|
PLATE WDE LCK HD VDR 5H 86MM R
|
Facility
|
IP
|
$5,184.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.05 |
| Max. Negotiated Rate |
$4,977.58 |
| Rate for Payer: Aetna Commercial |
$3,992.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,044.28
|
| Rate for Payer: Cash Price |
$2,592.49
|
| Rate for Payer: Cigna Commercial |
$4,303.53
|
| Rate for Payer: First Health Commercial |
$4,925.73
|
| Rate for Payer: Humana Commercial |
$4,407.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,251.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,826.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,562.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,888.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,607.34
|
| Rate for Payer: PHCS Commercial |
$4,977.58
|
| Rate for Payer: United Healthcare All Payer |
$4,562.78
|
|
|
PLATE WDE V-D-R HD LK 3 62MM L
|
Facility
|
IP
|
$5,016.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$4,815.96 |
| Rate for Payer: Aetna Commercial |
$3,862.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,912.96
|
| Rate for Payer: Cash Price |
$2,508.31
|
| Rate for Payer: Cigna Commercial |
$4,163.79
|
| Rate for Payer: First Health Commercial |
$4,765.79
|
| Rate for Payer: Humana Commercial |
$4,264.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,113.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,702.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,414.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,762.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,555.15
|
| Rate for Payer: PHCS Commercial |
$4,815.96
|
| Rate for Payer: United Healthcare All Payer |
$4,414.63
|
|
|
PLATE WDE V-D-R HD LK 3 62MM L
|
Facility
|
OP
|
$5,016.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$4,815.96 |
| Rate for Payer: Anthem Medicaid |
$1,725.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,912.96
|
| Rate for Payer: Cash Price |
$2,508.31
|
| Rate for Payer: Cigna Commercial |
$4,163.79
|
| Rate for Payer: First Health Commercial |
$4,765.79
|
| Rate for Payer: Humana Commercial |
$4,264.13
|
| Rate for Payer: Humana KY Medicaid |
$1,725.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,742.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,113.63
|
| Rate for Payer: Aetna Commercial |
$3,862.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,702.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,414.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,762.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,555.15
|
| Rate for Payer: PHCS Commercial |
$4,815.96
|
| Rate for Payer: United Healthcare All Payer |
$4,414.63
|
|
|
PLATE WDE V-D-R HD LK 5 86MM L
|
Facility
|
IP
|
$5,184.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.05 |
| Max. Negotiated Rate |
$4,977.58 |
| Rate for Payer: Aetna Commercial |
$3,992.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,044.28
|
| Rate for Payer: Cash Price |
$2,592.49
|
| Rate for Payer: Cigna Commercial |
$4,303.53
|
| Rate for Payer: First Health Commercial |
$4,925.73
|
| Rate for Payer: Humana Commercial |
$4,407.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,251.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,826.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,562.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,888.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,607.34
|
| Rate for Payer: PHCS Commercial |
$4,977.58
|
| Rate for Payer: United Healthcare All Payer |
$4,562.78
|
|
|
PLATE WDE V-D-R HD LK 5 86MM L
|
Facility
|
OP
|
$5,184.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.05 |
| Max. Negotiated Rate |
$4,977.58 |
| Rate for Payer: Aetna Commercial |
$3,992.43
|
| Rate for Payer: Anthem Medicaid |
$1,783.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,044.28
|
| Rate for Payer: Cash Price |
$2,592.49
|
| Rate for Payer: Cigna Commercial |
$4,303.53
|
| Rate for Payer: First Health Commercial |
$4,925.73
|
| Rate for Payer: Humana Commercial |
$4,407.23
|
| Rate for Payer: Humana KY Medicaid |
$1,783.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,251.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,826.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,818.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,562.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,888.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,607.34
|
