|
PLATE 3.5 MED COL MED R
|
Facility
|
IP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
PLATE 3.5 MED COL SM L
|
Facility
|
IP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
PLATE 3.5 MED COL SM L
|
Facility
|
OP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem Medicaid |
$2,839.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Humana KY Medicaid |
$2,839.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
PLATE 3.5 MED COL SM R
|
Facility
|
OP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem Medicaid |
$2,839.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Humana KY Medicaid |
$2,839.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
PLATE 3.5 MED COL SM R
|
Facility
|
IP
|
$8,256.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.38 |
| Max. Negotiated Rate |
$7,926.48 |
| Rate for Payer: Aetna Commercial |
$6,357.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,440.26
|
| Rate for Payer: Cash Price |
$4,128.38
|
| Rate for Payer: Cigna Commercial |
$6,853.10
|
| Rate for Payer: First Health Commercial |
$7,843.91
|
| Rate for Payer: Humana Commercial |
$7,018.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,770.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,093.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,477.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,651.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,559.59
|
| Rate for Payer: PHCS Commercial |
$7,926.48
|
| Rate for Payer: United Healthcare All Payer |
$7,265.94
|
|
|
PLATE 3.5MM VA-LCP TIB 4H
|
Facility
|
IP
|
$17,174.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.67 |
| Max. Negotiated Rate |
$16,487.42 |
| Rate for Payer: Aetna Commercial |
$13,224.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,396.03
|
| Rate for Payer: Cash Price |
$8,587.20
|
| Rate for Payer: Cigna Commercial |
$14,254.75
|
| Rate for Payer: First Health Commercial |
$16,315.68
|
| Rate for Payer: Humana Commercial |
$14,598.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,083.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,674.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,152.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,113.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,880.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,434.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,232.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,324.06
|
| Rate for Payer: PHCS Commercial |
$16,487.42
|
| Rate for Payer: United Healthcare All Payer |
$15,113.47
|
|
|
PLATE 3.5MM VA-LCP TIB 4H
|
Facility
|
OP
|
$17,174.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,232.67 |
| Max. Negotiated Rate |
$16,487.42 |
| Rate for Payer: Aetna Commercial |
$13,224.29
|
| Rate for Payer: Anthem Medicaid |
$5,906.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,396.03
|
| Rate for Payer: Cash Price |
$8,587.20
|
| Rate for Payer: Cigna Commercial |
$14,254.75
|
| Rate for Payer: First Health Commercial |
$16,315.68
|
| Rate for Payer: Humana Commercial |
$14,598.24
|
| Rate for Payer: Humana KY Medicaid |
$5,906.28
|
| Rate for Payer: Kentucky WC Medicaid |
$5,966.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,083.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,674.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,152.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,024.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,113.47
|
| Rate for Payer: Ohio Health Group HMO |
$12,880.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,434.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,232.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,324.06
|
| Rate for Payer: PHCS Commercial |
$16,487.42
|
| Rate for Payer: United Healthcare All Payer |
$15,113.47
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE L
|
Facility
|
OP
|
$801.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$769.84 |
| Rate for Payer: Aetna Commercial |
$617.48
|
| Rate for Payer: Anthem Medicaid |
$275.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.50
|
| Rate for Payer: Cash Price |
$400.96
|
| Rate for Payer: Cigna Commercial |
$665.59
|
| Rate for Payer: First Health Commercial |
$761.82
|
| Rate for Payer: Humana Commercial |
$681.63
|
| Rate for Payer: Humana KY Medicaid |
$275.78
|
| Rate for Payer: Kentucky WC Medicaid |
$278.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$657.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$281.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$705.69
|
| Rate for Payer: Ohio Health Group HMO |
$601.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.60
|
| Rate for Payer: PHCS Commercial |
$769.84
|
| Rate for Payer: United Healthcare All Payer |
$705.69
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE L
|
Facility
|
IP
|
$801.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$769.84 |
| Rate for Payer: Humana Commercial |
$681.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$657.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$591.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$240.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$705.69
|
| Rate for Payer: Ohio Health Group HMO |
$601.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$160.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$104.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$248.60
