|
PLATE T SMALL W PF 5H
|
Facility
|
OP
|
$2,047.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.35 |
| Max. Negotiated Rate |
$1,965.93 |
| Rate for Payer: Aetna Commercial |
$1,576.84
|
| Rate for Payer: Anthem Medicaid |
$704.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,597.32
|
| Rate for Payer: Cash Price |
$1,023.92
|
| Rate for Payer: Cigna Commercial |
$1,699.71
|
| Rate for Payer: First Health Commercial |
$1,945.45
|
| Rate for Payer: Humana Commercial |
$1,740.66
|
| Rate for Payer: Humana KY Medicaid |
$704.25
|
| Rate for Payer: Kentucky WC Medicaid |
$711.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,679.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,511.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$718.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,802.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,535.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.01
|
| Rate for Payer: PHCS Commercial |
$1,965.93
|
| Rate for Payer: United Healthcare All Payer |
$1,802.10
|
|
|
PLATE T SMALL W PF 5H
|
Facility
|
IP
|
$2,047.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.35 |
| Max. Negotiated Rate |
$1,965.93 |
| Rate for Payer: Aetna Commercial |
$1,576.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,597.32
|
| Rate for Payer: Cash Price |
$1,023.92
|
| Rate for Payer: Cigna Commercial |
$1,699.71
|
| Rate for Payer: First Health Commercial |
$1,945.45
|
| Rate for Payer: Humana Commercial |
$1,740.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,679.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,511.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,802.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,535.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.01
|
| Rate for Payer: PHCS Commercial |
$1,965.93
|
| Rate for Payer: United Healthcare All Payer |
$1,802.10
|
|
|
PLATE T TI 4H 84MM
|
Facility
|
OP
|
$5,432.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.71 |
| Max. Negotiated Rate |
$5,215.08 |
| Rate for Payer: Aetna Commercial |
$4,182.93
|
| Rate for Payer: Anthem Medicaid |
$1,868.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,237.26
|
| Rate for Payer: Cash Price |
$2,716.19
|
| Rate for Payer: Cigna Commercial |
$4,508.88
|
| Rate for Payer: First Health Commercial |
$5,160.76
|
| Rate for Payer: Humana Commercial |
$4,617.52
|
| Rate for Payer: Humana KY Medicaid |
$1,868.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,887.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,454.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,009.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,629.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,905.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,780.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,074.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,345.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,726.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,748.34
|
| Rate for Payer: PHCS Commercial |
$5,215.08
|
| Rate for Payer: United Healthcare All Payer |
$4,780.49
|
|
|
PLATE T TI 4H 84MM
|
Facility
|
IP
|
$5,432.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,629.71 |
| Max. Negotiated Rate |
$5,215.08 |
| Rate for Payer: Aetna Commercial |
$4,182.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,237.26
|
| Rate for Payer: Cash Price |
$2,716.19
|
| Rate for Payer: Cigna Commercial |
$4,508.88
|
| Rate for Payer: First Health Commercial |
$5,160.76
|
| Rate for Payer: Humana Commercial |
$4,617.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,454.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,009.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,629.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,780.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,074.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,345.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,726.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,748.34
|
| Rate for Payer: PHCS Commercial |
$5,215.08
|
| Rate for Payer: United Healthcare All Payer |
$4,780.49
|
|
|
PLATE T TI 6H 116MM
|
Facility
|
OP
|
$3,011.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.41 |
| Max. Negotiated Rate |
$2,890.92 |
| Rate for Payer: Aetna Commercial |
$2,318.76
|
| Rate for Payer: Anthem Medicaid |
$1,035.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,348.88
|
| Rate for Payer: Cash Price |
$1,505.69
|
| Rate for Payer: Cigna Commercial |
$2,499.45
|
| Rate for Payer: First Health Commercial |
$2,860.81
|
| Rate for Payer: Humana Commercial |
$2,559.67
|
| Rate for Payer: Humana KY Medicaid |
$1,035.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,046.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,469.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,222.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,056.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,650.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,258.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,619.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,077.85
|
| Rate for Payer: PHCS Commercial |
$2,890.92
|
| Rate for Payer: United Healthcare All Payer |
$2,650.01
|
|
|
PLATE T TI 6H 116MM
|
Facility
|
IP
|
$3,011.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.41 |
| Max. Negotiated Rate |
$2,890.92 |
| Rate for Payer: Aetna Commercial |
$2,318.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,348.88
|
| Rate for Payer: Cash Price |
$1,505.69
|
| Rate for Payer: Cigna Commercial |
$2,499.45
|
| Rate for Payer: First Health Commercial |
$2,860.81
|
| Rate for Payer: Humana Commercial |
$2,559.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,469.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,222.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$903.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,650.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,258.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,409.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,619.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,077.85
