|
PLATE TALS MDL 2.5M 17X20M T L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TALS MDL 2.5M 17X20M T R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TALS MDL 2.5M 17X20M T R
|
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
|
|
|
PLATE TALUS LTL 3H 16X22MM LT
|
Facility
|
IP
|
$5,617.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.17 |
| Max. Negotiated Rate |
$5,392.56 |
| Rate for Payer: Aetna Commercial |
$4,325.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,381.45
|
| Rate for Payer: Cash Price |
$2,808.62
|
| Rate for Payer: Cigna Commercial |
$4,662.32
|
| Rate for Payer: First Health Commercial |
$5,336.39
|
| Rate for Payer: Humana Commercial |
$4,774.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,145.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,212.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,493.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,875.90
|
| Rate for Payer: PHCS Commercial |
$5,392.56
|
| Rate for Payer: United Healthcare All Payer |
$4,943.18
|
|
|
PLATE TALUS LTL 3H 16X22MM LT
|
Facility
|
OP
|
$5,617.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.17 |
| Max. Negotiated Rate |
$5,392.56 |
| Rate for Payer: Aetna Commercial |
$4,325.28
|
| Rate for Payer: Anthem Medicaid |
$1,931.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,381.45
|
| Rate for Payer: Cash Price |
$2,808.62
|
| Rate for Payer: Cigna Commercial |
$4,662.32
|
| Rate for Payer: First Health Commercial |
$5,336.39
|
| Rate for Payer: Humana Commercial |
$4,774.66
|
| Rate for Payer: Humana KY Medicaid |
$1,931.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,145.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,212.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,493.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,875.90
|
| Rate for Payer: PHCS Commercial |
$5,392.56
|
| Rate for Payer: United Healthcare All Payer |
$4,943.18
|
|
|
PLATE TALUS LTL 3H 16X22MM RT
|
Facility
|
OP
|
$5,617.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.17 |
| Max. Negotiated Rate |
$5,392.56 |
| Rate for Payer: Aetna Commercial |
$4,325.28
|
| Rate for Payer: Anthem Medicaid |
$1,931.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,381.45
|
| Rate for Payer: Cash Price |
$2,808.62
|
| Rate for Payer: Cigna Commercial |
$4,662.32
|
| Rate for Payer: First Health Commercial |
$5,336.39
|
| Rate for Payer: Humana Commercial |
$4,774.66
|
| Rate for Payer: Humana KY Medicaid |
$1,931.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,145.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,212.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,493.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,875.90
|
| Rate for Payer: PHCS Commercial |
$5,392.56
|
| Rate for Payer: United Healthcare All Payer |
$4,943.18
|
|
|
PLATE TALUS LTL 3H 16X22MM RT
|
Facility
|
IP
|
$5,617.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.17 |
| Max. Negotiated Rate |
$5,392.56 |
| Rate for Payer: Aetna Commercial |
$4,325.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,381.45
|
| Rate for Payer: Cash Price |
$2,808.62
|
| Rate for Payer: Cigna Commercial |
$4,662.32
|
| Rate for Payer: First Health Commercial |
$5,336.39
|
| Rate for Payer: Humana Commercial |
$4,774.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,145.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,212.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,493.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,875.90
|
| Rate for Payer: PHCS Commercial |
$5,392.56
|
| Rate for Payer: United Healthcare All Payer |
$4,943.18
|
|
|
PLATE TALUS LTL 4H 16X25MM LT
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TALUS LTL 4H 16X25MM LT
|
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
|
|
|
PLATE TALUS LTL 4H 16X25MM RT
|
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
|
|
|
PLATE TALUS LTL 4H 16X25MM RT
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TALUS MDL 2.5 11X20M L L
|
Facility
|
OP
|
$5,617.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.17 |
| Max. Negotiated Rate |
$5,392.56 |
| Rate for Payer: Aetna Commercial |
$4,325.28
|
| Rate for Payer: Anthem Medicaid |
$1,931.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,381.45
|
| Rate for Payer: Cash Price |
$2,808.62
|
| Rate for Payer: Cigna Commercial |
$4,662.32
|
| Rate for Payer: First Health Commercial |
$5,336.39
|
| Rate for Payer: Humana Commercial |
$4,774.66
|
| Rate for Payer: Humana KY Medicaid |
