|
PLATE TUBULAR 1/3 2H*23MM
|
Facility
|
OP
|
$2,121.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.59 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,633.92
|
| Rate for Payer: Anthem Medicaid |
$729.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,655.14
|
| Rate for Payer: Cash Price |
$1,060.99
|
| Rate for Payer: Cigna Commercial |
$1,761.24
|
| Rate for Payer: First Health Commercial |
$2,015.88
|
| Rate for Payer: Humana Commercial |
$1,803.68
|
| Rate for Payer: Humana KY Medicaid |
$729.75
|
| Rate for Payer: Kentucky WC Medicaid |
$737.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,740.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,566.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$744.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,867.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,591.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,697.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.17
|
| Rate for Payer: PHCS Commercial |
$2,037.10
|
| Rate for Payer: United Healthcare All Payer |
$1,867.34
|
|
|
PLATE TUBULAR 1/3 3H*35MM
|
Facility
|
OP
|
$3,897.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.25 |
| Max. Negotiated Rate |
$3,741.60 |
| Rate for Payer: Aetna Commercial |
$3,001.07
|
| Rate for Payer: Anthem Medicaid |
$1,340.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,040.05
|
| Rate for Payer: Cash Price |
$1,948.75
|
| Rate for Payer: Cigna Commercial |
$3,234.93
|
| Rate for Payer: First Health Commercial |
$3,702.62
|
| Rate for Payer: Humana Commercial |
$3,312.88
|
| Rate for Payer: Humana KY Medicaid |
$1,340.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,353.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,195.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,876.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,367.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,429.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,923.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,390.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,689.28
|
| Rate for Payer: PHCS Commercial |
$3,741.60
|
| Rate for Payer: United Healthcare All Payer |
$3,429.80
|
|
|
PLATE TUBULAR 1/3 3H*35MM
|
Facility
|
IP
|
$3,897.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.25 |
| Max. Negotiated Rate |
$3,741.60 |
| Rate for Payer: Aetna Commercial |
$3,001.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,040.05
|
| Rate for Payer: Cash Price |
$1,948.75
|
| Rate for Payer: Cigna Commercial |
$3,234.93
|
| Rate for Payer: First Health Commercial |
$3,702.62
|
| Rate for Payer: Humana Commercial |
$3,312.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,195.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,876.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,429.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,923.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,118.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,390.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,689.28
|
| Rate for Payer: PHCS Commercial |
$3,741.60
|
| Rate for Payer: United Healthcare All Payer |
$3,429.80
|
|
|
PLATE TUBULAR 1/3 4H*47MM
|
Facility
|
OP
|
$2,184.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.39 |
| Max. Negotiated Rate |
$2,097.25 |
| Rate for Payer: Aetna Commercial |
$1,682.17
|
| Rate for Payer: Anthem Medicaid |
$751.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.02
|
| Rate for Payer: Cash Price |
$1,092.32
|
| Rate for Payer: Cigna Commercial |
$1,813.25
|
| Rate for Payer: First Health Commercial |
$2,075.41
|
| Rate for Payer: Humana Commercial |
$1,856.94
|
| Rate for Payer: Humana KY Medicaid |
$751.30
|
| Rate for Payer: Kentucky WC Medicaid |
$758.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.40
|
| Rate for Payer: PHCS Commercial |
$2,097.25
|
| Rate for Payer: United Healthcare All Payer |
$1,922.48
|
|
|
PLATE TUBULAR 1/3 4H*47MM
|
Facility
|
IP
|
$2,184.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.39 |
| Max. Negotiated Rate |
$2,097.25 |
| Rate for Payer: Aetna Commercial |
$1,682.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.02
|
| Rate for Payer: Cash Price |
$1,092.32
|
| Rate for Payer: Cigna Commercial |
$1,813.25
|
| Rate for Payer: First Health Commercial |
$2,075.41
|
| Rate for Payer: Humana Commercial |
$1,856.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.40
|
| Rate for Payer: PHCS Commercial |
$2,097.25
|
| Rate for Payer: United Healthcare All Payer |
$1,922.48
|
|
|
PLATE TUBULAR 1/3 5H*59MM
|
Facility
|
IP
|
$2,184.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.39 |
| Max. Negotiated Rate |
$2,097.25 |
| Rate for Payer: Aetna Commercial |
$1,682.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.02
|
| Rate for Payer: Cash Price |
$1,092.32
|
| Rate for Payer: Cigna Commercial |
$1,813.25
|
| Rate for Payer: First Health Commercial |
$2,075.41
|
| Rate for Payer: Humana Commercial |
$1,856.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.40
|
| Rate for Payer: PHCS Commercial |
$2,097.25
|
| Rate for Payer: United Healthcare All Payer |
$1,922.48
|
|
|
PLATE TUBULAR 1/3 5H*59MM
|
Facility
|
OP
|
$2,184.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.39 |
