|
PLATE TI LCP RECON 3.5*70 5H
|
Facility
|
OP
|
$3,653.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.04 |
| Max. Negotiated Rate |
$3,507.31 |
| Rate for Payer: Aetna Commercial |
$2,813.16
|
| Rate for Payer: Anthem Medicaid |
$1,256.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,849.69
|
| Rate for Payer: Cash Price |
$1,826.72
|
| Rate for Payer: Cigna Commercial |
$3,032.36
|
| Rate for Payer: First Health Commercial |
$3,470.78
|
| Rate for Payer: Humana Commercial |
$3,105.43
|
| Rate for Payer: Humana KY Medicaid |
$1,256.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,269.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,995.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,696.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,215.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,740.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,922.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,178.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.88
|
| Rate for Payer: PHCS Commercial |
$3,507.31
|
| Rate for Payer: United Healthcare All Payer |
$3,215.04
|
|
|
PLATE TI LCP RECON 3.5*84 6H
|
Facility
|
OP
|
$4,097.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.10 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$3,154.69
|
| Rate for Payer: Anthem Medicaid |
$1,408.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.66
|
| Rate for Payer: Cash Price |
$2,048.50
|
| Rate for Payer: Cigna Commercial |
$3,400.51
|
| Rate for Payer: First Health Commercial |
$3,892.15
|
| Rate for Payer: Humana Commercial |
$3,482.45
|
| Rate for Payer: Humana KY Medicaid |
$1,408.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,359.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,605.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,564.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.93
|
| Rate for Payer: PHCS Commercial |
$3,933.12
|
| Rate for Payer: United Healthcare All Payer |
$3,605.36
|
|
|
PLATE TI LCP RECON 3.5*84 6H
|
Facility
|
IP
|
$4,097.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.10 |
| Max. Negotiated Rate |
$3,933.12 |
| Rate for Payer: Aetna Commercial |
$3,154.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,195.66
|
| Rate for Payer: Cash Price |
$2,048.50
|
| Rate for Payer: Cigna Commercial |
$3,400.51
|
| Rate for Payer: First Health Commercial |
$3,892.15
|
| Rate for Payer: Humana Commercial |
$3,482.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,359.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,023.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,605.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,072.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,277.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,564.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,826.93
|
| Rate for Payer: PHCS Commercial |
$3,933.12
|
| Rate for Payer: United Healthcare All Payer |
$3,605.36
|
|
|
PLATE TI LCP RECON 3.5*98 7H
|
Facility
|
IP
|
$4,195.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.64 |
| Max. Negotiated Rate |
$4,027.66 |
| Rate for Payer: Aetna Commercial |
$3,230.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.47
|
| Rate for Payer: Cash Price |
$2,097.74
|
| Rate for Payer: Cigna Commercial |
$3,482.25
|
| Rate for Payer: First Health Commercial |
$3,985.71
|
| Rate for Payer: Humana Commercial |
$3,566.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,894.88
|
| Rate for Payer: PHCS Commercial |
$4,027.66
|
| Rate for Payer: United Healthcare All Payer |
$3,692.02
|
|
|
PLATE TI LCP RECON 3.5*98 7H
|
Facility
|
OP
|
$4,195.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.64 |
| Max. Negotiated Rate |
$4,027.66 |
| Rate for Payer: Aetna Commercial |
$3,230.52
|
| Rate for Payer: Anthem Medicaid |
$1,442.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.47
|
| Rate for Payer: Cash Price |
$2,097.74
|
| Rate for Payer: Cigna Commercial |
$3,482.25
|
| Rate for Payer: First Health Commercial |
$3,985.71
|
| Rate for Payer: Humana Commercial |
$3,566.16
|
| Rate for Payer: Humana KY Medicaid |
$1,442.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,894.88
|
| Rate for Payer: PHCS Commercial |
$4,027.66
|
| Rate for Payer: United Healthcare All Payer |
$3,692.02
|
|
|
PLATE TI RECON 10H 118MM
|
Facility
|
IP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 10H 118MM
|
Facility
|
OP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem Medicaid |
$1,156.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Humana KY Medicaid |
$1,156.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 5H 58MM
|
Facility
|