$1,931.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,951.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,145.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,970.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,212.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,493.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,875.90
|
| Rate for Payer: PHCS Commercial |
$5,392.56
|
| Rate for Payer: United Healthcare All Payer |
$4,943.18
|
|
|
PLATE TALUS MDL 2.5 11X20M L L
|
Facility
|
IP
|
$5,617.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,685.17 |
| Max. Negotiated Rate |
$5,392.56 |
| Rate for Payer: Aetna Commercial |
$4,325.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,381.45
|
| Rate for Payer: Cash Price |
$2,808.62
|
| Rate for Payer: Cigna Commercial |
$4,662.32
|
| Rate for Payer: First Health Commercial |
$5,336.39
|
| Rate for Payer: Humana Commercial |
$4,774.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,606.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,145.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,685.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,943.18
|
| Rate for Payer: Ohio Health Group HMO |
$4,212.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,493.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,887.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,875.90
|
| Rate for Payer: PHCS Commercial |
$5,392.56
|
| Rate for Payer: United Healthcare All Payer |
$4,943.18
|
|
|
PLATE TALUS MDL 2.5 11X20M L R
|
Facility
|
IP
|
$5,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,531.50 |
| Max. Negotiated Rate |
$4,900.80 |
| Rate for Payer: Aetna Commercial |
$3,930.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,981.90
|
| Rate for Payer: Cash Price |
$2,552.50
|
| Rate for Payer: Cigna Commercial |
$4,237.15
|
| Rate for Payer: First Health Commercial |
$4,849.75
|
| Rate for Payer: Humana Commercial |
$4,339.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,186.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,767.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,531.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,492.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,828.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.45
|
| Rate for Payer: PHCS Commercial |
$4,900.80
|
| Rate for Payer: United Healthcare All Payer |
$4,492.40
|
|
|
PLATE TALUS MDL 2.5 11X20M L R
|
Facility
|
OP
|
$5,105.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,531.50 |
| Max. Negotiated Rate |
$4,900.80 |
| Rate for Payer: Aetna Commercial |
$3,930.85
|
| Rate for Payer: Anthem Medicaid |
$1,755.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,981.90
|
| Rate for Payer: Cash Price |
$2,552.50
|
| Rate for Payer: Cigna Commercial |
$4,237.15
|
| Rate for Payer: First Health Commercial |
$4,849.75
|
| Rate for Payer: Humana Commercial |
$4,339.25
|
| Rate for Payer: Humana KY Medicaid |
$1,755.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,773.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,186.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,767.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,531.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,790.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,492.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,828.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,084.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,441.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,522.45
|
| Rate for Payer: PHCS Commercial |
$4,900.80
|
| Rate for Payer: United Healthcare All Payer |
$4,492.40
|
|
|
PLATE TB L-K 3.5M 1/3 10H 122M
|
Facility
|
IP
|
$3,086.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.02 |
| Max. Negotiated Rate |
$2,963.28 |
| Rate for Payer: Aetna Commercial |
$2,376.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,407.66
|
| Rate for Payer: Cash Price |
$1,543.38
|
| Rate for Payer: Cigna Commercial |
$2,562.00
|
| Rate for Payer: First Health Commercial |
$2,932.41
|
| Rate for Payer: Humana Commercial |
$2,623.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,716.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,469.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,685.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,129.86
|
| Rate for Payer: PHCS Commercial |
$2,963.28
|
| Rate for Payer: United Healthcare All Payer |
$2,716.34
|
|
|
PLATE TB L-K 3.5M 1/3 10H 122M
|
Facility
|
OP
|
$3,086.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.02 |
| Max. Negotiated Rate |
$2,963.28 |
| Rate for Payer: Aetna Commercial |
$2,376.80
|
| Rate for Payer: Anthem Medicaid |
$1,061.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,407.66
|
| Rate for Payer: Cash Price |
$1,543.38
|
