
PLATE SEMI-TUB PF 5H
|
Facility
|
IP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
PLATE SEMI-TUB PF 5H
|
Facility
|
OP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem Medicaid |
$519.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Humana KY Medicaid |
$519.84
|
| Rate for Payer: Kentucky WC Medicaid |
$525.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
PLATE SEMI-TUB PF 7H
|
Facility
|
IP
|
$1,566.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$1,503.48 |
| Rate for Payer: Aetna Commercial |
$1,205.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.58
|
| Rate for Payer: Cash Price |
$783.07
|
| Rate for Payer: Cigna Commercial |
$1,299.89
|
| Rate for Payer: First Health Commercial |
$1,487.82
|
| Rate for Payer: Humana Commercial |
$1,331.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,252.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,362.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,080.63
|
| Rate for Payer: PHCS Commercial |
$1,503.48
|
| Rate for Payer: United Healthcare All Payer |
$1,378.19
|
|
|
PLATE SEMI-TUB PF 7H
|
Facility
|
OP
|
$1,566.13
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$1,503.48 |
| Rate for Payer: Aetna Commercial |
$1,205.92
|
| Rate for Payer: Anthem Medicaid |
$538.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.58
|
| Rate for Payer: Cash Price |
$783.07
|
| Rate for Payer: Cigna Commercial |
$1,299.89
|
| Rate for Payer: First Health Commercial |
$1,487.82
|
| Rate for Payer: Humana Commercial |
$1,331.21
|
| Rate for Payer: Humana KY Medicaid |
$538.59
|
| Rate for Payer: Kentucky WC Medicaid |
$544.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,284.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,378.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,252.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,362.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,080.63
|
| Rate for Payer: PHCS Commercial |
$1,503.48
|
| Rate for Payer: United Healthcare All Payer |
$1,378.19
|
|
|
PLATE SEMI-TUBULAR 10X167MM
|
Facility
|
IP
|
$1,744.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.21 |
| Max. Negotiated Rate |
$1,674.27 |
| Rate for Payer: Aetna Commercial |
$1,342.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.34
|
| Rate for Payer: Cash Price |
$872.02
|
| Rate for Payer: Cigna Commercial |
$1,447.54
|
| Rate for Payer: First Health Commercial |
$1,656.83
|
| Rate for Payer: Humana Commercial |
$1,482.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.38
|
| Rate for Payer: PHCS Commercial |
$1,674.27
|
| Rate for Payer: United Healthcare All Payer |
$1,534.75
|
|
|
PLATE SEMI-TUBULAR 10X167MM
|
Facility
|
OP
|
$1,744.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$523.21 |
| Max. Negotiated Rate |
$1,674.27 |
| Rate for Payer: Aetna Commercial |
$1,342.90
|
| Rate for Payer: Anthem Medicaid |
$599.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,360.34
|
| Rate for Payer: Cash Price |
$872.02
|
| Rate for Payer: Cigna Commercial |
$1,447.54
|
| Rate for Payer: First Health Commercial |
$1,656.83
|
| Rate for Payer: Humana Commercial |
$1,482.43
|
| Rate for Payer: Humana KY Medicaid |
$599.77
|
| Rate for Payer: Kentucky WC Medicaid |
$605.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,430.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,287.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$523.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$611.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,534.75
|
| Rate for Payer: Ohio Health Group HMO |
$1,308.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,517.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.38
|
| Rate for Payer: PHCS Commercial |
$1,674.27
|
| Rate for Payer: United Healthcare All Payer |
$1,534.75
|
|
|
PLATE SEMI-TUBULAR 11X183MM
|
Facility
|
IP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
PLATE SEMI-TUBULAR 11X183MM
|
Facility
|
OP
|
$1,759.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.88 |
| Max. Negotiated Rate |
$1,689.23 |
| Rate for Payer: Aetna Commercial |
$1,354.90
|
| Rate for Payer: Anthem Medicaid |
$605.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.50
|
| Rate for Payer: Cash Price |
$879.80
|
| Rate for Payer: Cigna Commercial |
$1,460.48
|
| Rate for Payer: First Health Commercial |
$1,671.63
|
| Rate for Payer: Humana Commercial |
$1,495.67
|
| Rate for Payer: Humana KY Medicaid |
$605.13
|
| Rate for Payer: Kentucky WC Medicaid |
$611.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,214.13
|
| Rate for Payer: PHCS Commercial |
$1,689.23
|
| Rate for Payer: United Healthcare All Payer |
$1,548.46
|
|
|
PLATE SEMI-TUBULAR 12X183MM
|
Facility
|
OP
|
$1,775.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.56 |
