|
PLATE TIB OPN WDG TI OST 5M
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 7M
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 7M
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 9M
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 9M
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TI CLASSIC 4H 135 DEG
|
Facility
|
OP
|
$4,206.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.89 |
| Max. Negotiated Rate |
$4,038.06 |
| Rate for Payer: Aetna Commercial |
$3,238.86
|
| Rate for Payer: Anthem Medicaid |
$1,446.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.92
|
| Rate for Payer: Cash Price |
$2,103.16
|
| Rate for Payer: Cigna Commercial |
$3,491.24
|
| Rate for Payer: First Health Commercial |
$3,995.99
|
| Rate for Payer: Humana Commercial |
$3,575.36
|
| Rate for Payer: Humana KY Medicaid |
$1,446.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,461.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,449.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,365.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.35
|
| Rate for Payer: PHCS Commercial |
$4,038.06
|
| Rate for Payer: United Healthcare All Payer |
$3,701.55
|
|
|
PLATE TI CLASSIC 4H 135 DEG
|
Facility
|
IP
|
$4,206.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.89 |
| Max. Negotiated Rate |
$4,038.06 |
| Rate for Payer: Aetna Commercial |
$3,238.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.92
|
| Rate for Payer: Cash Price |
$2,103.16
|
| Rate for Payer: Cigna Commercial |
$3,491.24
|
| Rate for Payer: First Health Commercial |
$3,995.99
|
| Rate for Payer: Humana Commercial |
$3,575.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,449.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,365.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.35
|
| Rate for Payer: PHCS Commercial |
$4,038.06
|
| Rate for Payer: United Healthcare All Payer |
$3,701.55
|
|
|
PLATE TI CLOVERLEAF 3H 88MM
|
Facility
|
OP
|
$3,187.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.30 |
| Max. Negotiated Rate |
$3,060.15 |
| Rate for Payer: Aetna Commercial |
$2,454.50
|
| Rate for Payer: Anthem Medicaid |
$1,096.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,486.37
|
| Rate for Payer: Cash Price |
$1,593.83
|
| Rate for Payer: Cigna Commercial |
$2,645.76
|
| Rate for Payer: First Health Commercial |
$3,028.28
|
| Rate for Payer: Humana Commercial |
$2,709.51
|
| Rate for Payer: Humana KY Medicaid |
$1,096.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,107.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,118.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,805.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,773.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.49
|
| Rate for Payer: PHCS Commercial |
$3,060.15
|
| Rate for Payer: United Healthcare All Payer |
$2,805.14
|
|
|
PLATE TI CLOVERLEAF 3H 88MM
|
Facility
|
IP
|
$3,187.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.30 |
| Max. Negotiated Rate |
$3,060.15 |
| Rate for Payer: Aetna Commercial |
$2,454.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,486.37
|
| Rate for Payer: Cash Price |
$1,593.83
|
| Rate for Payer: Cigna Commercial |
$2,645.76
|
| Rate for Payer: First Health Commercial |
$3,028.28
|
| Rate for Payer: Humana Commercial |
$2,709.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,805.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,773.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.49
|
| Rate for Payer: PHCS Commercial |
$3,060.15
|
| Rate for Payer: United Healthcare All Payer |
$2,805.14
|
|
|
PLATE TI CLOVERLEAF 4H 104MM
|
Facility
|
OP
|
$3,187.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.30 |
| Max. Negotiated Rate |
$3,060.15 |
| Rate for Payer: Aetna Commercial |
$2,454.50
|
| Rate for Payer: Anthem Medicaid |
$1,096.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,486.37
|
| Rate for Payer: Cash Price |
$1,593.83
|
| Rate for Payer: Cigna Commercial |
$2,645.76
|
| Rate for Payer: First Health Commercial |
$3,028.28
|
| Rate for Payer: Humana Commercial |
$2,709.51
|
| Rate for Payer: Humana KY Medicaid |
$1,096.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,107.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,118.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,805.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,773.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.49
|
| Rate for Payer: PHCS Commercial |
$3,060.15
|
| Rate for Payer: United Healthcare All Payer |
$2,805.14
|
|
|
PLATE TI CLOVERLEAF 4H 104MM
|
Facility
|
IP
|
$3,187.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.30 |
| Max. Negotiated Rate |
$3,060.15 |