| Rate for Payer: Cigna Commercial |
$2,562.00
|
| Rate for Payer: First Health Commercial |
$2,932.41
|
| Rate for Payer: Humana Commercial |
$2,623.74
|
| Rate for Payer: Humana KY Medicaid |
$1,061.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,072.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,716.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,469.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,685.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,129.86
|
| Rate for Payer: PHCS Commercial |
$2,963.28
|
| Rate for Payer: United Healthcare All Payer |
$2,716.34
|
|
|
PLATE TB L-K 3.5M 1/3 12H 146M
|
Facility
|
IP
|
$3,181.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.38 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.38
|
| Rate for Payer: Cash Price |
$1,590.62
|
| Rate for Payer: Cigna Commercial |
$2,640.44
|
| Rate for Payer: First Health Commercial |
$3,022.19
|
| Rate for Payer: Humana Commercial |
$2,704.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.06
|
| Rate for Payer: PHCS Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Payer |
$2,799.50
|
|
|
PLATE TB L-K 3.5M 1/3 12H 146M
|
Facility
|
OP
|
$3,181.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.38 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Anthem Medicaid |
$1,094.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.38
|
| Rate for Payer: Cash Price |
$1,590.62
|
| Rate for Payer: Cigna Commercial |
$2,640.44
|
| Rate for Payer: First Health Commercial |
$3,022.19
|
| Rate for Payer: Humana Commercial |
$2,704.06
|
| Rate for Payer: Humana KY Medicaid |
$1,094.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,105.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.06
|
| Rate for Payer: PHCS Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Payer |
$2,799.50
|
|
|
PLATE TBLK 3.5M148M 10 L A-L-D
|
Facility
|
OP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem Medicaid |
$3,305.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Humana KY Medicaid |
$3,305.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,338.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,371.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TBLK 3.5M148M 10 L A-L-D
|
Facility
|
IP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TBLK 3.5M148M10 R A-L-D
|
Facility
|
IP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TBLK 3.5M148M10 R A-L-D
|
Facility
|
OP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem Medicaid |
$3,305.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Humana KY Medicaid |
$3,305.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,338.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,371.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TBLK 3.5M 186M13 L A-L-D
|
Facility
|
OP
|
$9,664.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.42 |
| Max. Negotiated Rate |
$9,278.13 |
| Rate for Payer: Aetna Commercial |
$7,441.83
|
| Rate for Payer: Anthem Medicaid |
$3,323.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.48
|
| Rate for Payer: Cash Price |
$4,832.36
|
| Rate for Payer: Cigna Commercial |
$8,021.72
|
| Rate for Payer: First Health Commercial |
$9,181.48
|
| Rate for Payer: Humana Commercial |
$8,215.01
|
| Rate for Payer: Humana KY Medicaid |
$3,323.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,357.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,390.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,504.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.66
|
| Rate for Payer: PHCS Commercial |
$9,278.13
|
| Rate for Payer: United Healthcare All Payer |
$8,504.95
|
|
|
PLATE TBLK 3.5M 186M13 L A-L-D
|
Facility
|
IP
|
$9,664.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,899.42 |
| Max. Negotiated Rate |
$9,278.13 |
| Rate for Payer: Aetna Commercial |
$7,441.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,538.48
|
| Rate for Payer: Cash Price |
$4,832.36
|
| Rate for Payer: Cigna Commercial |
$8,021.72
|
| Rate for Payer: First Health Commercial |
$9,181.48
|
| Rate for Payer: Humana Commercial |
$8,215.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,925.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,132.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,899.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,504.95
|
| Rate for Payer: Ohio Health Group HMO |
$7,248.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,731.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,408.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,668.66
|
| Rate for Payer: PHCS Commercial |
$9,278.13
|
| Rate for Payer: United Healthcare All Payer |
$8,504.95
|
|
