|
PLATE T 4.5 LCP 8H 147MM
|
Facility
|
IP
|
$4,322.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,296.80 |
| Max. Negotiated Rate |
$4,149.77 |
| Rate for Payer: Aetna Commercial |
$3,328.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,371.69
|
| Rate for Payer: Cash Price |
$2,161.34
|
| Rate for Payer: Cigna Commercial |
$3,587.82
|
| Rate for Payer: First Health Commercial |
$4,106.55
|
| Rate for Payer: Humana Commercial |
$3,674.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,544.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,190.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,803.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,242.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,760.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.65
|
| Rate for Payer: PHCS Commercial |
$4,149.77
|
| Rate for Payer: United Healthcare All Payer |
$3,803.96
|
|
|
PLATE T 4.5 LCP 8H 147MM
|
Facility
|
OP
|
$4,322.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,296.80 |
| Max. Negotiated Rate |
$4,149.77 |
| Rate for Payer: Aetna Commercial |
$3,328.46
|
| Rate for Payer: Anthem Medicaid |
$1,486.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,371.69
|
| Rate for Payer: Cash Price |
$2,161.34
|
| Rate for Payer: Cigna Commercial |
$3,587.82
|
| Rate for Payer: First Health Commercial |
$4,106.55
|
| Rate for Payer: Humana Commercial |
$3,674.28
|
| Rate for Payer: Humana KY Medicaid |
$1,486.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,501.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,544.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,190.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,516.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,803.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,242.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,458.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,760.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.65
|
| Rate for Payer: PHCS Commercial |
$4,149.77
|
| Rate for Payer: United Healthcare All Payer |
$3,803.96
|
|
|
PLATE T 4H HD 4H SHFT 3.5*56R
|
Facility
|
OP
|
$3,187.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.25 |
| Max. Negotiated Rate |
$3,060.01 |
| Rate for Payer: Aetna Commercial |
$2,454.38
|
| Rate for Payer: Anthem Medicaid |
$1,096.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,486.26
|
| Rate for Payer: Cash Price |
$1,593.76
|
| Rate for Payer: Cigna Commercial |
$2,645.63
|
| Rate for Payer: First Health Commercial |
$3,028.13
|
| Rate for Payer: Humana Commercial |
$2,709.38
|
| Rate for Payer: Humana KY Medicaid |
$1,096.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,107.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,118.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,805.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,773.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.38
|
| Rate for Payer: PHCS Commercial |
$3,060.01
|
| Rate for Payer: United Healthcare All Payer |
$2,805.01
|
|
|
PLATE T 4H HD 4H SHFT 3.5*56R
|
Facility
|
IP
|
$3,187.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.25 |
| Max. Negotiated Rate |
$3,060.01 |
| Rate for Payer: Aetna Commercial |
$2,454.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,486.26
|
| Rate for Payer: Cash Price |
$1,593.76
|
| Rate for Payer: Cigna Commercial |
$2,645.63
|
| Rate for Payer: First Health Commercial |
$3,028.13
|
| Rate for Payer: Humana Commercial |
$2,709.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,805.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,773.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.38
|
| Rate for Payer: PHCS Commercial |
$3,060.01
|
| Rate for Payer: United Healthcare All Payer |
$2,805.01
|
|
|
PLATE T 4H HD 6H SHFT 3.5* 78R
|
Facility
|
OP
|
$3,815.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.68 |
| Max. Negotiated Rate |
$3,662.98 |
| Rate for Payer: Aetna Commercial |
$2,938.01
|
| Rate for Payer: Anthem Medicaid |
$1,312.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,976.17
|
| Rate for Payer: Cash Price |
$1,907.80
|
| Rate for Payer: Cigna Commercial |
$3,166.95
|
| Rate for Payer: First Health Commercial |
$3,624.82
|
| Rate for Payer: Humana Commercial |
$3,243.26
|
| Rate for Payer: Humana KY Medicaid |
$1,312.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,325.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,128.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,815.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,338.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,357.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,861.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,052.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,319.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.76
|
| Rate for Payer: PHCS Commercial |
$3,662.98
|
| Rate for Payer: United Healthcare All Payer |
$3,357.73
|
|
|
PLATE T 4H HD 6H SHFT 3.5* 78R
|
Facility
|
IP
|
$3,815.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,144.68 |
| Max. Negotiated Rate |
$3,662.98 |
| Rate for Payer: Aetna Commercial |
$2,938.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,976.17
|
| Rate for Payer: Cash Price |
$1,907.80
|
| Rate for Payer: Cigna Commercial |
$3,166.95
|
| Rate for Payer: First Health Commercial |
$3,624.82
|
| Rate for Payer: Humana Commercial |
