|
PLATE SUPERIOR DECREASED 8H R
|
Facility
|
OP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem Medicaid |
$1,813.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Humana KY Medicaid |
$1,813.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE SUPERIOR DECREASED 8H R
|
Facility
|
IP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE SUPERIOR LATERAL 3H R
|
Facility
|
IP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE SUPERIOR LATERAL 3H R
|
Facility
|
OP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem Medicaid |
$1,813.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Humana KY Medicaid |
$1,813.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE SUPERIOR LATERAL 4H L
|
Facility
|
IP
|
$11,008.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,302.65 |
| Max. Negotiated Rate |
$10,568.47 |
| Rate for Payer: Aetna Commercial |
$8,476.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,586.88
|
| Rate for Payer: Cash Price |
$5,504.41
|
| Rate for Payer: Cigna Commercial |
$9,137.32
|
| Rate for Payer: First Health Commercial |
$10,458.38
|
| Rate for Payer: Humana Commercial |
$9,357.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,027.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,124.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,302.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,687.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,256.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,807.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,577.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,596.09
|
| Rate for Payer: PHCS Commercial |
$10,568.47
|
| Rate for Payer: United Healthcare All Payer |
$9,687.76
|
|
|
PLATE SUPERIOR LATERAL 4H L
|
Facility
|
OP
|
$11,008.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,302.65 |
| Max. Negotiated Rate |
$10,568.47 |
| Rate for Payer: Aetna Commercial |
$8,476.79
|
| Rate for Payer: Anthem Medicaid |
$3,785.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,586.88
|
| Rate for Payer: Cash Price |
$5,504.41
|
| Rate for Payer: Cigna Commercial |
$9,137.32
|
| Rate for Payer: First Health Commercial |
$10,458.38
|
| Rate for Payer: Humana Commercial |
$9,357.50
|
| Rate for Payer: Humana KY Medicaid |
$3,785.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,824.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,027.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,124.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,302.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,861.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,687.76
|
| Rate for Payer: Ohio Health Group HMO |
$8,256.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,807.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,577.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,596.09
|
| Rate for Payer: PHCS Commercial |
$10,568.47
|
| Rate for Payer: United Healthcare All Payer |
$9,687.76
|
|
|
PLATE SUPERIOR LATERAL 5H L
|
Facility
|
OP
|
$8,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,402.10 |
| Max. Negotiated Rate |
$7,686.72 |
| Rate for Payer: Aetna Commercial |
$6,165.39
|
| Rate for Payer: Anthem Medicaid |
$2,753.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,245.46
|
| Rate for Payer: Cash Price |
$4,003.50
|
| Rate for Payer: Cigna Commercial |
$6,645.81
|
| Rate for Payer: First Health Commercial |
$7,606.65
|
| Rate for Payer: Humana Commercial |
$6,805.95
|
| Rate for Payer: Humana KY Medicaid |
$2,753.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,781.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,565.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,909.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,402.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,808.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,046.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,005.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,966.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,524.83
|
| Rate for Payer: PHCS Commercial |
$7,686.72
|
| Rate for Payer: United Healthcare All Payer |
$7,046.16
|
|
|
PLATE SUPERIOR LATERAL 5H L
|
Facility
|
IP
|
$8,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,402.10 |
| Max. Negotiated Rate |
$7,686.72 |
| Rate for Payer: Aetna Commercial |
$6,165.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,245.46
|
| Rate for Payer: Cash Price |
$4,003.50
|
| Rate for Payer: Cigna Commercial |
$6,645.81
|
| Rate for Payer: First Health Commercial |
$7,606.65
|
| Rate for Payer: Humana Commercial |
$6,805.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,565.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,909.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,402.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,046.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,005.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,405.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,966.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,524.83
|
| Rate for Payer: PHCS Commercial |
$7,686.72
|
| Rate for Payer: United Healthcare All Payer |
$7,046.16
|
|
|
PLATE SUPERIOR LATERAL 7H R
|
Facility
|
OP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem Medicaid |
$2,889.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Humana KY Medicaid |
