|
PLATE TBLK 3.5M 186M13 R 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
|
|
|
PLATE TBLK 3.5M 186M13 R 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 TB LK 3.5M M-D 6H 127M L
|
Facility
|
OP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem Medicaid |
$1,948.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Humana KY Medicaid |
$1,948.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TB LK 3.5M M-D 6H 127M L
|
Facility
|
IP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TB LK 3.5M M-D 6H 127M R
|
Facility
|
IP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TB LK 3.5M M-D 6H 127M R
|
Facility
|
OP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem Medicaid |
$1,948.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Humana KY Medicaid |
$1,948.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TB LK 3.5M PM-P 4H 64M L
|
Facility
|
IP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TB LK 3.5M PM-P 4H 64M L
|
Facility
|
OP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem Medicaid |
$1,901.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Humana KY Medicaid |
$1,901.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,940.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TB LK 3.5M PM-P 7H 98M L
|
Facility
|
OP
|
$5,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.60 |
| Max. Negotiated Rate |
$5,445.12 |
| Rate for Payer: Aetna Commercial |
$4,367.44
|
| Rate for Payer: Anthem Medicaid |
$1,950.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,424.16
|
| Rate for Payer: Cash Price |
$2,836.00
|
| Rate for Payer: Cigna Commercial |
$4,707.76
|
| Rate for Payer: First Health Commercial |
$5,388.40
|
| Rate for Payer: Humana Commercial |
$4,821.20
|
| Rate for Payer: Humana KY Medicaid |
$1,950.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,970.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,651.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,185.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,701.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,989.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,991.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,254.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,934.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,913.68
|
| Rate for Payer: PHCS Commercial |
$5,445.12
|
| Rate for Payer: United Healthcare All Payer |
$4,991.36
|
|
|
PLATE TB LK 3.5M PM-P 7H 98M L
|
Facility
|
IP
|
$5,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,701.60 |
| Max. Negotiated Rate |
$5,445.12 |
| Rate for Payer: Aetna Commercial |
$4,367.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,424.16
|
| Rate for Payer: Cash Price |
$2,836.00
|
| Rate for Payer: Cigna Commercial |
$4,707.76
|
| Rate for Payer: First Health Commercial |
$5,388.40
|
| Rate for Payer: Humana Commercial |
$4,821.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,651.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,185.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,701.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,991.36
|
| Rate for Payer: Ohio Health Group HMO |
$4,254.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,537.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,934.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,913.68
|
| Rate for Payer: PHCS Commercial |
$5,445.12
|
| Rate for Payer: United Healthcare All Payer |
$4,991.36
|
|
|
PLATE TB LK PL-D 3.5M 155M 11L
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.75 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.97
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,030.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,196.43
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE TB LK PL-D 3.5M 155M 11L
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.75 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.03
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.97
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,030.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,196.43
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE T BUTTRESS 4X80MM
|
Facility
|
IP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE T BUTTRESS 4X80MM
|
Facility
|
OP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem Medicaid |
$1,200.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Humana KY Medicaid |
$1,200.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,212.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,224.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE T BUTTRESS 5X96MM
|
Facility
|
OP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem Medicaid |
$1,200.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Humana KY Medicaid |
$1,200.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,212.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,224.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE T BUTTRESS 5X96MM
|
Facility
|
IP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE T BUTTRESS 6X112MM
|
Facility
|
IP
|
$4,021.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.54 |
| Max. Negotiated Rate |
$3,860.94 |
| Rate for Payer: Aetna Commercial |
$3,096.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,137.01
|
| Rate for Payer: Cash Price |
$2,010.91
|
| Rate for Payer: Cigna Commercial |
$3,338.10
|
| Rate for Payer: First Health Commercial |
$3,820.72
|
| Rate for Payer: Humana Commercial |
$3,418.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,297.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,968.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,539.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,016.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,498.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,775.05