| Max. Negotiated Rate |
$2,097.25 |
| Rate for Payer: Aetna Commercial |
$1,682.17
|
| Rate for Payer: Anthem Medicaid |
$751.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,704.02
|
| Rate for Payer: Cash Price |
$1,092.32
|
| Rate for Payer: Cigna Commercial |
$1,813.25
|
| Rate for Payer: First Health Commercial |
$2,075.41
|
| Rate for Payer: Humana Commercial |
$1,856.94
|
| Rate for Payer: Humana KY Medicaid |
$751.30
|
| Rate for Payer: Kentucky WC Medicaid |
$758.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,791.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,612.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$655.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$766.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,922.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,638.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,747.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,900.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,507.40
|
| Rate for Payer: PHCS Commercial |
$2,097.25
|
| Rate for Payer: United Healthcare All Payer |
$1,922.48
|
|
|
PLATE TUBULAR 1/3 6H*71MM
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
PLATE TUBULAR 1/3 6H*71MM
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
PLATE TUBULAR 1/3 7H*83MM
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
PLATE TUBULAR 1/3 7H*83MM
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
PLATE TUBULAR 1/3 8H*95MM
|
Facility
|
OP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem Medicaid |
$1,029.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Humana KY Medicaid |
$1,029.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,040.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,050.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
PLATE TUBULAR 1/3 8H*95MM
|
Facility
|
IP
|
$2,993.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.12 |
| Max. Negotiated Rate |
$2,874.00 |
| Rate for Payer: Aetna Commercial |
$2,305.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,335.12
|
| Rate for Payer: Cash Price |
$1,496.88
|
| Rate for Payer: Cigna Commercial |
$2,484.81
|
| Rate for Payer: First Health Commercial |
$2,844.06
|
| Rate for Payer: Humana Commercial |
$2,544.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,454.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,209.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$898.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,634.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,245.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,395.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,604.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,065.69
|
| Rate for Payer: PHCS Commercial |
$2,874.00
|
| Rate for Payer: United Healthcare All Payer |
$2,634.50
|
|
|
PLATE TUBULAR 1/3 9H*107MM
|
Facility
|
IP
|
$3,671.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.58 |
| Max. Negotiated Rate |
$3,525.06 |
| Rate for Payer: Aetna Commercial |
$2,827.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,864.11
|
| Rate for Payer: Cash Price |
$1,835.97
|
| Rate for Payer: Cigna Commercial |
$3,047.71
|
| Rate for Payer: First Health Commercial |
$3,488.34
|
| Rate for Payer: Humana Commercial |
$3,121.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,010.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,709.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,231.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,753.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,937.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,194.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,533.64
|
| Rate for Payer: PHCS Commercial |
$3,525.06
|
| Rate for Payer: United Healthcare All Payer |
$3,231.31
|
|
|
PLATE TUBULAR 1/3 9H*107MM
|
Facility
|
OP
|
$3,671.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.58 |
| Max. Negotiated Rate |
$3,525.06 |
| Rate for Payer: Aetna Commercial |
$2,827.39
|
| Rate for Payer: Anthem Medicaid |
$1,262.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,864.11
|
| Rate for Payer: Cash Price |
$1,835.97
|
| Rate for Payer: Cigna Commercial |
$3,047.71
|
| Rate for Payer: First Health Commercial |
$3,488.34
|
| Rate for Payer: Humana Commercial |
$3,121.15
|
| Rate for Payer: Humana KY Medicaid |
$1,262.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,275.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,010.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,709.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,288.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,231.31
|
| Rate for Payer: Ohio Health Group HMO |
$2,753.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,937.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,194.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,533.64
|
| Rate for Payer: PHCS Commercial |
$3,525.06
|
| Rate for Payer: United Healthcare All Payer |
$3,231.31
|
|
|
PLATE TUBULAR ONE-THIRD 10X121
|
Facility
|
OP
|
$1,488.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.47 |
| Max. Negotiated Rate |
$1,428.70 |
| Rate for Payer: Aetna Commercial |
$1,145.94
|
| Rate for Payer: Anthem Medicaid |