$2,889.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,918.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,947.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
PLATE SUPERIOR LATERAL 7H R
|
Facility
|
IP
|
$8,402.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,520.60 |
| Max. Negotiated Rate |
$8,065.92 |
| Rate for Payer: Aetna Commercial |
$6,469.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,553.56
|
| Rate for Payer: Cash Price |
$4,201.00
|
| Rate for Payer: Cigna Commercial |
$6,973.66
|
| Rate for Payer: First Health Commercial |
$7,981.90
|
| Rate for Payer: Humana Commercial |
$7,141.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,889.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,200.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,520.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,393.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,301.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,721.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,309.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,797.38
|
| Rate for Payer: PHCS Commercial |
$8,065.92
|
| Rate for Payer: United Healthcare All Payer |
$7,393.76
|
|
|
PLATE SUP MED LCK 8H*97MM LEFT
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE SUP MED LCK 8H*97MM LEFT
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE T 2.0MM 2X2 HOLE
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem Medicaid |
$391.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Humana KY Medicaid |
$391.01
|
| Rate for Payer: Kentucky WC Medicaid |
$394.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE T 2.0MM 2X2 HOLE
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE T 2.0MM 3X9 HOLE
|
Facility
|
OP
|
$2,125.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.72 |
| Max. Negotiated Rate |
$2,040.71 |
| Rate for Payer: Aetna Commercial |
$1,636.82
|
| Rate for Payer: Anthem Medicaid |
$731.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.08
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cigna Commercial |
$1,764.36
|
| Rate for Payer: First Health Commercial |
$2,019.45
|
| Rate for Payer: Humana Commercial |
$1,806.88
|
| Rate for Payer: Humana KY Medicaid |
$731.04
|
| Rate for Payer: Kentucky WC Medicaid |
$738.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.76
|
| Rate for Payer: PHCS Commercial |
$2,040.71
|
| Rate for Payer: United Healthcare All Payer |
$1,870.65
|
|
|
PLATE T 2.0MM 3X9 HOLE
|
Facility
|
IP
|
$2,125.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.72 |
| Max. Negotiated Rate |
$2,040.71 |
| Rate for Payer: Aetna Commercial |
$1,636.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,658.08
|
| Rate for Payer: Cash Price |
$1,062.87
|
| Rate for Payer: Cigna Commercial |
$1,764.36
|
| Rate for Payer: First Health Commercial |
$2,019.45
|
| Rate for Payer: Humana Commercial |
$1,806.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,743.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,568.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,870.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,594.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,849.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.76
|
| Rate for Payer: PHCS Commercial |
$2,040.71
|
| Rate for Payer: United Healthcare All Payer |
$1,870.65
|
|
|
PLATE T 2.0MM 4X9 HOLE
|
Facility
|
IP
|
$2,172.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.74 |
| Max. Negotiated Rate |
$2,085.58 |
| Rate for Payer: Aetna Commercial |
$1,672.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.53
|
| Rate for Payer: Cash Price |
$1,086.24
|
| Rate for Payer: Cigna Commercial |
$1,803.16
|
| Rate for Payer: First Health Commercial |
$2,063.86
|
| Rate for Payer: Humana Commercial |
$1,846.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,499.01
|
| Rate for Payer: PHCS Commercial |
$2,085.58
|
| Rate for Payer: United Healthcare All Payer |
$1,911.78
|
|
|
PLATE T 2.0MM 4X9 HOLE
|
Facility
|
OP
|
$2,172.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$651.74 |
| Max. Negotiated Rate |
$2,085.58 |
| Rate for Payer: Aetna Commercial |
$1,672.81
|
| Rate for Payer: Anthem Medicaid |
$747.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,694.53
|
| Rate for Payer: Cash Price |
$1,086.24
|
| Rate for Payer: Cigna Commercial |
$1,803.16
|
| Rate for Payer: First Health Commercial |
$2,063.86
|
| Rate for Payer: Humana Commercial |
$1,846.61
|
| Rate for Payer: Humana KY Medicaid |
$747.12
|
| Rate for Payer: Kentucky WC Medicaid |
$754.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,781.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,603.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$651.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,911.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,629.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,499.01
|
| Rate for Payer: PHCS Commercial |
$2,085.58
|
| Rate for Payer: United Healthcare All Payer |
$1,911.78
|
|
|
PLATE T 2.70MM
|
Facility
|
OP
|
$4,216.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.82 |
| Max. Negotiated Rate |
$4,047.42 |
| Rate for Payer: Aetna Commercial |
$3,246.37
|
| Rate for Payer: Anthem Medicaid |
$1,449.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,288.53
