|
PLATE TI SM T-PLATE 3H 50MM RT
|
Facility
|
IP
|
$1,500.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.12 |
| Max. Negotiated Rate |
$1,440.37 |
| Rate for Payer: Aetna Commercial |
$1,155.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.30
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cigna Commercial |
$1,245.32
|
| Rate for Payer: First Health Commercial |
$1,425.37
|
| Rate for Payer: Humana Commercial |
$1,275.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.27
|
| Rate for Payer: PHCS Commercial |
$1,440.37
|
| Rate for Payer: United Healthcare All Payer |
$1,320.34
|
|
|
PLATE TI SM T-PLATE 3H 50MM RT
|
Facility
|
OP
|
$1,500.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.12 |
| Max. Negotiated Rate |
$1,440.37 |
| Rate for Payer: Aetna Commercial |
$1,155.30
|
| Rate for Payer: Anthem Medicaid |
$515.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.30
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cigna Commercial |
$1,245.32
|
| Rate for Payer: First Health Commercial |
$1,425.37
|
| Rate for Payer: Humana Commercial |
$1,275.33
|
| Rate for Payer: Humana KY Medicaid |
$515.98
|
| Rate for Payer: Kentucky WC Medicaid |
$521.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.27
|
| Rate for Payer: PHCS Commercial |
$1,440.37
|
| Rate for Payer: United Healthcare All Payer |
$1,320.34
|
|
|
PLATE TI SM T-PLATE 3H 53MM OB
|
Facility
|
OP
|
$1,780.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.19 |
| Max. Negotiated Rate |
$1,709.40 |
| Rate for Payer: Aetna Commercial |
$1,371.08
|
| Rate for Payer: Anthem Medicaid |
$612.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,388.88
|
| Rate for Payer: Cash Price |
$890.31
|
| Rate for Payer: Cigna Commercial |
$1,477.91
|
| Rate for Payer: First Health Commercial |
$1,691.59
|
| Rate for Payer: Humana Commercial |
$1,513.53
|
| Rate for Payer: Humana KY Medicaid |
$612.36
|
| Rate for Payer: Kentucky WC Medicaid |
$618.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,460.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,314.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$624.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,566.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,424.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,549.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.63
|
| Rate for Payer: PHCS Commercial |
$1,709.40
|
| Rate for Payer: United Healthcare All Payer |
$1,566.95
|
|
|
PLATE TI SM T-PLATE 3H 53MM OB
|
Facility
|
IP
|
$1,780.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.19 |
| Max. Negotiated Rate |
$1,709.40 |
| Rate for Payer: Aetna Commercial |
$1,371.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,388.88
|
| Rate for Payer: Cash Price |
$890.31
|
| Rate for Payer: Cigna Commercial |
$1,477.91
|
| Rate for Payer: First Health Commercial |
$1,691.59
|
| Rate for Payer: Humana Commercial |
$1,513.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,460.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,314.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,566.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,424.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,549.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.63
|
| Rate for Payer: PHCS Commercial |
$1,709.40
|
| Rate for Payer: United Healthcare All Payer |
$1,566.95
|
|
|
PLATE TI SM T-PLATE 3H 63MM OB
|
Facility
|
IP
|
$1,780.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.19 |
| Max. Negotiated Rate |
$1,709.40 |
| Rate for Payer: Aetna Commercial |
$1,371.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,388.88
|
| Rate for Payer: Cash Price |
$890.31
|
| Rate for Payer: Cigna Commercial |
$1,477.91
|
| Rate for Payer: First Health Commercial |
$1,691.59
|
| Rate for Payer: Humana Commercial |
$1,513.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,460.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,314.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,566.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,424.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,549.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.63
|
| Rate for Payer: PHCS Commercial |
$1,709.40
|
| Rate for Payer: United Healthcare All Payer |
$1,566.95
|
|
|
PLATE TI SM T-PLATE 3H 63MM OB
|
Facility
|
OP
|
$1,780.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.19 |
| Max. Negotiated Rate |
$1,709.40 |
| Rate for Payer: Aetna Commercial |
$1,371.08
|
| Rate for Payer: Anthem Medicaid |
$612.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,388.88
|
| Rate for Payer: Cash Price |
$890.31
|
| Rate for Payer: Cigna Commercial |
$1,477.91
|
| Rate for Payer: First Health Commercial |
$1,691.59
|
| Rate for Payer: Humana Commercial |
$1,513.53
|
| Rate for Payer: Humana KY Medicaid |
$612.36
|
| Rate for Payer: Kentucky WC Medicaid |
$618.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,460.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,314.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$624.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,566.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,335.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,424.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,549.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.63
|
| Rate for Payer: PHCS Commercial |
$1,709.40
|
| Rate for Payer: United Healthcare All Payer |
$1,566.95
|
|
|
PLATE TI SM T-PLATE 3H 67MM RT
|
Facility
|
OP
|
$1,500.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.12 |
| Max. Negotiated Rate |
$1,440.37 |
| Rate for Payer: Aetna Commercial |
$1,155.30
|
| Rate for Payer: Anthem Medicaid |
$515.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.30
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cigna Commercial |
$1,245.32
|
| Rate for Payer: First Health Commercial |
$1,425.37
|
| Rate for Payer: Humana Commercial |
$1,275.33
|
| Rate for Payer: Humana KY Medicaid |
$515.98
|
| Rate for Payer: Kentucky WC Medicaid |