$3,243.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,128.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,815.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,144.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,357.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,861.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,052.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,319.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,632.76
|
| Rate for Payer: PHCS Commercial |
$3,662.98
|
| Rate for Payer: United Healthcare All Payer |
$3,357.73
|
|
|
PLATE T 4 HOLE
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem Medicaid |
$675.76
|
| Rate for Payer: Anthem Medicaid |
$1,105.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Humana KY Medicaid |
$675.76
|
| Rate for Payer: Humana KY Medicaid |
$1,105.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.89
|
| Rate for Payer: Kentucky WC Medicaid |
$682.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,797.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.35
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
|
|
PLATE T 4 HOLE
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.50 |
| Max. Negotiated Rate |
$1,886.40 |
| Rate for Payer: Aetna Commercial |
$1,513.05
|
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$982.50
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$1,630.95
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: First Health Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Humana Commercial |
$1,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,572.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,709.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,797.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,355.85
|
| Rate for Payer: PHCS Commercial |
$1,886.40
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$1,729.20
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
PLATE T 4 HOLE 84MM
|
Facility
|
OP
|
$3,022.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.73 |
| Max. Negotiated Rate |
$2,901.54 |
| Rate for Payer: Aetna Commercial |
$2,327.28
|
| Rate for Payer: Anthem Medicaid |
$1,039.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,357.50
|
| Rate for Payer: Cash Price |
$1,511.22
|
| Rate for Payer: Cigna Commercial |
$2,508.63
|
| Rate for Payer: First Health Commercial |
$2,871.32
|
| Rate for Payer: Humana Commercial |
$2,569.07
|
| Rate for Payer: Humana KY Medicaid |
$1,039.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,050.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,478.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,230.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,060.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,659.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,266.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,629.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,085.48
|
| Rate for Payer: PHCS Commercial |
$2,901.54
|
| Rate for Payer: United Healthcare All Payer |
$2,659.75
|
|
|
PLATE T 4 HOLE 84MM
|
Facility
|
IP
|
$3,022.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$906.73 |
| Max. Negotiated Rate |
$2,901.54 |
| Rate for Payer: Aetna Commercial |
$2,327.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,357.50
|
| Rate for Payer: Cash Price |
$1,511.22
|
| Rate for Payer: Cigna Commercial |
$2,508.63
|
| Rate for Payer: First Health Commercial |
$2,871.32
|
| Rate for Payer: Humana Commercial |
$2,569.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,478.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,230.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$906.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,659.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,266.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,417.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,629.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,085.48
|
| Rate for Payer: PHCS Commercial |
$2,901.54
|
| Rate for Payer: United Healthcare All Payer |
$2,659.75
|
|
|
PLATE T 5 HOLE 100MM
|
Facility
|
OP
|
$3,083.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.18 |
| Max. Negotiated Rate |
$2,960.58 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Anthem Medicaid |
$1,060.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,405.47
|
| Rate for Payer: Cash Price |
$1,541.97
|
| Rate for Payer: Cigna Commercial |
$2,559.67
|
| Rate for Payer: First Health Commercial |
$2,929.74
|
| Rate for Payer: Humana Commercial |
$2,621.35
|
| Rate for Payer: Humana KY Medicaid |
$1,060.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,528.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,081.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,713.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.92
|
| Rate for Payer: PHCS Commercial |
$2,960.58
|
| Rate for Payer: United Healthcare All Payer |
$2,713.87
|
|
|
PLATE T 5 HOLE 100MM
|
Facility
|
IP
|
$3,083.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$925.18 |
| Max. Negotiated Rate |
$2,960.58 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,405.47
|
| Rate for Payer: Cash Price |
$1,541.97
|
| Rate for Payer: Cigna Commercial |
$2,559.67
|
| Rate for Payer: First Health Commercial |
$2,929.74
|
| Rate for Payer: Humana Commercial |
$2,621.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,528.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,275.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,713.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,312.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,467.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,683.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,127.92
|
| Rate for Payer: PHCS Commercial |
$2,960.58