|
| Rate for Payer: PHCS Commercial |
$2,890.92
|
| Rate for Payer: United Healthcare All Payer |
$2,650.01
|
|
|
PLATE T TI 8H 148MM
|
Facility
|
OP
|
$3,332.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.67 |
| Max. Negotiated Rate |
$3,198.93 |
| Rate for Payer: Aetna Commercial |
$2,565.81
|
| Rate for Payer: Anthem Medicaid |
$1,145.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,599.13
|
| Rate for Payer: Cash Price |
$1,666.11
|
| Rate for Payer: Cigna Commercial |
$2,765.74
|
| Rate for Payer: First Health Commercial |
$3,165.61
|
| Rate for Payer: Humana Commercial |
$2,832.39
|
| Rate for Payer: Humana KY Medicaid |
$1,145.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,157.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,732.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,459.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$999.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,168.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,932.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,499.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,665.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,899.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,299.23
|
| Rate for Payer: PHCS Commercial |
$3,198.93
|
| Rate for Payer: United Healthcare All Payer |
$2,932.35
|
|
|
PLATE T TI 8H 148MM
|
Facility
|
IP
|
$3,332.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.67 |
| Max. Negotiated Rate |
$3,198.93 |
| Rate for Payer: Aetna Commercial |
$2,565.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,599.13
|
| Rate for Payer: Cash Price |
$1,666.11
|
| Rate for Payer: Cigna Commercial |
$2,765.74
|
| Rate for Payer: First Health Commercial |
$3,165.61
|
| Rate for Payer: Humana Commercial |
$2,832.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,732.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,459.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$999.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,932.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,499.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,665.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,899.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,299.23
|
| Rate for Payer: PHCS Commercial |
$3,198.93
|
| Rate for Payer: United Healthcare All Payer |
$2,932.35
|
|
|
PLATE-T TI LCP 3H 3.5*50 R ANG
|
Facility
|
IP
|
$3,170.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.28 |
| Max. Negotiated Rate |
$3,044.10 |
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.33
|
| Rate for Payer: Cash Price |
$1,585.47
|
| Rate for Payer: Cigna Commercial |
$2,631.88
|
| Rate for Payer: First Health Commercial |
$3,012.39
|
| Rate for Payer: Humana Commercial |
$2,695.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,536.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,758.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,187.95
|
| Rate for Payer: PHCS Commercial |
$3,044.10
|
| Rate for Payer: United Healthcare All Payer |
$2,790.43
|
|
|
PLATE-T TI LCP 3H 3.5*50 R ANG
|
Facility
|
OP
|
$3,170.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.28 |
| Max. Negotiated Rate |
$3,044.10 |
| Rate for Payer: Aetna Commercial |
$2,441.62
|
| Rate for Payer: Anthem Medicaid |
$1,090.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.33
|
| Rate for Payer: Cash Price |
$1,585.47
|
| Rate for Payer: Cigna Commercial |
$2,631.88
|
| Rate for Payer: First Health Commercial |
$3,012.39
|
| Rate for Payer: Humana Commercial |
$2,695.30
|
| Rate for Payer: Humana KY Medicaid |
$1,090.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,101.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,112.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.43
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,536.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,758.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,187.95
|
| Rate for Payer: PHCS Commercial |
$3,044.10
|
| Rate for Payer: United Healthcare All Payer |
$2,790.43
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB L
|
Facility
|
IP
|
$3,296.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.08 |
| Max. Negotiated Rate |
$3,165.06 |
| Rate for Payer: Aetna Commercial |
$2,538.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.61
|
| Rate for Payer: Cash Price |
$1,648.47
|
| Rate for Payer: Cigna Commercial |
$2,736.46
|
| Rate for Payer: First Health Commercial |
$3,132.09
|
| Rate for Payer: Humana Commercial |
$2,802.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,472.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,637.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,868.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$3,165.06
|
| Rate for Payer: United Healthcare All Payer |
$2,901.31
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB L
|
Facility
|
OP
|
$3,296.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.08 |
| Max. Negotiated Rate |
$3,165.06 |
| Rate for Payer: Aetna Commercial |
$2,538.64
|
| Rate for Payer: Anthem Medicaid |
$1,133.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.61
|
| Rate for Payer: Cash Price |
$1,648.47
|
| Rate for Payer: Cigna Commercial |
$2,736.46
|
| Rate for Payer: First Health Commercial |
$3,132.09
|
| Rate for Payer: Humana Commercial |
$2,802.40
|
| Rate for Payer: Humana KY Medicaid |
$1,133.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,145.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,156.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,472.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,637.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,868.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$3,165.06
