|
PLATE TUBULAR ONE-THIRD 6X73MM
|
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 6X73MM
|
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 7X85MM
|
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 7X85MM
|
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 8X97MM
|
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 8X97MM
|
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 9X109
|
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 9X109
|
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 THRD 10H
|
Facility
|
OP
|
$3,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem Medicaid |
$1,048.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Humana KY Medicaid |
$1,048.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,059.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,069.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
PLATE TUBULAR THRD 10H
|
Facility
|
IP
|
$3,050.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.00 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$2,348.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.00
|
| Rate for Payer: Cash Price |
$1,525.00
|
| Rate for Payer: Cigna Commercial |
$2,531.50
|
| Rate for Payer: First Health Commercial |
$2,897.50
|
| Rate for Payer: Humana Commercial |
$2,592.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,501.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,250.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,684.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,287.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,104.50
|
| Rate for Payer: PHCS Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare All Payer |
$2,684.00
|
|
|
PLATE TUBULAR THRD 12H
|
Facility
|
IP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
PLATE TUBULAR THRD 12H
|
Facility
|
OP
|
$3,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.50 |
| Max. Negotiated Rate |
$3,000.00 |
| Rate for Payer: Aetna Commercial |
$2,406.25
|
| Rate for Payer: Anthem Medicaid |
$1,074.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,437.50
|
| Rate for Payer: Cash Price |
$1,562.50
|
| Rate for Payer: Cigna Commercial |
$2,593.75
|
| Rate for Payer: First Health Commercial |
$2,968.75
|
| Rate for Payer: Humana Commercial |
$2,656.25
|
| Rate for Payer: Humana KY Medicaid |
$1,074.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,562.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,306.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,343.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,500.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,718.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,156.25
|
| Rate for Payer: PHCS Commercial |
$3,000.00
|
| Rate for Payer: United Healthcare All Payer |
$2,750.00
|
|
|
PLATE TUBULAR THRD 4H
|
Facility
|
IP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
PLATE TUBULAR THRD 4H
|
Facility
|
OP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem Medicaid |
$755.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Humana KY Medicaid |
$755.81
|
| Rate for Payer: Kentucky WC Medicaid |
$763.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
PLATE TUBULAR THRD 5H
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem Medicaid |
$754.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Humana KY Medicaid |
$754.17
|
| Rate for Payer: Kentucky WC Medicaid |
$761.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
PLATE TUBULAR THRD 5H
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
PLATE TUBULAR THRD 6H
|
Facility
|
IP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.28
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
PLATE TUBULAR THRD 6H
|
Facility
|
OP
|
$2,212.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.60 |
| Max. Negotiated Rate |
$2,123.52 |
| Rate for Payer: Aetna Commercial |
$1,703.24
|
| Rate for Payer: Anthem Medicaid |
$760.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,725.36
|
| Rate for Payer: Cash Price |
$1,106.00
|
| Rate for Payer: Cigna Commercial |
$1,835.96
|
| Rate for Payer: First Health Commercial |
$2,101.40
|
| Rate for Payer: Humana Commercial |
$1,880.20
|
| Rate for Payer: Humana KY Medicaid |
$760.71
|
| Rate for Payer: Kentucky WC Medicaid |
$768.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,632.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,946.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,659.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,769.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,924.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,526.28
|
| Rate for Payer: PHCS Commercial |
$2,123.52
|
| Rate for Payer: United Healthcare All Payer |
$1,946.56
|
|
|
PLATE TUBULAR THRD 7H
|
Facility
|
IP
|
$2,956.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.88 |
| Max. Negotiated Rate |
$2,838.00 |
| Rate for Payer: Aetna Commercial |
$2,276.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,305.88
|
| Rate for Payer: Cash Price |
$1,478.12
|
| Rate for Payer: Cigna Commercial |
$2,453.69
|
| Rate for Payer: First Health Commercial |
$2,808.44
|
| Rate for Payer: Humana Commercial |
$2,512.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,424.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,181.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$886.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,601.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,217.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,571.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.81
|
| Rate for Payer: PHCS Commercial |
$2,838.00
|
| Rate for Payer: United Healthcare All Payer |
$2,601.50
|
|
|
PLATE TUBULAR THRD 7H
|
Facility
|
OP
|
$2,956.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$886.88 |
| Max. Negotiated Rate |
$2,838.00 |
| Rate for Payer: Aetna Commercial |
$2,276.31
|
| Rate for Payer: Anthem Medicaid |
$1,016.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,305.88
|
| Rate for Payer: Cash Price |
$1,478.12
|
| Rate for Payer: Cigna Commercial |
$2,453.69
|
| Rate for Payer: First Health Commercial |
$2,808.44
|
| Rate for Payer: Humana Commercial |
$2,512.81
|
| Rate for Payer: Humana KY Medicaid |
$1,016.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,424.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,181.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$886.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,601.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,217.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,571.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,039.81
|
| Rate for Payer: PHCS Commercial |
$2,838.00
|
| Rate for Payer: United Healthcare All Payer |
$2,601.50
|
|
|
PLATE TUBULAR THRD 8H
|
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 THRD 8H
|
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 TW 3H 65MM LG
|
Facility
|
IP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE TW 3H 65MM LG
|
Facility
|
OP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem Medicaid |
$632.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Humana KY Medicaid |
$632.64
|
| Rate for Payer: Kentucky WC Medicaid |
$639.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
|
PLATE TW 4H 85MM
|
Facility
|
OP
|
$1,839.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.88 |
| Max. Negotiated Rate |
$1,766.02 |
| Rate for Payer: Aetna Commercial |
$1,416.49
|
| Rate for Payer: Anthem Medicaid |
$632.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,434.89
|
| Rate for Payer: Cash Price |
$919.80
|
| Rate for Payer: Cigna Commercial |
$1,526.87
|
| Rate for Payer: First Health Commercial |
$1,747.62
|
| Rate for Payer: Humana Commercial |
$1,563.66
|
| Rate for Payer: Humana KY Medicaid |
$632.64
|
| Rate for Payer: Kentucky WC Medicaid |
$639.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,618.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,379.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,600.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,269.32
|
| Rate for Payer: PHCS Commercial |
$1,766.02
|
| Rate for Payer: United Healthcare All Payer |
$1,618.85
|
|