OP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem Medicaid |
$1,156.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Humana KY Medicaid |
$1,156.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 5H 58MM
|
Facility
|
IP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 6H 70MM
|
Facility
|
OP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem Medicaid |
$1,156.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Humana KY Medicaid |
$1,156.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 6H 70MM
|
Facility
|
IP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 7H 82MM
|
Facility
|
IP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 7H 82MM
|
Facility
|
OP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem Medicaid |
$1,156.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Humana KY Medicaid |
$1,156.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 8H 94MM
|
Facility
|
OP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem Medicaid |
$1,156.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Humana KY Medicaid |
$1,156.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 8H 94MM
|
Facility
|
IP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 9H 106MM
|
Facility
|
IP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI RECON 9H 106MM
|
Facility
|
OP
|
$3,363.61
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.08 |
| Max. Negotiated Rate |
$3,229.07 |
| Rate for Payer: Aetna Commercial |
$2,589.98
|
| Rate for Payer: Anthem Medicaid |
$1,156.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,623.62
|
| Rate for Payer: Cash Price |
$1,681.81
|
| Rate for Payer: Cigna Commercial |
$2,791.80
|
| Rate for Payer: First Health Commercial |
$3,195.43
|
| Rate for Payer: Humana Commercial |
$2,859.07
|
| Rate for Payer: Humana KY Medicaid |
$1,156.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,758.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,482.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,959.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,522.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,690.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,926.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,320.89
|
| Rate for Payer: PHCS Commercial |
$3,229.07
|
| Rate for Payer: United Healthcare All Payer |
$2,959.98
|
|
|
PLATE TI SEMI-TUBLAR 4H 71MM
|
Facility
|
IP
|
$1,138.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.49 |
| Max. Negotiated Rate |
$1,092.77 |
| Rate for Payer: Aetna Commercial |
$876.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.87
|
| Rate for Payer: Cash Price |
$569.15
|
| Rate for Payer: Cigna Commercial |
$944.79
|
| Rate for Payer: First Health Commercial |
$1,081.38
|
| Rate for Payer: Humana Commercial |
$967.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$840.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.70
|
| Rate for Payer: Ohio Health Group HMO |
$853.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$910.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$785.43
|
| Rate for Payer: PHCS Commercial |
$1,092.77
|
| Rate for Payer: United Healthcare All Payer |
$1,001.70
|
|
|
PLATE TI SEMI-TUBLAR 4H 71MM
|
Facility
|
OP
|
$1,138.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.49 |
| Max. Negotiated Rate |
$1,092.77 |
| Rate for Payer: Aetna Commercial |
$876.49
|
| Rate for Payer: Anthem Medicaid |
$391.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.87
|
| Rate for Payer: Cash Price |
$569.15
|
| Rate for Payer: Cigna Commercial |
$944.79
|
| Rate for Payer: First Health Commercial |
$1,081.38
|
| Rate for Payer: Humana Commercial |
$967.55
|
| Rate for Payer: Humana KY Medicaid |
$391.46
|
| Rate for Payer: Kentucky WC Medicaid |
$395.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$840.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.70
|
| Rate for Payer: Ohio Health Group HMO |
$853.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$910.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$785.43
|
| Rate for Payer: PHCS Commercial |
$1,092.77
|
| Rate for Payer: United Healthcare All Payer |
$1,001.70
|
|
|
PLATE TI SEMI-TUBLAR 5H 87MM
|
Facility
|
IP
|
$1,149.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.97 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna Commercial |
$885.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.92
|
| Rate for Payer: Cash Price |
$574.95
|
| Rate for Payer: Cigna Commercial |
$954.42
|
| Rate for Payer: First Health Commercial |
$1,092.40
|
| Rate for Payer: Humana Commercial |
$977.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.91
|
| Rate for Payer: Ohio Health Group HMO |
