|
PLATE SH FUSION TMT 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 SHORT CONN 10H 115MM
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
PLATE SHORT CONN 10H 115MM
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem Medicaid |
$669.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Humana KY Medicaid |
$669.23
|
| Rate for Payer: Kentucky WC Medicaid |
$676.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
PLATE SHORT CONN 2H 35MM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 2H 35MM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 3H 45MM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 3H 45MM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 4H 55MM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 4H 55MM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 5H 65MM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 5H 65MM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 6H 75MM
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 6H 75MM
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE SHORT CONN 7H 85MM
|
Facility
|
IP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE SHORT CONN 7H 85MM
|
Facility
|
OP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem Medicaid |
$632.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Humana KY Medicaid |
$632.64
|
| Rate for Payer: Kentucky WC Medicaid |
$639.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE SHORT CONN 8H 95MM
|
Facility
|
IP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE SHORT CONN 8H 95MM
|
Facility
|
OP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem Medicaid |
$632.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Humana KY Medicaid |
$632.64
|
| Rate for Payer: Kentucky WC Medicaid |
$639.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE SHORT CONN 9H 105MM
|
Facility
|
IP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE SHORT CONN 9H 105MM
|
Facility
|
OP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem Medicaid |
$632.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Humana KY Medicaid |
$632.64
|
| Rate for Payer: Kentucky WC Medicaid |
$639.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE SM 3.5MM 14X169MM
|
Facility
|
IP
|
$3,437.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.27 |
| Max. Negotiated Rate |
$3,300.06 |
| Rate for Payer: Aetna Commercial |
$2,646.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,681.30
|
| Rate for Payer: Cash Price |
$1,718.78
|
| Rate for Payer: Cigna Commercial |
$2,853.17
|
| Rate for Payer: First Health Commercial |
$3,265.68
|
| Rate for Payer: Humana Commercial |
$2,921.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,818.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,536.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,025.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,578.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,750.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,990.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,371.92
|
| Rate for Payer: PHCS Commercial |
$3,300.06
|
| Rate for Payer: United Healthcare All Payer |
$3,025.05
|
|
|
PLATE SM 3.5MM 14X169MM
|
Facility
|
OP
|
$3,437.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.27 |
| Max. Negotiated Rate |
$3,300.06 |
| Rate for Payer: Aetna Commercial |
$2,646.92
|
| Rate for Payer: Anthem Medicaid |
$1,182.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,681.30
|
| Rate for Payer: Cash Price |
$1,718.78
|
| Rate for Payer: Cigna Commercial |
$2,853.17
|
| Rate for Payer: First Health Commercial |
$3,265.68
|
| Rate for Payer: Humana Commercial |
$2,921.93
|
| Rate for Payer: Humana KY Medicaid |
$1,182.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,818.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,536.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,205.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,025.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,578.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,750.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,990.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,371.92
|
| Rate for Payer: PHCS Commercial |
$3,300.06
|
| Rate for Payer: United Healthcare All Payer |
$3,025.05
|
|
|
PLATE SM 3.5MM 16X194MM
|
Facility
|
OP
|
$3,652.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.84 |
| Max. Negotiated Rate |
$3,506.70 |
| Rate for Payer: Aetna Commercial |
$2,812.66
|
| Rate for Payer: Anthem Medicaid |
$1,256.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,849.19
|
| Rate for Payer: Cash Price |
$1,826.41
|
| Rate for Payer: Cigna Commercial |
$3,031.83
|
| Rate for Payer: First Health Commercial |
$3,470.17
|
| Rate for Payer: Humana Commercial |
$3,104.89
|
| Rate for Payer: Humana KY Medicaid |
$1,256.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,995.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,214.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,922.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.44
|
| Rate for Payer: PHCS Commercial |
$3,506.70
|
| Rate for Payer: United Healthcare All Payer |
$3,214.47
|
|
|
PLATE SM 3.5MM 16X194MM
|
Facility
|
IP
|
$3,652.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.84 |
| Max. Negotiated Rate |
$3,506.70 |
| Rate for Payer: Aetna Commercial |
$2,812.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,849.19
|
| Rate for Payer: Cash Price |
$1,826.41
|
| Rate for Payer: Cigna Commercial |
$3,031.83
|
| Rate for Payer: First Health Commercial |
$3,470.17
|
| Rate for Payer: Humana Commercial |
$3,104.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,995.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,214.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,922.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.44
|
| Rate for Payer: PHCS Commercial |
$3,506.70
|
| Rate for Payer: United Healthcare All Payer |
$3,214.47
|
|
|
PLATE SM 3.5MM 18X217MM
|
Facility
|
OP
|
$4,229.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.81 |
| Max. Negotiated Rate |
$4,060.20 |
| Rate for Payer: Aetna Commercial |
$3,256.62
|
| Rate for Payer: Anthem Medicaid |
$1,454.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,298.92
|
| Rate for Payer: Cash Price |
$2,114.69
|
| Rate for Payer: Cigna Commercial |
$3,510.39
|
| Rate for Payer: First Health Commercial |
$4,017.91
|
| Rate for Payer: Humana Commercial |
$3,594.97
|
| Rate for Payer: Humana KY Medicaid |
$1,454.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,721.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,383.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,679.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,918.27
|
| Rate for Payer: PHCS Commercial |
$4,060.20
|
| Rate for Payer: United Healthcare All Payer |
$3,721.85
|
|
|
PLATE SM 3.5MM 18X217MM
|
Facility
|
IP
|
$4,229.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.81 |
| Max. Negotiated Rate |
$4,060.20 |
| Rate for Payer: Aetna Commercial |
$3,256.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,298.92
|
| Rate for Payer: Cash Price |
$2,114.69
|
| Rate for Payer: Cigna Commercial |
$3,510.39
|
| Rate for Payer: First Health Commercial |
$4,017.91
|
| Rate for Payer: Humana Commercial |
$3,594.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,721.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,383.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,679.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,918.27
|
| Rate for Payer: PHCS Commercial |
$4,060.20
|
| Rate for Payer: United Healthcare All Payer |
$3,721.85
|
|