|
| Rate for Payer: Cash Price |
$2,108.03
|
| Rate for Payer: Cigna Commercial |
$3,499.33
|
| Rate for Payer: First Health Commercial |
$4,005.26
|
| Rate for Payer: Humana Commercial |
$3,583.65
|
| Rate for Payer: Humana KY Medicaid |
$1,449.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,464.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,457.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,111.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,478.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,710.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,162.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,372.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,667.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.08
|
| Rate for Payer: PHCS Commercial |
$4,047.42
|
| Rate for Payer: United Healthcare All Payer |
$3,710.13
|
|
|
PLATE T 2.70MM
|
Facility
|
IP
|
$4,216.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.82 |
| Max. Negotiated Rate |
$4,047.42 |
| Rate for Payer: Aetna Commercial |
$3,246.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,288.53
|
| Rate for Payer: Cash Price |
$2,108.03
|
| Rate for Payer: Cigna Commercial |
$3,499.33
|
| Rate for Payer: First Health Commercial |
$4,005.26
|
| Rate for Payer: Humana Commercial |
$3,583.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,457.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,111.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,264.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,710.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,162.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,372.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,667.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,909.08
|
| Rate for Payer: PHCS Commercial |
$4,047.42
|
| Rate for Payer: United Healthcare All Payer |
$3,710.13
|
|
|
PLATE T 2.7MM
|
Facility
|
IP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE T 2.7MM
|
Facility
|
OP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem Medicaid |
$398.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Humana KY Medicaid |
$398.06
|
| Rate for Payer: Kentucky WC Medicaid |
$402.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE T 3H HD 3H SHFT 3.5*50 R
|
Facility
|
IP
|
$2,222.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.71 |
| Max. Negotiated Rate |
$2,133.48 |
| Rate for Payer: Aetna Commercial |
$1,711.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.45
|
| Rate for Payer: Cash Price |
$1,111.19
|
| Rate for Payer: Cigna Commercial |
$1,844.57
|
| Rate for Payer: First Health Commercial |
$2,111.25
|
| Rate for Payer: Humana Commercial |
$1,889.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,955.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,666.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,933.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,533.44
|
| Rate for Payer: PHCS Commercial |
$2,133.48
|
| Rate for Payer: United Healthcare All Payer |
$1,955.69
|
|
|
PLATE T 3H HD 3H SHFT 3.5*50 R
|
Facility
|
OP
|
$2,222.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.71 |
| Max. Negotiated Rate |
$2,133.48 |
| Rate for Payer: Aetna Commercial |
$1,711.22
|
| Rate for Payer: Anthem Medicaid |
$764.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,733.45
|
| Rate for Payer: Cash Price |
$1,111.19
|
| Rate for Payer: Cigna Commercial |
$1,844.57
|
| Rate for Payer: First Health Commercial |
$2,111.25
|
| Rate for Payer: Humana Commercial |
$1,889.01
|
| Rate for Payer: Humana KY Medicaid |
$764.27
|
| Rate for Payer: Kentucky WC Medicaid |
$772.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,822.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,640.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$666.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$779.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,955.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,666.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,777.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,933.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,533.44
|
| Rate for Payer: PHCS Commercial |
$2,133.48
|
| Rate for Payer: United Healthcare All Payer |
$1,955.69
|
|
|
PLATE T 3H HD 3H SHT 3.5*52 OL
|
Facility
|
IP
|
$3,043.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.99 |
| Max. Negotiated Rate |
$2,921.56 |
| Rate for Payer: Aetna Commercial |
$2,343.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,373.77
|
| Rate for Payer: Cash Price |
$1,521.64
|
| Rate for Payer: Cigna Commercial |
$2,525.93
|
| Rate for Payer: First Health Commercial |
$2,891.13
|
| Rate for Payer: Humana Commercial |
$2,586.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,495.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,245.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$912.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,678.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,282.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,434.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,647.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,099.87
|
| Rate for Payer: PHCS Commercial |
$2,921.56
|
| Rate for Payer: United Healthcare All Payer |
$2,678.10
|
|
