|
PLATE TI TIB A/P SLOPED 12.5
|
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 15.0
|
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 15.0
|
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 17.5
|
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 17.5
|
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 TUB W/COLLAR 10H 127
|
Facility
|
OP
|
$1,218.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,169.47 |
| Rate for Payer: Aetna Commercial |
$938.01
|
| Rate for Payer: Anthem Medicaid |
$418.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.20
|
| Rate for Payer: Cash Price |
$609.10
|
| Rate for Payer: Cigna Commercial |
$1,011.11
|
| Rate for Payer: First Health Commercial |
$1,157.29
|
| Rate for Payer: Humana Commercial |
$1,035.47
|
| Rate for Payer: Humana KY Medicaid |
$418.94
|
| Rate for Payer: Kentucky WC Medicaid |
$423.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$998.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.02
|
| Rate for Payer: Ohio Health Group HMO |
$913.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$840.56
|
| Rate for Payer: PHCS Commercial |
$1,169.47
|
| Rate for Payer: United Healthcare All Payer |
$1,072.02
|
|
|
PLATE TI TUB W/COLLAR 10H 127
|
Facility
|
IP
|
$1,218.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,169.47 |
| Rate for Payer: Aetna Commercial |
$938.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.20
|
| Rate for Payer: Cash Price |
$609.10
|
| Rate for Payer: Cigna Commercial |
$1,011.11
|
| Rate for Payer: First Health Commercial |
$1,157.29
|
| Rate for Payer: Humana Commercial |
$1,035.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$998.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.02
|
| Rate for Payer: Ohio Health Group HMO |
$913.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$840.56
|
| Rate for Payer: PHCS Commercial |
$1,169.47
|
| Rate for Payer: United Healthcare All Payer |
$1,072.02
|
|
|
PLATE TI TUB W/COLLAR 2H 25MM
|
Facility
|
OP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.88 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem Medicaid |
$398.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Humana KY Medicaid |
$398.79
|
| Rate for Payer: Kentucky WC Medicaid |
$402.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.12
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE TI TUB W/COLLAR 2H 25MM
|
Facility
|
IP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.88 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.12
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE TI TUB W/COLLAR 3H 37MM
|
Facility
|
IP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.88 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.12
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE TI TUB W/COLLAR 3H 37MM
|
Facility
|
OP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.88 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem Medicaid |
$398.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Humana KY Medicaid |
$398.79
|
| Rate for Payer: Kentucky WC Medicaid |
$402.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.12
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE TI TUB W/COLLAR 4H 49MM
|
Facility
|
OP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.88 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem Medicaid |
$398.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Humana KY Medicaid |
$398.79
|
| Rate for Payer: Kentucky WC Medicaid |
$402.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.12
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE TI TUB W/COLLAR 4H 49MM
|
Facility
|
IP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.88 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$927.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,008.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$800.12
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE TI TUB W/COLLAR 5H 61MM
|
Facility
|
OP
|
$1,178.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.42 |
| Max. Negotiated Rate |
$1,130.93 |
| Rate for Payer: Aetna Commercial |
$907.10
|
| Rate for Payer: Anthem Medicaid |
$405.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.88
|
| Rate for Payer: Cash Price |
$589.02
|
| Rate for Payer: Cigna Commercial |
$977.78
|
| Rate for Payer: First Health Commercial |
$1,119.15
|
| Rate for Payer: Humana Commercial |
$1,001.34
|
| Rate for Payer: Humana KY Medicaid |
$405.13
|
| Rate for Payer: Kentucky WC Medicaid |
$409.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$966.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$413.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.68
|
| Rate for Payer: Ohio Health Group HMO |