|
| Rate for Payer: United Healthcare All Payer |
$2,713.87
|
|
|
PLATE T 6H 4.5MM
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem Medicaid |
$1,131.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Humana KY Medicaid |
$1,131.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,142.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
PLATE T 6H 4.5MM
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
PLATE T 6 HOLE
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
PLATE T 6 HOLE
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
PLATE T 6 HOLE 116MM
|
Facility
|
IP
|
$3,199.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.77 |
| Max. Negotiated Rate |
$3,071.28 |
| Rate for Payer: Aetna Commercial |
$2,463.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,495.41
|
| Rate for Payer: Cash Price |
$1,599.62
|
| Rate for Payer: Cigna Commercial |
$2,655.38
|
| Rate for Payer: First Health Commercial |
$3,039.29
|
| Rate for Payer: Humana Commercial |
$2,719.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,623.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,815.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,399.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,559.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,783.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,207.48
|
| Rate for Payer: PHCS Commercial |
$3,071.28
|
| Rate for Payer: United Healthcare All Payer |
$2,815.34
|
|
|
PLATE T 6 HOLE 116MM
|
Facility
|
OP
|
$3,199.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.77 |
| Max. Negotiated Rate |
$3,071.28 |
| Rate for Payer: Aetna Commercial |
$2,463.42
|
| Rate for Payer: Anthem Medicaid |
$1,100.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,495.41
|
| Rate for Payer: Cash Price |
$1,599.62
|
| Rate for Payer: Cigna Commercial |
$2,655.38
|
| Rate for Payer: First Health Commercial |
$3,039.29
|
| Rate for Payer: Humana Commercial |
$2,719.36
|
| Rate for Payer: Humana KY Medicaid |
$1,100.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,623.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$959.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,122.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,815.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,399.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,559.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,783.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,207.48
|
| Rate for Payer: PHCS Commercial |
$3,071.28
|
| Rate for Payer: United Healthcare All Payer |
$2,815.34
|
|
|
PLATE T 8H 4.5MM
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
PLATE T 8H 4.5MM
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem Medicaid |
$1,131.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Humana KY Medicaid |
$1,131.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,142.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
PLATE T 8 HOLE
|
Facility
|
OP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.75 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem Medicaid |
$1,087.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Humana KY Medicaid |
$1,087.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,109.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,751.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.12
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
|
PLATE T 8 HOLE
|
Facility
|
IP
|
$3,162.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.75 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$2,435.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,466.75
|
| Rate for Payer: Cash Price |
$1,581.25
|
| Rate for Payer: Cigna Commercial |
$2,624.88
|
| Rate for Payer: First Health Commercial |
$3,004.38
|
| Rate for Payer: Humana Commercial |
$2,688.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,593.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,783.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,530.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,751.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,182.12
|
| Rate for Payer: PHCS Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare All Payer |
$2,783.00
|
|
|
PLATE T 8 HOLE 148MM
|
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 T 8 HOLE 148MM
|
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 TALS MDL 2.5M 17X20M T L
|
Facility
|
OP
|
$6,878.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,063.60 |
| Max. Negotiated Rate |
$6,603.52 |
| Rate for Payer: Aetna Commercial |
$5,296.58
|
| Rate for Payer: Anthem Medicaid |
$2,365.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,365.36
|
| Rate for Payer: Cash Price |
$3,439.34
|
| Rate for Payer: Cigna Commercial |
$5,709.30
|
| Rate for Payer: First Health Commercial |
$6,534.74
|
| Rate for Payer: Humana Commercial |
$5,846.87
|
| Rate for Payer: Humana KY Medicaid |
$2,365.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,389.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,640.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,076.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,063.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,413.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,053.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,159.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,502.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,984.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,746.28
|
| Rate for Payer: PHCS Commercial |
$6,603.52
|
| Rate for Payer: United Healthcare All Payer |
$6,053.23
|
|