|
| Rate for Payer: PHCS Commercial |
$3,860.94
|
| Rate for Payer: United Healthcare All Payer |
$3,539.19
|
|
|
PLATE T BUTTRESS 6X112MM
|
Facility
|
OP
|
$4,021.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,206.54 |
| Max. Negotiated Rate |
$3,860.94 |
| Rate for Payer: Aetna Commercial |
$3,096.79
|
| Rate for Payer: Anthem Medicaid |
$1,383.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,137.01
|
| Rate for Payer: Cash Price |
$2,010.91
|
| Rate for Payer: Cigna Commercial |
$3,338.10
|
| Rate for Payer: First Health Commercial |
$3,820.72
|
| Rate for Payer: Humana Commercial |
$3,418.54
|
| Rate for Payer: Humana KY Medicaid |
$1,383.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,397.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,297.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,968.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,206.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,410.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,539.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,016.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,217.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,498.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,775.05
|
| Rate for Payer: PHCS Commercial |
$3,860.94
|
| Rate for Payer: United Healthcare All Payer |
$3,539.19
|
|
|
PLATE T FRAGMENT 2.7*61
|
Facility
|
IP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
|
PLATE T FRAGMENT 2.7*61
|
Facility
|
OP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem Medicaid |
$1,082.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Humana KY Medicaid |
$1,082.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
|
PLATE TI 3.5 10H 129MM
|
Facility
|
OP
|
$3,343.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.02 |
| Max. Negotiated Rate |
$3,209.66 |
| Rate for Payer: Aetna Commercial |
$2,574.42
|
| Rate for Payer: Anthem Medicaid |
$1,149.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.85
|
| Rate for Payer: Cash Price |
$1,671.70
|
| Rate for Payer: Cigna Commercial |
$2,775.02
|
| Rate for Payer: First Health Commercial |
$3,176.23
|
| Rate for Payer: Humana Commercial |
$2,841.89
|
| Rate for Payer: Humana KY Medicaid |
$1,149.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,942.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.95
|
| Rate for Payer: PHCS Commercial |
$3,209.66
|
| Rate for Payer: United Healthcare All Payer |
$2,942.19
|
|
|
PLATE TI 3.5 10H 129MM
|
Facility
|
IP
|
$3,343.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.02 |
| Max. Negotiated Rate |
$3,209.66 |
| Rate for Payer: Aetna Commercial |
$2,574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.85
|
| Rate for Payer: Cash Price |
$1,671.70
|
| Rate for Payer: Cigna Commercial |
$2,775.02
|
| Rate for Payer: First Health Commercial |
$3,176.23
|
| Rate for Payer: Humana Commercial |
$2,841.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,942.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.95
|
| Rate for Payer: PHCS Commercial |
$3,209.66
|
| Rate for Payer: United Healthcare All Payer |
$2,942.19
|
|
|
PLATE TI 3.5 6H 77MM
|
Facility
|
IP
|
$1,851.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.39 |
| Max. Negotiated Rate |
$1,777.25 |
| Rate for Payer: Aetna Commercial |
$1,425.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.01
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cigna Commercial |
$1,536.58
|
| Rate for Payer: First Health Commercial |
$1,758.73
|
| Rate for Payer: Humana Commercial |
$1,573.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,481.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.40
|
| Rate for Payer: PHCS Commercial |
$1,777.25
|
| Rate for Payer: United Healthcare All Payer |
$1,629.14
|
|
|
PLATE TI 3.5 6H 77MM
|
Facility
|
OP
|
$1,851.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.39 |
| Max. Negotiated Rate |
$1,777.25 |
| Rate for Payer: Aetna Commercial |
$1,425.50
|
| Rate for Payer: Anthem Medicaid |
$636.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.01
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cigna Commercial |
$1,536.58
|
| Rate for Payer: First Health Commercial |
$1,758.73
|
| Rate for Payer: Humana Commercial |
$1,573.61
|
| Rate for Payer: Humana KY Medicaid |
$636.66
|
| Rate for Payer: Kentucky WC Medicaid |
$643.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,481.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.40
|
| Rate for Payer: PHCS Commercial |
$1,777.25
|
| Rate for Payer: United Healthcare All Payer |
$1,629.14
|
|
|
PLATE TI 3.5 7H 103MM
|
Facility
|
IP
|
$1,731.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.35 |
| Max. Negotiated Rate |
$1,661.90 |
| Rate for Payer: Aetna Commercial |
$1,332.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,350.30
|
| Rate for Payer: Cash Price |
$865.57
|
| Rate for Payer: Cigna Commercial |
$1,436.85
|
| Rate for Payer: First Health Commercial |
$1,644.59
|
| Rate for Payer: Humana Commercial |
$1,471.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,419.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,277.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,523.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,298.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,384.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,506.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,194.49
|
| Rate for Payer: PHCS Commercial |
$1,661.90
|
| Rate for Payer: United Healthcare All Payer |
$1,523.41
|
|