$883.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.85
|
| Rate for Payer: PHCS Commercial |
$1,130.93
|
| Rate for Payer: United Healthcare All Payer |
$1,036.68
|
|
|
PLATE TI TUB W/COLLAR 5H 61MM
|
Facility
|
IP
|
$1,178.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$353.42 |
| Max. Negotiated Rate |
$1,130.93 |
| Rate for Payer: Aetna Commercial |
$907.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$918.88
|
| Rate for Payer: Cash Price |
$589.02
|
| Rate for Payer: Cigna Commercial |
$977.78
|
| Rate for Payer: First Health Commercial |
$1,119.15
|
| Rate for Payer: Humana Commercial |
$1,001.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$966.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$869.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$353.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,036.68
|
| Rate for Payer: Ohio Health Group HMO |
$883.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,024.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$812.85
|
| Rate for Payer: PHCS Commercial |
$1,130.93
|
| Rate for Payer: United Healthcare All Payer |
$1,036.68
|
|
|
PLATE TI TUB W/COLLAR 6H 73MM
|
Facility
|
IP
|
$1,190.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.06 |
| Max. Negotiated Rate |
$1,142.59 |
| Rate for Payer: Aetna Commercial |
$916.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.36
|
| Rate for Payer: Cash Price |
$595.10
|
| Rate for Payer: Cigna Commercial |
$987.87
|
| Rate for Payer: First Health Commercial |
$1,130.69
|
| Rate for Payer: Humana Commercial |
$1,011.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.38
|
| Rate for Payer: Ohio Health Group HMO |
$892.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.24
|
| Rate for Payer: PHCS Commercial |
$1,142.59
|
| Rate for Payer: United Healthcare All Payer |
$1,047.38
|
|
|
PLATE TI TUB W/COLLAR 6H 73MM
|
Facility
|
OP
|
$1,190.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.06 |
| Max. Negotiated Rate |
$1,142.59 |
| Rate for Payer: Aetna Commercial |
$916.45
|
| Rate for Payer: Anthem Medicaid |
$409.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$928.36
|
| Rate for Payer: Cash Price |
$595.10
|
| Rate for Payer: Cigna Commercial |
$987.87
|
| Rate for Payer: First Health Commercial |
$1,130.69
|
| Rate for Payer: Humana Commercial |
$1,011.67
|
| Rate for Payer: Humana KY Medicaid |
$409.31
|
| Rate for Payer: Kentucky WC Medicaid |
$413.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$975.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$878.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$417.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,047.38
|
| Rate for Payer: Ohio Health Group HMO |
$892.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,035.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$821.24
|
| Rate for Payer: PHCS Commercial |
$1,142.59
|
| Rate for Payer: United Healthcare All Payer |
$1,047.38
|
|
|
PLATE TI TUB W/ COLLAR 7H 85MM
|
Facility
|
IP
|
$1,221.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.45 |
| Max. Negotiated Rate |
$1,172.64 |
| Rate for Payer: Aetna Commercial |
$940.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$952.77
|
| Rate for Payer: Cash Price |
$610.75
|
| Rate for Payer: Cigna Commercial |
$1,013.85
|
| Rate for Payer: First Health Commercial |
$1,160.42
|
| Rate for Payer: Humana Commercial |
$1,038.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,001.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$901.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,074.92
|
| Rate for Payer: Ohio Health Group HMO |
$916.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,062.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$842.84
|
| Rate for Payer: PHCS Commercial |
$1,172.64
|
| Rate for Payer: United Healthcare All Payer |
$1,074.92
|
|
|
PLATE TI TUB W/ COLLAR 7H 85MM
|
Facility
|
OP
|
$1,221.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.45 |
| Max. Negotiated Rate |
$1,172.64 |
| Rate for Payer: Aetna Commercial |
$940.55
|
| Rate for Payer: Anthem Medicaid |
$420.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$952.77
|
| Rate for Payer: Cash Price |
$610.75
|
| Rate for Payer: Cigna Commercial |
$1,013.85
|
| Rate for Payer: First Health Commercial |
$1,160.42
|
| Rate for Payer: Humana Commercial |
$1,038.28
|
| Rate for Payer: Humana KY Medicaid |
$420.07
|
| Rate for Payer: Kentucky WC Medicaid |
$424.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,001.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$901.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$428.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,074.92
|
| Rate for Payer: Ohio Health Group HMO |