|
| Rate for Payer: United Healthcare All Payer |
$2,901.31
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB R
|
Facility
|
OP
|
$3,296.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.08 |
| Max. Negotiated Rate |
$3,165.06 |
| Rate for Payer: Aetna Commercial |
$2,538.64
|
| Rate for Payer: Anthem Medicaid |
$1,133.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.61
|
| Rate for Payer: Cash Price |
$1,648.47
|
| Rate for Payer: Cigna Commercial |
$2,736.46
|
| Rate for Payer: First Health Commercial |
$3,132.09
|
| Rate for Payer: Humana Commercial |
$2,802.40
|
| Rate for Payer: Humana KY Medicaid |
$1,133.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,145.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,156.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,472.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,637.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,868.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$3,165.06
|
| Rate for Payer: United Healthcare All Payer |
$2,901.31
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB R
|
Facility
|
IP
|
$3,296.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.08 |
| Max. Negotiated Rate |
$3,165.06 |
| Rate for Payer: Aetna Commercial |
$2,538.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,571.61
|
| Rate for Payer: Cash Price |
$1,648.47
|
| Rate for Payer: Cigna Commercial |
$2,736.46
|
| Rate for Payer: First Health Commercial |
$3,132.09
|
| Rate for Payer: Humana Commercial |
$2,802.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,703.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,433.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,901.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,472.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,637.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,868.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,274.89
|
| Rate for Payer: PHCS Commercial |
$3,165.06
|
| Rate for Payer: United Healthcare All Payer |
$2,901.31
|
|
|
PLATE-T TI LCP 4H 3.5*56 R ANG
|
Facility
|
IP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.50 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,797.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.35
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
PLATE-T TI LCP 4H 3.5*56 R ANG
|
Facility
|
OP
|
$3,215.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.50 |
| Max. Negotiated Rate |
$3,086.40 |
| Rate for Payer: Aetna Commercial |
$2,475.55
|
| Rate for Payer: Anthem Medicaid |
$1,105.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.70
|
| Rate for Payer: Cash Price |
$1,607.50
|
| Rate for Payer: Cigna Commercial |
$2,668.45
|
| Rate for Payer: First Health Commercial |
$3,054.25
|
| Rate for Payer: Humana Commercial |
$2,732.75
|
| Rate for Payer: Humana KY Medicaid |
$1,105.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,572.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,797.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.35
|
| Rate for Payer: PHCS Commercial |
$3,086.40
|
| Rate for Payer: United Healthcare All Payer |
$2,829.20
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB L
|
Facility
|
IP
|
$3,359.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.99 |
| Max. Negotiated Rate |
$3,225.58 |
| Rate for Payer: Aetna Commercial |
$2,587.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.78
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cigna Commercial |
$2,788.78
|
| Rate for Payer: First Health Commercial |
$3,191.98
|
| Rate for Payer: Humana Commercial |
$2,855.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,755.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,687.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,923.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,318.39
|
| Rate for Payer: PHCS Commercial |
$3,225.58
|
| Rate for Payer: United Healthcare All Payer |
$2,956.78
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB L
|
Facility
|
OP
|
$3,359.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.99 |
| Max. Negotiated Rate |
$3,225.58 |
| Rate for Payer: Aetna Commercial |
$2,587.18
|
| Rate for Payer: Anthem Medicaid |
$1,155.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.78
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cigna Commercial |
$2,788.78
|
| Rate for Payer: First Health Commercial |
$3,191.98
|
| Rate for Payer: Humana Commercial |
$2,855.98
|
| Rate for Payer: Humana KY Medicaid |
$1,155.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,167.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,755.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,687.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,923.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,318.39
|
| Rate for Payer: PHCS Commercial |
$3,225.58
|
| Rate for Payer: United Healthcare All Payer |
$2,956.78
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB R
|
Facility
|
IP
|
$3,359.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.99 |
| Max. Negotiated Rate |
$3,225.58 |
| Rate for Payer: Aetna Commercial |
$2,587.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.78
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cigna Commercial |
$2,788.78
|
| Rate for Payer: First Health Commercial |
$3,191.98
|
| Rate for Payer: Humana Commercial |
$2,855.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,755.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,687.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,923.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,318.39
|
| Rate for Payer: PHCS Commercial |
$3,225.58
|
| Rate for Payer: United Healthcare All Payer |
$2,956.78
|
|
|
PLATE-T TI LCP 4H 3.5*63 OB R
|
Facility
|
OP
|
$3,359.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.99 |
| Max. Negotiated Rate |
$3,225.58 |
| Rate for Payer: Aetna Commercial |
$2,587.18
|