| Rate for Payer: PHCS Commercial |
$4,977.58
|
| Rate for Payer: United Healthcare All Payer |
$4,562.78
|
|
|
PLATE WEDGED PROFILE
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
PLATE WEDGED PROFILE
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
PLATE WRIST FUSION SHRT BND 12
|
Facility
|
OP
|
$13,315.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.03 |
| Max. Negotiated Rate |
$12,782.98 |
| Rate for Payer: Aetna Commercial |
$10,253.01
|
| Rate for Payer: Anthem Medicaid |
$4,579.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,386.17
|
| Rate for Payer: Cash Price |
$6,657.80
|
| Rate for Payer: Cigna Commercial |
$11,051.95
|
| Rate for Payer: First Health Commercial |
$12,649.82
|
| Rate for Payer: Humana Commercial |
$11,318.26
|
| Rate for Payer: Humana KY Medicaid |
$4,579.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4,625.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,918.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,826.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,994.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,671.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,717.73
|
| Rate for Payer: Ohio Health Group HMO |
$9,986.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,127.84
|
| Rate for Payer: PHCS Commercial |
$12,782.98
|
| Rate for Payer: United Healthcare All Payer |
$11,717.73
|
|
|
PLATE WRIST FUSION SHRT BND 12
|
Facility
|
IP
|
$13,315.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,731.03 |
| Max. Negotiated Rate |
$12,782.98 |
| Rate for Payer: Aetna Commercial |
$10,253.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,386.17
|
| Rate for Payer: Cash Price |
$6,657.80
|
| Rate for Payer: Cigna Commercial |
$11,051.95
|
| Rate for Payer: First Health Commercial |
$12,649.82
|
| Rate for Payer: Humana Commercial |
$11,318.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,918.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,826.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,994.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,717.73
|
| Rate for Payer: Ohio Health Group HMO |
$9,986.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,663.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,731.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,127.84
|
| Rate for Payer: PHCS Commercial |
$12,782.98
|
| Rate for Payer: United Healthcare All Payer |
$11,717.73
|
|
|
PLATE WRIST FUSION STR 120MM
|
Facility
|
OP
|
$9,515.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.97 |
| Max. Negotiated Rate |
$9,134.52 |
| Rate for Payer: Aetna Commercial |
$7,326.64
|
| Rate for Payer: Anthem Medicaid |
$3,272.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.79
|
| Rate for Payer: Cash Price |
$4,757.56
|
| Rate for Payer: Cigna Commercial |
$7,897.55
|
| Rate for Payer: First Health Commercial |
$9,039.36
|
| Rate for Payer: Humana Commercial |
$8,087.85
|
| Rate for Payer: Humana KY Medicaid |
$3,272.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.69
|
| Rate for Payer: PHCS Commercial |
$9,134.52
|
| Rate for Payer: United Healthcare All Payer |
$8,373.31
|
|
|
PLATE WRIST FUSION STR 120MM
|
Facility
|
IP
|
$9,515.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.97 |
| Max. Negotiated Rate |
$9,134.52 |
| Rate for Payer: Aetna Commercial |
$7,326.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.79
|
| Rate for Payer: Cash Price |
$4,757.56
|
| Rate for Payer: Cigna Commercial |
$7,897.55
|
| Rate for Payer: First Health Commercial |
$9,039.36
|
| Rate for Payer: Humana Commercial |
$8,087.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.69
|
| Rate for Payer: PHCS Commercial |
$9,134.52
|
| Rate for Payer: United Healthcare All Payer |
$8,373.31
|
|
|
PLATE WRIST FUSN STD BEND 120M
|
Facility
|
OP
|
$9,515.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.97 |
| Max. Negotiated Rate |
$9,134.52 |
| Rate for Payer: Aetna Commercial |
$7,326.64
|
| Rate for Payer: Anthem Medicaid |
$3,272.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.79
|
| Rate for Payer: Cash Price |
$4,757.56
|
| Rate for Payer: Cigna Commercial |
$7,897.55
|
| Rate for Payer: First Health Commercial |
$9,039.36
|
| Rate for Payer: Humana Commercial |
$8,087.85
|
| Rate for Payer: Humana KY Medicaid |
$3,272.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,337.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.69
|