$916.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$977.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,062.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$842.84
|
| Rate for Payer: PHCS Commercial |
$1,172.64
|
| Rate for Payer: United Healthcare All Payer |
$1,074.92
|
|
|
PLATE TI TUB W/COLLAR 8H 97MM
|
Facility
|
OP
|
$1,218.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,169.47 |
| Rate for Payer: Aetna Commercial |
$938.01
|
| Rate for Payer: Anthem Medicaid |
$418.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.20
|
| Rate for Payer: Cash Price |
$609.10
|
| Rate for Payer: Cigna Commercial |
$1,011.11
|
| Rate for Payer: First Health Commercial |
$1,157.29
|
| Rate for Payer: Humana Commercial |
$1,035.47
|
| Rate for Payer: Humana KY Medicaid |
$418.94
|
| Rate for Payer: Kentucky WC Medicaid |
$423.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$998.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.02
|
| Rate for Payer: Ohio Health Group HMO |
$913.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$840.56
|
| Rate for Payer: PHCS Commercial |
$1,169.47
|
| Rate for Payer: United Healthcare All Payer |
$1,072.02
|
|
|
PLATE TI TUB W/COLLAR 8H 97MM
|
Facility
|
IP
|
$1,218.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$365.46 |
| Max. Negotiated Rate |
$1,169.47 |
| Rate for Payer: Aetna Commercial |
$938.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$950.20
|
| Rate for Payer: Cash Price |
$609.10
|
| Rate for Payer: Cigna Commercial |
$1,011.11
|
| Rate for Payer: First Health Commercial |
$1,157.29
|
| Rate for Payer: Humana Commercial |
$1,035.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$998.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$899.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$365.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,072.02
|
| Rate for Payer: Ohio Health Group HMO |
$913.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,059.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$840.56
|
| Rate for Payer: PHCS Commercial |
$1,169.47
|
| Rate for Payer: United Healthcare All Payer |
$1,072.02
|
|
|
PLATE TI VA-LCP 3H 2.4*37 -90
|
Facility
|
IP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LCP 3H 2.4*37 -90
|
Facility
|
OP
|
$4,195.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.77 |
| Max. Negotiated Rate |
$4,028.05 |
| Rate for Payer: Aetna Commercial |
$3,230.84
|
| Rate for Payer: Anthem Medicaid |
$1,442.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.79
|
| Rate for Payer: Cash Price |
$2,097.94
|
| Rate for Payer: Cigna Commercial |
$3,482.59
|
| Rate for Payer: First Health Commercial |
$3,986.10
|
| Rate for Payer: Humana Commercial |
$3,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,442.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,440.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,096.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,692.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,650.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,895.16
|
| Rate for Payer: PHCS Commercial |
$4,028.05
|
| Rate for Payer: United Healthcare All Payer |
$3,692.38
|
|
|
PLATE TI VA-LCP 3H 2.4*41 +90
|
Facility
|
OP
|
$4,355.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.52 |
| Max. Negotiated Rate |
$4,180.88 |
| Rate for Payer: Aetna Commercial |
$3,353.41
|
| Rate for Payer: Anthem Medicaid |
$1,497.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.96
|
| Rate for Payer: Cash Price |
$2,177.54
|
| Rate for Payer: Cigna Commercial |
$3,614.72
|
| Rate for Payer: First Health Commercial |
$4,137.33
|
| Rate for Payer: Humana Commercial |
$3,701.82
|
| Rate for Payer: Humana KY Medicaid |
$1,497.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,512.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,214.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,527.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,005.01
|
| Rate for Payer: PHCS Commercial |
$4,180.88
|
| Rate for Payer: United Healthcare All Payer |
$3,832.47
|
|
|
PLATE TI VA-LCP 3H 2.4*41 +90
|
Facility
|
IP
|
$4,355.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.52 |
| Max. Negotiated Rate |
$4,180.88 |
| Rate for Payer: Aetna Commercial |
$3,353.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.96
|
| Rate for Payer: Cash Price |
$2,177.54
|
| Rate for Payer: Cigna Commercial |
$3,614.72
|
| Rate for Payer: First Health Commercial |
$4,137.33
|
| Rate for Payer: Humana Commercial |
$3,701.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,214.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,005.01
|
| Rate for Payer: PHCS Commercial |
$4,180.88
|
| Rate for Payer: United Healthcare All Payer |
$3,832.47
|
|