| Rate for Payer: Aetna Commercial |
$2,454.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,486.37
|
| Rate for Payer: Cash Price |
$1,593.83
|
| Rate for Payer: Cigna Commercial |
$2,645.76
|
| Rate for Payer: First Health Commercial |
$3,028.28
|
| Rate for Payer: Humana Commercial |
$2,709.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,613.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,352.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$956.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,805.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,390.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,550.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,773.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.49
|
| Rate for Payer: PHCS Commercial |
$3,060.15
|
| Rate for Payer: United Healthcare All Payer |
$2,805.14
|
|
|
PLATE TI LCP 1/3 TB CL 10H 117
|
Facility
|
IP
|
$1,998.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.69 |
| Max. Negotiated Rate |
$1,919.01 |
| Rate for Payer: Aetna Commercial |
$1,539.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,559.20
|
| Rate for Payer: Cash Price |
$999.49
|
| Rate for Payer: Cigna Commercial |
$1,659.15
|
| Rate for Payer: First Health Commercial |
$1,899.02
|
| Rate for Payer: Humana Commercial |
$1,699.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,639.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,475.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,759.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,499.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,599.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,739.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,379.29
|
| Rate for Payer: PHCS Commercial |
$1,919.01
|
| Rate for Payer: United Healthcare All Payer |
$1,759.09
|
|
|
PLATE TI LCP 1/3 TB CL 10H 117
|
Facility
|
OP
|
$1,998.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.69 |
| Max. Negotiated Rate |
$1,919.01 |
| Rate for Payer: Aetna Commercial |
$1,539.21
|
| Rate for Payer: Anthem Medicaid |
$687.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,559.20
|
| Rate for Payer: Cash Price |
$999.49
|
| Rate for Payer: Cigna Commercial |
$1,659.15
|
| Rate for Payer: First Health Commercial |
$1,899.02
|
| Rate for Payer: Humana Commercial |
$1,699.12
|
| Rate for Payer: Humana KY Medicaid |
$687.45
|
| Rate for Payer: Kentucky WC Medicaid |
$694.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,639.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,475.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,759.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,499.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,599.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,739.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,379.29
|
| Rate for Payer: PHCS Commercial |
$1,919.01
|
| Rate for Payer: United Healthcare All Payer |
$1,759.09
|
|
|
PLATE TI LCP 1/3 TB CL 12H 141
|
Facility
|
OP
|
$1,995.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.73 |
| Max. Negotiated Rate |
$1,915.95 |
| Rate for Payer: Aetna Commercial |
$1,536.75
|
| Rate for Payer: Anthem Medicaid |
$686.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,556.71
|
| Rate for Payer: Cash Price |
$997.89
|
| Rate for Payer: Cigna Commercial |
$1,656.50
|
| Rate for Payer: First Health Commercial |
$1,895.99
|
| Rate for Payer: Humana Commercial |
$1,696.41
|
| Rate for Payer: Humana KY Medicaid |
$686.35
|
| Rate for Payer: Kentucky WC Medicaid |
$693.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,472.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,496.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.09
|
| Rate for Payer: PHCS Commercial |
$1,915.95
|
| Rate for Payer: United Healthcare All Payer |
$1,756.29
|
|
|
PLATE TI LCP 1/3 TB CL 12H 141
|
Facility
|
IP
|
$1,995.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.73 |
| Max. Negotiated Rate |
$1,915.95 |
| Rate for Payer: Aetna Commercial |
$1,536.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,556.71
|
| Rate for Payer: Cash Price |
$997.89
|
| Rate for Payer: Cigna Commercial |
$1,656.50
|
| Rate for Payer: First Health Commercial |
$1,895.99
|
| Rate for Payer: Humana Commercial |
$1,696.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,636.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,472.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,756.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,496.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,596.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,736.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,377.09
|