| Rate for Payer: Anthem Medicaid |
$1,155.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.78
|
| Rate for Payer: Cash Price |
$1,679.99
|
| Rate for Payer: Cigna Commercial |
$2,788.78
|
| Rate for Payer: First Health Commercial |
$3,191.98
|
| Rate for Payer: Humana Commercial |
$2,855.98
|
| Rate for Payer: Humana KY Medicaid |
$1,155.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,167.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,755.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,687.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,923.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,318.39
|
| Rate for Payer: PHCS Commercial |
$3,225.58
|
| Rate for Payer: United Healthcare All Payer |
$2,956.78
|
|
|
PLATE-T TI LCP 5H 3.5*67 R ANG
|
Facility
|
OP
|
$3,336.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,000.90 |
| Max. Negotiated Rate |
$3,202.90 |
| Rate for Payer: Aetna Commercial |
$2,568.99
|
| Rate for Payer: Anthem Medicaid |
$1,147.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,602.35
|
| Rate for Payer: Cash Price |
$1,668.17
|
| Rate for Payer: Cigna Commercial |
$2,769.17
|
| Rate for Payer: First Health Commercial |
$3,169.53
|
| Rate for Payer: Humana Commercial |
$2,835.90
|
| Rate for Payer: Humana KY Medicaid |
$1,147.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,735.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,462.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,935.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,502.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,669.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,902.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.08
|
| Rate for Payer: PHCS Commercial |
$3,202.90
|
| Rate for Payer: United Healthcare All Payer |
$2,935.99
|
|
|
PLATE-T TI LCP 5H 3.5*67 R ANG
|
Facility
|
IP
|
$3,336.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,000.90 |
| Max. Negotiated Rate |
$3,202.90 |
| Rate for Payer: Aetna Commercial |
$2,568.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,602.35
|
| Rate for Payer: Cash Price |
$1,668.17
|
| Rate for Payer: Cigna Commercial |
$2,769.17
|
| Rate for Payer: First Health Commercial |
$3,169.53
|
| Rate for Payer: Humana Commercial |
$2,835.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,735.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,462.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,935.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,502.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,669.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,902.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.08
|
| Rate for Payer: PHCS Commercial |
$3,202.90
|
| Rate for Payer: United Healthcare All Payer |
$2,935.99
|
|
|
PLATE-T TI LCP 5H 3.5*74 OB L
|
Facility
|
OP
|
$3,416.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.90 |
| Max. Negotiated Rate |
$3,279.69 |
| Rate for Payer: Aetna Commercial |
$2,630.58
|
| Rate for Payer: Anthem Medicaid |
$1,174.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,664.75
|
| Rate for Payer: Cash Price |
$1,708.17
|
| Rate for Payer: Cigna Commercial |
$2,835.56
|
| Rate for Payer: First Health Commercial |
$3,245.52
|
| Rate for Payer: Humana Commercial |
$2,903.89
|
| Rate for Payer: Humana KY Medicaid |
$1,174.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,186.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,801.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,521.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,198.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,006.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,562.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,733.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,972.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,357.27
|
| Rate for Payer: PHCS Commercial |
$3,279.69
|
| Rate for Payer: United Healthcare All Payer |
$3,006.38
|
|
|
PLATE-T TI LCP 5H 3.5*74 OB L
|
Facility
|
IP
|
$3,416.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.90 |
| Max. Negotiated Rate |
$3,279.69 |
| Rate for Payer: Aetna Commercial |
$2,630.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,664.75
|
| Rate for Payer: Cash Price |
$1,708.17
|
| Rate for Payer: Cigna Commercial |
$2,835.56
|
| Rate for Payer: First Health Commercial |
$3,245.52
|
| Rate for Payer: Humana Commercial |
$2,903.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,801.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,521.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,006.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,562.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,733.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,972.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,357.27
|
| Rate for Payer: PHCS Commercial |
$3,279.69
|
| Rate for Payer: United Healthcare All Payer |
$3,006.38
|
|
|
PLATE-T TI LCP 5H 3.5*74 OB R
|
Facility
|
OP
|
$3,546.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.01 |
| Max. Negotiated Rate |
$3,404.82 |
| Rate for Payer: Aetna Commercial |
$2,730.95
|
| Rate for Payer: Anthem Medicaid |
$1,219.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,766.42
|
| Rate for Payer: Cash Price |
$1,773.34
|
| Rate for Payer: Cigna Commercial |
$2,943.75
|
| Rate for Payer: First Health Commercial |
$3,369.36
|
| Rate for Payer: Humana Commercial |
$3,014.69
|
| Rate for Payer: Humana KY Medicaid |
$1,219.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,232.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,617.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,244.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,837.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,085.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,447.22
|
| Rate for Payer: PHCS Commercial |
$3,404.82
|
| Rate for Payer: United Healthcare All Payer |
$3,121.09
|
|