$511.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.82
|
| Rate for Payer: Cash Price |
$744.12
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: First Health Commercial |
$1,413.82
|
| Rate for Payer: Humana Commercial |
$1,265.00
|
| Rate for Payer: Humana KY Medicaid |
$511.80
|
| Rate for Payer: Kentucky WC Medicaid |
$517.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$446.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$522.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.88
|
| Rate for Payer: PHCS Commercial |
$1,428.70
|
| Rate for Payer: United Healthcare All Payer |
$1,309.64
|
|
|
PLATE TUBULAR ONE-THIRD 10X121
|
Facility
|
IP
|
$1,488.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.47 |
| Max. Negotiated Rate |
$1,428.70 |
| Rate for Payer: Aetna Commercial |
$1,145.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,160.82
|
| Rate for Payer: Cash Price |
$744.12
|
| Rate for Payer: Cigna Commercial |
$1,235.23
|
| Rate for Payer: First Health Commercial |
$1,413.82
|
| Rate for Payer: Humana Commercial |
$1,265.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,220.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,098.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$446.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,309.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,116.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,294.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,026.88
|
| Rate for Payer: PHCS Commercial |
$1,428.70
|
| Rate for Payer: United Healthcare All Payer |
$1,309.64
|
|
|
PLATE TUBULAR ONE-THIRD 2X25MM
|
Facility
|
OP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem Medicaid |
$415.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Humana KY Medicaid |
$415.69
|
| Rate for Payer: Kentucky WC Medicaid |
$419.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$424.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE TUBULAR ONE-THIRD 2X25MM
|
Facility
|
IP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE TUBULAR ONE-THIRD 3X37MM
|
Facility
|
IP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE TUBULAR ONE-THIRD 3X37MM
|
Facility
|
OP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem Medicaid |
$398.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Humana KY Medicaid |
$398.06
|
| Rate for Payer: Kentucky WC Medicaid |
$402.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE TUBULAR ONE-THIRD 4X49MM
|
Facility
|
IP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE TUBULAR ONE-THIRD 4X49MM
|
Facility
|
OP
|
$1,208.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.62 |
| Max. Negotiated Rate |
$1,160.40 |
| Rate for Payer: Aetna Commercial |
$930.74
|
| Rate for Payer: Anthem Medicaid |
$415.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$942.83
|
| Rate for Payer: Cash Price |
$604.38
|
| Rate for Payer: Cigna Commercial |
$1,003.26
|
| Rate for Payer: First Health Commercial |
$1,148.31
|
| Rate for Payer: Humana Commercial |
$1,027.44
|
| Rate for Payer: Humana KY Medicaid |
$415.69
|
| Rate for Payer: Kentucky WC Medicaid |
$419.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$991.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$362.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$424.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,063.70
|
| Rate for Payer: Ohio Health Group HMO |
$906.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,051.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.04
|
| Rate for Payer: PHCS Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Payer |
$1,063.70
|
|
|
PLATE TUBULAR ONE-THIRD 5X61MM
|
Facility
|
OP
|
$1,542.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.83 |
| Max. Negotiated Rate |
$1,481.05 |
| Rate for Payer: Aetna Commercial |
$1,187.93
|
| Rate for Payer: Anthem Medicaid |
$530.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,203.35
|
| Rate for Payer: Cash Price |
$771.38
|
| Rate for Payer: Cigna Commercial |
$1,280.49
|
| Rate for Payer: First Health Commercial |
$1,465.62
|
| Rate for Payer: Humana Commercial |
$1,311.35
|
| Rate for Payer: Humana KY Medicaid |
$530.56
|
| Rate for Payer: Kentucky WC Medicaid |
$535.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,265.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,342.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.50
|
| Rate for Payer: PHCS Commercial |
$1,481.05
|
| Rate for Payer: United Healthcare All Payer |
$1,357.63
|
|
|
PLATE TUBULAR ONE-THIRD 5X61MM
|
Facility
|
IP
|
$1,542.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.83 |
| Max. Negotiated Rate |
$1,481.05 |
| Rate for Payer: Aetna Commercial |
$1,187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,203.35
|
| Rate for Payer: Cash Price |
$771.38
|
| Rate for Payer: Cigna Commercial |
$1,280.49
|
| Rate for Payer: First Health Commercial |
$1,465.62
|
| Rate for Payer: Humana Commercial |
$1,311.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,265.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,342.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.50
|
| Rate for Payer: PHCS Commercial |
$1,481.05
|
| Rate for Payer: United Healthcare All Payer |
$1,357.63
|
|