| Max. Negotiated Rate |
$1,704.18 |
| Rate for Payer: Aetna Commercial |
$1,366.90
|
| Rate for Payer: Anthem Medicaid |
$610.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.65
|
| Rate for Payer: Cash Price |
$887.60
|
| Rate for Payer: Cigna Commercial |
$1,473.41
|
| Rate for Payer: First Health Commercial |
$1,686.43
|
| Rate for Payer: Humana Commercial |
$1,508.91
|
| Rate for Payer: Humana KY Medicaid |
$610.49
|
| Rate for Payer: Kentucky WC Medicaid |
$616.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,310.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.88
|
| Rate for Payer: PHCS Commercial |
$1,704.18
|
| Rate for Payer: United Healthcare All Payer |
$1,562.17
|
|
|
PLATE SEMI-TUBULAR 12X183MM
|
Facility
|
IP
|
$1,775.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.56 |
| Max. Negotiated Rate |
$1,704.18 |
| Rate for Payer: Aetna Commercial |
$1,366.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,384.65
|
| Rate for Payer: Cash Price |
$887.60
|
| Rate for Payer: Cigna Commercial |
$1,473.41
|
| Rate for Payer: First Health Commercial |
$1,686.43
|
| Rate for Payer: Humana Commercial |
$1,508.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,455.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,310.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,562.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,331.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,544.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,224.88
|
| Rate for Payer: PHCS Commercial |
$1,704.18
|
| Rate for Payer: United Healthcare All Payer |
$1,562.17
|
|
|
PLATE SEMI-TUBULAR 4X71MM
|
Facility
|
OP
|
$1,198.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$1,150.56 |
| Rate for Payer: Aetna Commercial |
$922.85
|
| Rate for Payer: Anthem Medicaid |
$412.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.83
|
| Rate for Payer: Cash Price |
$599.25
|
| Rate for Payer: Cigna Commercial |
$994.75
|
| Rate for Payer: First Health Commercial |
$1,138.58
|
| Rate for Payer: Humana Commercial |
$1,018.73
|
| Rate for Payer: Humana KY Medicaid |
$412.16
|
| Rate for Payer: Kentucky WC Medicaid |
$416.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.68
|
| Rate for Payer: Ohio Health Group HMO |
$898.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.97
|
| Rate for Payer: PHCS Commercial |
$1,150.56
|
| Rate for Payer: United Healthcare All Payer |
$1,054.68
|
|
|
PLATE SEMI-TUBULAR 4X71MM
|
Facility
|
IP
|
$1,198.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$1,150.56 |
| Rate for Payer: Aetna Commercial |
$922.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.83
|
| Rate for Payer: Cash Price |
$599.25
|
| Rate for Payer: Cigna Commercial |
$994.75
|
| Rate for Payer: First Health Commercial |
$1,138.58
|
| Rate for Payer: Humana Commercial |
$1,018.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.68
|
| Rate for Payer: Ohio Health Group HMO |
$898.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.97
|
| Rate for Payer: PHCS Commercial |
$1,150.56
|
| Rate for Payer: United Healthcare All Payer |
$1,054.68
|
|
|
PLATE SEMI-TUBULAR 5X87MM
|
Facility
|
OP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem Medicaid |
$415.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Humana KY Medicaid |
$415.69
|
| Rate for Payer: Kentucky WC Medicaid |
$419.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$424.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE SEMI-TUBULAR 5X87MM
|
Facility
|
IP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE SEMI-TUBULAR 6X103MM
|
Facility
|
IP
|
$1,488.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.47 |
| Max. Negotiated Rate |
$1,428.70 |
| Rate for Payer: Aetna Commercial |
$1,145.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.82
|
| Rate for Payer: Cash Price |
$744.12
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: First Health Commercial |
$1,413.82
|
| Rate for Payer: Humana Commercial |
$1,265.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$446.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.88
|
| Rate for Payer: PHCS Commercial |
$1,428.70
|
| Rate for Payer: United Healthcare All Payer |
$1,309.64
|
|
|
PLATE SEMI-TUBULAR 6X103MM
|
Facility
|
OP
|
$1,488.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.47 |
| Max. Negotiated Rate |
$1,428.70 |
| Rate for Payer: Aetna Commercial |
$1,145.94
|
| Rate for Payer: Anthem Medicaid |
$511.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.82
|
| Rate for Payer: Cash Price |
$744.12
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: First Health Commercial |
$1,413.82
|
| Rate for Payer: Humana Commercial |
$1,265.00
|
| Rate for Payer: Humana KY Medicaid |
$511.80
|
| Rate for Payer: Kentucky WC Medicaid |