$862.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.43
|
| Rate for Payer: PHCS Commercial |
$1,103.90
|
| Rate for Payer: United Healthcare All Payer |
$1,011.91
|
|
|
PLATE TI SEMI-TUBLAR 5H 87MM
|
Facility
|
OP
|
$1,149.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.97 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna Commercial |
$885.42
|
| Rate for Payer: Anthem Medicaid |
$395.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.92
|
| Rate for Payer: Cash Price |
$574.95
|
| Rate for Payer: Cigna Commercial |
$954.42
|
| Rate for Payer: First Health Commercial |
$1,092.40
|
| Rate for Payer: Humana Commercial |
$977.41
|
| Rate for Payer: Humana KY Medicaid |
$395.45
|
| Rate for Payer: Kentucky WC Medicaid |
$399.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.91
|
| Rate for Payer: Ohio Health Group HMO |
$862.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$919.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,000.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$793.43
|
| Rate for Payer: PHCS Commercial |
$1,103.90
|
| Rate for Payer: United Healthcare All Payer |
$1,011.91
|
|
|
PLATE TI SEMI-TUBLAR 6H 103MM
|
Facility
|
OP
|
$1,177.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.34 |
| Max. Negotiated Rate |
$1,130.69 |
| Rate for Payer: Aetna Commercial |
$906.91
|
| Rate for Payer: Anthem Medicaid |
$405.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.68
|
| Rate for Payer: Cash Price |
$588.90
|
| Rate for Payer: Cigna Commercial |
$977.57
|
| Rate for Payer: First Health Commercial |
$1,118.91
|
| Rate for Payer: Humana Commercial |
$1,001.13
|
| Rate for Payer: Humana KY Medicaid |
$405.05
|
| Rate for Payer: Kentucky WC Medicaid |
$409.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$965.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$413.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.46
|
| Rate for Payer: Ohio Health Group HMO |
$883.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.68
|
| Rate for Payer: PHCS Commercial |
$1,130.69
|
| Rate for Payer: United Healthcare All Payer |
$1,036.46
|
|
|
PLATE TI SEMI-TUBLAR 6H 103MM
|
Facility
|
IP
|
$1,177.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.34 |
| Max. Negotiated Rate |
$1,130.69 |
| Rate for Payer: Aetna Commercial |
$906.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.68
|
| Rate for Payer: Cash Price |
$588.90
|
| Rate for Payer: Cigna Commercial |
$977.57
|
| Rate for Payer: First Health Commercial |
$1,118.91
|
| Rate for Payer: Humana Commercial |
$1,001.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$965.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.46
|
| Rate for Payer: Ohio Health Group HMO |
$883.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.68
|
| Rate for Payer: PHCS Commercial |
$1,130.69
|
| Rate for Payer: United Healthcare All Payer |
$1,036.46
|
|
|
PLATE TI SEMI-TUBLAR 7H 119MM
|
Facility
|
OP
|
$1,177.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.34 |
| Max. Negotiated Rate |
$1,130.69 |
| Rate for Payer: Aetna Commercial |
$906.91
|
| Rate for Payer: Anthem Medicaid |
$405.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.68
|
| Rate for Payer: Cash Price |
$588.90
|
| Rate for Payer: Cigna Commercial |
$977.57
|
| Rate for Payer: First Health Commercial |
$1,118.91
|
| Rate for Payer: Humana Commercial |
$1,001.13
|
| Rate for Payer: Humana KY Medicaid |
$405.05
|
| Rate for Payer: Kentucky WC Medicaid |
$409.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$965.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$413.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.46
|
| Rate for Payer: Ohio Health Group HMO |
$883.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.68
|
| Rate for Payer: PHCS Commercial |
$1,130.69
|
| Rate for Payer: United Healthcare All Payer |
$1,036.46
|
|
|
PLATE TI SEMI-TUBLAR 7H 119MM
|
Facility
|
IP
|
$1,177.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.34 |
| Max. Negotiated Rate |
$1,130.69 |
| Rate for Payer: Aetna Commercial |
$906.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.68
|
| Rate for Payer: Cash Price |
$588.90
|
| Rate for Payer: Cigna Commercial |
$977.57
|
| Rate for Payer: First Health Commercial |
$1,118.91
|
| Rate for Payer: Humana Commercial |
$1,001.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$965.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.46
|
| Rate for Payer: Ohio Health Group HMO |
$883.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.68
|
| Rate for Payer: PHCS Commercial |
$1,130.69
|
| Rate for Payer: United Healthcare All Payer |
$1,036.46
|
|