| Rate for Payer: PHCS Commercial |
$1,915.95
|
| Rate for Payer: United Healthcare All Payer |
$1,756.29
|
|
|
PLATE TI LCP 1/3 TB W/CL 5H 57
|
Facility
|
OP
|
$3,627.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.25 |
| Max. Negotiated Rate |
$3,482.40 |
| Rate for Payer: Aetna Commercial |
$2,793.18
|
| Rate for Payer: Anthem Medicaid |
$1,247.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.45
|
| Rate for Payer: Cash Price |
$1,813.75
|
| Rate for Payer: Cigna Commercial |
$3,010.82
|
| Rate for Payer: First Health Commercial |
$3,446.12
|
| Rate for Payer: Humana Commercial |
$3,083.38
|
| Rate for Payer: Humana KY Medicaid |
$1,247.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,260.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,272.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,720.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,155.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,502.97
|
| Rate for Payer: PHCS Commercial |
$3,482.40
|
| Rate for Payer: United Healthcare All Payer |
$3,192.20
|
|
|
PLATE TI LCP 1/3 TB W/CL 5H 57
|
Facility
|
IP
|
$3,627.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.25 |
| Max. Negotiated Rate |
$3,482.40 |
| Rate for Payer: Aetna Commercial |
$2,793.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.45
|
| Rate for Payer: Cash Price |
$1,813.75
|
| Rate for Payer: Cigna Commercial |
$3,010.82
|
| Rate for Payer: First Health Commercial |
$3,446.12
|
| Rate for Payer: Humana Commercial |
$3,083.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,720.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,155.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,502.97
|
| Rate for Payer: PHCS Commercial |
$3,482.40
|
| Rate for Payer: United Healthcare All Payer |
$3,192.20
|
|
|
PLATE TI LCP 1/3 TB W/CL 6H 69
|
Facility
|
IP
|
$2,017.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.19 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.49
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.35
|
| Rate for Payer: First Health Commercial |
$1,916.43
|
| Rate for Payer: Humana Commercial |
$1,714.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,613.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,391.93
|
| Rate for Payer: PHCS Commercial |
$1,936.60
|
| Rate for Payer: United Healthcare All Payer |
$1,775.22
|
|
|
PLATE TI LCP 1/3 TB W/CL 6H 69
|
Facility
|
OP
|
$2,017.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.19 |
| Max. Negotiated Rate |
$1,936.60 |
| Rate for Payer: Aetna Commercial |
$1,553.31
|
| Rate for Payer: Anthem Medicaid |
$693.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,573.49
|
| Rate for Payer: Cash Price |
$1,008.64
|
| Rate for Payer: Cigna Commercial |
$1,674.35
|
| Rate for Payer: First Health Commercial |
$1,916.43
|
| Rate for Payer: Humana Commercial |
$1,714.70
|
| Rate for Payer: Humana KY Medicaid |
$693.75
|
| Rate for Payer: Kentucky WC Medicaid |
$700.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,654.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,488.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$707.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,775.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,512.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,613.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,755.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,391.93
|
| Rate for Payer: PHCS Commercial |
$1,936.60
|
| Rate for Payer: United Healthcare All Payer |
$1,775.22
|
|
|
PLATE TI LCP 1/3 TB W/CL 7H 81
|
Facility
|
IP
|
$2,061.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.48 |
| Max. Negotiated Rate |
$1,979.14 |
| Rate for Payer: Aetna Commercial |
$1,587.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,608.05
|
| Rate for Payer: Cash Price |
$1,030.80
|
| Rate for Payer: Cigna Commercial |
$1,711.13
|
| Rate for Payer: First Health Commercial |
$1,958.52
|
| Rate for Payer: Humana Commercial |
$1,752.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,690.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,521.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,814.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,546.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,649.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,793.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,422.50
|
| Rate for Payer: PHCS Commercial |
$1,979.14
|
| Rate for Payer: United Healthcare All Payer |
$1,814.21
|
|
|
PLATE TI LCP 1/3 TB W/CL 7H 81
|
Facility
|
OP
|
$2,061.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.48 |
| Max. Negotiated Rate |
$1,979.14 |
| Rate for Payer: Aetna Commercial |
$1,587.43
|