$517.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$446.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$522.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.88
|
| Rate for Payer: PHCS Commercial |
$1,428.70
|
| Rate for Payer: United Healthcare All Payer |
$1,309.64
|
|
|
PLATE SEMI-TUBULAR 7X119MM
|
Facility
|
IP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
PLATE SEMI-TUBULAR 7X119MM
|
Facility
|
OP
|
$1,511.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$453.48 |
| Max. Negotiated Rate |
$1,451.14 |
| Rate for Payer: Aetna Commercial |
$1,163.93
|
| Rate for Payer: Anthem Medicaid |
$519.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,179.05
|
| Rate for Payer: Cash Price |
$755.80
|
| Rate for Payer: Cigna Commercial |
$1,254.63
|
| Rate for Payer: First Health Commercial |
$1,436.02
|
| Rate for Payer: Humana Commercial |
$1,284.86
|
| Rate for Payer: Humana KY Medicaid |
$519.84
|
| Rate for Payer: Kentucky WC Medicaid |
$525.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,239.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,115.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$453.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$530.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,330.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,133.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,209.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,315.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.00
|
| Rate for Payer: PHCS Commercial |
$1,451.14
|
| Rate for Payer: United Healthcare All Payer |
$1,330.21
|
|
|
PLATE SEMI-TUBULAR 8X135MM
|
Facility
|
OP
|
$1,705.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.52 |
| Max. Negotiated Rate |
$1,636.88 |
| Rate for Payer: Aetna Commercial |
$1,312.91
|
| Rate for Payer: Anthem Medicaid |
$586.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.96
|
| Rate for Payer: Cash Price |
$852.54
|
| Rate for Payer: Cigna Commercial |
$1,415.22
|
| Rate for Payer: First Health Commercial |
$1,619.83
|
| Rate for Payer: Humana Commercial |
$1,449.32
|
| Rate for Payer: Humana KY Medicaid |
$586.38
|
| Rate for Payer: Kentucky WC Medicaid |
$592.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.51
|
| Rate for Payer: PHCS Commercial |
$1,636.88
|
| Rate for Payer: United Healthcare All Payer |
$1,500.47
|
|
|
PLATE SEMI-TUBULAR 8X135MM
|
Facility
|
IP
|
$1,705.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.52 |
| Max. Negotiated Rate |
$1,636.88 |
| Rate for Payer: Aetna Commercial |
$1,312.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.96
|
| Rate for Payer: Cash Price |
$852.54
|
| Rate for Payer: Cigna Commercial |
$1,415.22
|
| Rate for Payer: First Health Commercial |
$1,619.83
|
| Rate for Payer: Humana Commercial |
$1,449.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.51
|
| Rate for Payer: PHCS Commercial |
$1,636.88
|
| Rate for Payer: United Healthcare All Payer |
$1,500.47
|
|
|
PLATE SEMI-TUBULAR 9X151MM
|
Facility
|
IP
|
$1,558.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.50 |
| Max. Negotiated Rate |
$1,496.01 |
| Rate for Payer: Aetna Commercial |
$1,199.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.51
|
| Rate for Payer: Cash Price |
$779.17
|
| Rate for Payer: Cigna Commercial |
$1,293.42
|
| Rate for Payer: First Health Commercial |
$1,480.42
|
| Rate for Payer: Humana Commercial |
$1,324.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,277.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,168.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,355.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.25
|
| Rate for Payer: PHCS Commercial |
$1,496.01
|
| Rate for Payer: United Healthcare All Payer |
$1,371.34
|
|
|
PLATE SEMI-TUBULAR 9X151MM
|
Facility
|
OP
|
$1,558.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.50 |
| Max. Negotiated Rate |
$1,496.01 |
| Rate for Payer: Aetna Commercial |
$1,199.92
|
| Rate for Payer: Anthem Medicaid |
$535.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.51
|
| Rate for Payer: Cash Price |
$779.17
|
| Rate for Payer: Cigna Commercial |
$1,293.42
|
| Rate for Payer: First Health Commercial |
$1,480.42
|
| Rate for Payer: Humana Commercial |
$1,324.59
|
| Rate for Payer: Humana KY Medicaid |
$535.91
|
| Rate for Payer: Kentucky WC Medicaid |
$541.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,277.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,168.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,355.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.25
|
| Rate for Payer: PHCS Commercial |
$1,496.01
|
| Rate for Payer: United Healthcare All Payer |
$1,371.34
|
|
|
PLATE SH FUSION TMT 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
|
|