| Rate for Payer: PHCS Commercial |
$9,134.52
|
| Rate for Payer: United Healthcare All Payer |
$8,373.31
|
|
|
PLATE WRIST FUSN STD BEND 120M
|
Facility
|
IP
|
$9,515.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.97 |
| Max. Negotiated Rate |
$9,134.52 |
| Rate for Payer: Aetna Commercial |
$7,326.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,421.79
|
| Rate for Payer: Cash Price |
$4,757.56
|
| Rate for Payer: Cigna Commercial |
$7,897.55
|
| Rate for Payer: First Health Commercial |
$9,039.36
|
| Rate for Payer: Humana Commercial |
$8,087.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,802.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,373.31
|
| Rate for Payer: Ohio Health Group HMO |
$7,136.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.69
|
| Rate for Payer: PHCS Commercial |
$9,134.52
|
| Rate for Payer: United Healthcare All Payer |
$8,373.31
|
|
|
PLATE WRIST SPANNING TI
|
Facility
|
OP
|
$9,351.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.73 |
| Max. Negotiated Rate |
$8,977.68 |
| Rate for Payer: Aetna Commercial |
$7,200.85
|
| Rate for Payer: Anthem Medicaid |
$3,216.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.36
|
| Rate for Payer: Cash Price |
$4,675.88
|
| Rate for Payer: Cigna Commercial |
$7,761.95
|
| Rate for Payer: First Health Commercial |
$8,884.16
|
| Rate for Payer: Humana Commercial |
$7,948.99
|
| Rate for Payer: Humana KY Medicaid |
$3,216.07
|
| Rate for Payer: Kentucky WC Medicaid |
$3,248.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,668.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,229.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,870.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,899.04
|
| Rate for Payer: PHCS Commercial |
$8,977.68
|
| Rate for Payer: United Healthcare All Payer |
$8,229.54
|
|
|
PLATE WRIST SPANNING TI
|
Facility
|
IP
|
$9,351.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.73 |
| Max. Negotiated Rate |
$8,977.68 |
| Rate for Payer: Aetna Commercial |
$7,200.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.36
|
| Rate for Payer: Cash Price |
$4,675.88
|
| Rate for Payer: Cigna Commercial |
$7,761.95
|
| Rate for Payer: First Health Commercial |
$8,884.16
|
| Rate for Payer: Humana Commercial |
$7,948.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,668.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,901.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,229.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,013.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,870.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,215.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,899.04
|
| Rate for Payer: PHCS Commercial |
$8,977.68
|
| Rate for Payer: United Healthcare All Payer |
$8,229.54
|
|
|
PLATE X LARGE 3.0MM TI
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE X LARGE 3.0MM TI
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE X MED 3.0MM TI
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE X MED 3.0MM TI
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE X SM 2.4MM TI
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE X SM 2.4MM TI
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE Y FRAGMENT
|
Facility
|
IP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
PLATE Y FRAGMENT
|
Facility
|
OP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
PLATE Y PROFYLE 90D 2.3 7H
|
Facility
|
IP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
|
PLATE Y PROFYLE 90D 2.3 7H
|
Facility
|
OP
|
$3,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.92 |
| Max. Negotiated Rate |
$3,536.64 |
| Rate for Payer: Aetna Commercial |
$2,836.68
|
| Rate for Payer: Anthem Medicaid |
$1,266.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,873.52
|
| Rate for Payer: Cash Price |
$1,842.00
|
| Rate for Payer: Cigna Commercial |
$3,057.72
|
| Rate for Payer: First Health Commercial |
$3,499.80
|
| Rate for Payer: Humana Commercial |
$3,131.40
|
| Rate for Payer: Humana KY Medicaid |
$1,266.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,020.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,718.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,241.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,763.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,142.04
|
| Rate for Payer: PHCS Commercial |
$3,536.64
|
| Rate for Payer: United Healthcare All Payer |
$3,241.92
|
|