$521.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$526.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.27
|
| Rate for Payer: PHCS Commercial |
$1,440.37
|
| Rate for Payer: United Healthcare All Payer |
$1,320.34
|
|
|
PLATE TI SM T-PLATE 3H 67MM RT
|
Facility
|
IP
|
$1,500.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.12 |
| Max. Negotiated Rate |
$1,440.37 |
| Rate for Payer: Aetna Commercial |
$1,155.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,170.30
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cigna Commercial |
$1,245.32
|
| Rate for Payer: First Health Commercial |
$1,425.37
|
| Rate for Payer: Humana Commercial |
$1,275.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,230.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,107.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$450.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,320.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,125.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,200.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,305.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,035.27
|
| Rate for Payer: PHCS Commercial |
$1,440.37
|
| Rate for Payer: United Healthcare All Payer |
$1,320.34
|
|
|
PLATE TI SM T-PLATE 3H 75MM OB
|
Facility
|
IP
|
$2,177.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.17 |
| Max. Negotiated Rate |
$2,090.14 |
| Rate for Payer: Aetna Commercial |
$1,676.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.24
|
| Rate for Payer: Cash Price |
$1,088.62
|
| Rate for Payer: Cigna Commercial |
$1,807.10
|
| Rate for Payer: First Health Commercial |
$2,068.37
|
| Rate for Payer: Humana Commercial |
$1,850.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,741.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.29
|
| Rate for Payer: PHCS Commercial |
$2,090.14
|
| Rate for Payer: United Healthcare All Payer |
$1,915.96
|
|
|
PLATE TI SM T-PLATE 3H 75MM OB
|
Facility
|
OP
|
$2,177.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.17 |
| Max. Negotiated Rate |
$2,090.14 |
| Rate for Payer: Aetna Commercial |
$1,676.47
|
| Rate for Payer: Anthem Medicaid |
$748.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,698.24
|
| Rate for Payer: Cash Price |
$1,088.62
|
| Rate for Payer: Cigna Commercial |
$1,807.10
|
| Rate for Payer: First Health Commercial |
$2,068.37
|
| Rate for Payer: Humana Commercial |
$1,850.65
|
| Rate for Payer: Humana KY Medicaid |
$748.75
|
| Rate for Payer: Kentucky WC Medicaid |
$756.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,785.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,741.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,894.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.29
|
| Rate for Payer: PHCS Commercial |
$2,090.14
|
| Rate for Payer: United Healthcare All Payer |
$1,915.96
|
|
|
PLATE TITANIUM 2 HOLE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE TITANIUM 2 HOLE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE TITANIUM ACCORD 320MM
|
Facility
|
OP
|
$8,622.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.85 |
| Max. Negotiated Rate |
$8,277.92 |
| Rate for Payer: Aetna Commercial |
$6,639.58
|
| Rate for Payer: Anthem Medicaid |
$2,965.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,725.81
|
| Rate for Payer: Cash Price |
$4,311.41
|
| Rate for Payer: Cigna Commercial |
$7,156.95
|
| Rate for Payer: First Health Commercial |
$8,191.69
|
| Rate for Payer: Humana Commercial |
$7,329.41
|
| Rate for Payer: Humana KY Medicaid |
$2,965.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,995.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,070.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,363.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,024.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,588.09
|
| Rate for Payer: Ohio Health Group HMO |
$6,467.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,898.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,501.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,949.75
|
| Rate for Payer: PHCS Commercial |
$8,277.92
|
| Rate for Payer: United Healthcare All Payer |
$7,588.09
|
|
|
PLATE TITANIUM ACCORD 320MM
|
Facility
|
IP
|
$8,622.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,586.85 |
| Max. Negotiated Rate |
$8,277.92 |
| Rate for Payer: Aetna Commercial |
$6,639.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,725.81
|
| Rate for Payer: Cash Price |
$4,311.41
|
| Rate for Payer: Cigna Commercial |
$7,156.95
|
| Rate for Payer: First Health Commercial |
$8,191.69
|
| Rate for Payer: Humana Commercial |
$7,329.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,070.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,363.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,586.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,588.09
|
| Rate for Payer: Ohio Health Group HMO |
$6,467.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,898.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,501.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,949.75
|
| Rate for Payer: PHCS Commercial |
$8,277.92
|
| Rate for Payer: United Healthcare All Payer |
$7,588.09
|
|
|
PLATE TI TIB A/P SLOPED 05.0
|
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 TI TIB A/P SLOPED 05.0
|
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 TIB A/P SLOPED 07.5
|
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 TIB A/P SLOPED 07.5
|
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 TI TIB A/P SLOPED 09.0
|
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 TI TIB A/P SLOPED 09.0
|
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 TIB A/P SLOPED 10.0
|
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 TIB A/P SLOPED 10.0
|
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 TI TIB A/P SLOPED 11.0
|
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 TIB A/P SLOPED 11.0
|
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 TI TIB A/P SLOPED 12.5
|
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
|
|