| Rate for Payer: Anthem Medicaid |
$708.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,608.05
|
| Rate for Payer: Cash Price |
$1,030.80
|
| Rate for Payer: Cigna Commercial |
$1,711.13
|
| Rate for Payer: First Health Commercial |
$1,958.52
|
| Rate for Payer: Humana Commercial |
$1,752.36
|
| Rate for Payer: Humana KY Medicaid |
$708.98
|
| Rate for Payer: Kentucky WC Medicaid |
$716.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,690.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,521.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$723.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,814.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,546.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,649.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,793.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,422.50
|
| Rate for Payer: PHCS Commercial |
$1,979.14
|
| Rate for Payer: United Healthcare All Payer |
$1,814.21
|
|
|
PLATE TI LCP 1/3 TB W/CL 8H 93
|
Facility
|
OP
|
$2,030.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.13 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,563.44
|
| Rate for Payer: Anthem Medicaid |
$698.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.74
|
| Rate for Payer: Cash Price |
$1,015.22
|
| Rate for Payer: Cigna Commercial |
$1,685.27
|
| Rate for Payer: First Health Commercial |
$1,928.92
|
| Rate for Payer: Humana Commercial |
$1,725.87
|
| Rate for Payer: Humana KY Medicaid |
$698.27
|
| Rate for Payer: Kentucky WC Medicaid |
$705.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,766.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.00
|
| Rate for Payer: PHCS Commercial |
$1,949.22
|
| Rate for Payer: United Healthcare All Payer |
$1,786.79
|
|
|
PLATE TI LCP 1/3 TB W/CL 8H 93
|
Facility
|
IP
|
$2,030.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.13 |
| Max. Negotiated Rate |
$1,949.22 |
| Rate for Payer: Aetna Commercial |
$1,563.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.74
|
| Rate for Payer: Cash Price |
$1,015.22
|
| Rate for Payer: Cigna Commercial |
$1,685.27
|
| Rate for Payer: First Health Commercial |
$1,928.92
|
| Rate for Payer: Humana Commercial |
$1,725.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,498.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,766.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,401.00
|
| Rate for Payer: PHCS Commercial |
$1,949.22
|
| Rate for Payer: United Healthcare All Payer |
$1,786.79
|
|
|
PLATE TI LCP 3.5*111MM 8H
|
Facility
|
IP
|
$3,372.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.85 |
| Max. Negotiated Rate |
$3,237.93 |
| Rate for Payer: Aetna Commercial |
$2,597.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,630.82
|
| Rate for Payer: Cash Price |
$1,686.42
|
| Rate for Payer: Cigna Commercial |
$2,799.46
|
| Rate for Payer: First Health Commercial |
$3,204.20
|
| Rate for Payer: Humana Commercial |
$2,866.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,765.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,489.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,011.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,968.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,529.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,698.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,934.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,327.26
|
| Rate for Payer: PHCS Commercial |
$3,237.93
|
| Rate for Payer: United Healthcare All Payer |
$2,968.10
|
|
|
PLATE TI LCP 3.5*111MM 8H
|
Facility
|
OP
|
$3,372.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.85 |
| Max. Negotiated Rate |
$3,237.93 |
| Rate for Payer: Aetna Commercial |
$2,597.09
|
| Rate for Payer: Anthem Medicaid |
$1,159.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,630.82
|
| Rate for Payer: Cash Price |
$1,686.42
|
| Rate for Payer: Cigna Commercial |
$2,799.46
|
| Rate for Payer: First Health Commercial |
$3,204.20
|
| Rate for Payer: Humana Commercial |
$2,866.91
|
| Rate for Payer: Humana KY Medicaid |
$1,159.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,171.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,765.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,489.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,011.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,968.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,529.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,698.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,934.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,327.26
|
| Rate for Payer: PHCS Commercial |
$3,237.93
|
| Rate for Payer: United Healthcare All Payer |
$2,968.10
|
|