|
| Rate for Payer: PHCS Commercial |
$769.84
|
| Rate for Payer: United Healthcare All Payer |
$705.69
|
| Rate for Payer: Aetna Commercial |
$617.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$625.50
|
| Rate for Payer: Cash Price |
$400.96
|
| Rate for Payer: Cigna Commercial |
$665.59
|
| Rate for Payer: First Health Commercial |
$761.82
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE R
|
Facility
|
OP
|
$768.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem Medicaid |
$264.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Humana KY Medicaid |
$264.37
|
| Rate for Payer: Kentucky WC Medicaid |
$267.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
PLATE 3 HOLE SHAFT OBLIQUE R
|
Facility
|
IP
|
$768.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
PLATE 3 HOLE SHAFT T
|
Facility
|
OP
|
$768.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem Medicaid |
$264.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Humana KY Medicaid |
$264.37
|
| Rate for Payer: Kentucky WC Medicaid |
$267.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$269.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
PLATE 3 HOLE SHAFT T
|
Facility
|
IP
|
$768.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$99.94 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Aetna Commercial |
$591.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$599.62
|
| Rate for Payer: Cash Price |
$384.38
|
| Rate for Payer: Cigna Commercial |
$638.06
|
| Rate for Payer: First Health Commercial |
$730.31
|
| Rate for Payer: Humana Commercial |
$653.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$630.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$567.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$230.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$676.50
|
| Rate for Payer: Ohio Health Group HMO |
$576.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$153.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$99.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$238.31
|
| Rate for Payer: PHCS Commercial |
$738.00
|
| Rate for Payer: United Healthcare All Payer |
$676.50
|
|
|
PLATE 4.5/5.0 TI CANN 10H STR
|
Facility
|
IP
|
$1,983.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.86 |
| Max. Negotiated Rate |
$1,904.16 |
| Rate for Payer: Aetna Commercial |
$1,527.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.13
|
| Rate for Payer: Cash Price |
$991.75
|
| Rate for Payer: Cigna Commercial |
$1,646.30
|
| Rate for Payer: First Health Commercial |
$1,884.32
|
| Rate for Payer: Humana Commercial |
$1,685.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.88
|
| Rate for Payer: PHCS Commercial |
$1,904.16
|
| Rate for Payer: United Healthcare All Payer |
$1,745.48
|
|
|
PLATE 4.5/5.0 TI CANN 10H STR
|
Facility
|
OP
|
$1,983.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.86 |
| Max. Negotiated Rate |
$1,904.16 |
| Rate for Payer: Aetna Commercial |
$1,527.30
|
| Rate for Payer: Anthem Medicaid |
$682.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.13
|
| Rate for Payer: Cash Price |
$991.75
|
| Rate for Payer: Cigna Commercial |
$1,646.30
|
| Rate for Payer: First Health Commercial |
$1,884.32
|
| Rate for Payer: Humana Commercial |
$1,685.98
|
| Rate for Payer: Humana KY Medicaid |
$682.13
|
| Rate for Payer: Kentucky WC Medicaid |
$689.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,626.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,463.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$695.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,745.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,487.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$614.88
|
| Rate for Payer: PHCS Commercial |
$1,904.16
|
| Rate for Payer: United Healthcare All Payer |
$1,745.48
|
|
|
PLATE 4.5/5.0 TI CANN 6H STR
|
Facility
|
OP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Humana KY Medicaid |
$626.76
|
| Rate for Payer: Kentucky WC Medicaid |
$633.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem Medicaid |
$626.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
|
|
PLATE 4.5/5.0 TI CANN 6H STR
|
Facility
|
IP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
PLATE 4.5/5.0 TI CANN 8H STR
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
PLATE 4.5/5.0 TI CANN 8H STR
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
PLATE 4.5 BROAD LCP 10H 188MM
|
Facility
|
OP
|
$3,902.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.31 |
| Max. Negotiated Rate |
$3,746.27 |
| Rate for Payer: Aetna Commercial |
$3,004.82
|
| Rate for Payer: Anthem Medicaid |
$1,342.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.84
|
| Rate for Payer: Cash Price |
$1,951.18
|
| Rate for Payer: Cigna Commercial |
$3,238.96
|
| Rate for Payer: First Health Commercial |
$3,707.24
|
| Rate for Payer: Humana Commercial |
$3,317.01
|
| Rate for Payer: Humana KY Medicaid |
$1,342.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.73
|
| Rate for Payer: PHCS Commercial |
$3,746.27
|
| Rate for Payer: United Healthcare All Payer |
$3,434.08
|
|
|
PLATE 4.5 BROAD LCP 10H 188MM
|
Facility
|
IP
|
$3,902.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.31 |
| Max. Negotiated Rate |
$3,746.27 |
| Rate for Payer: Aetna Commercial |
$3,004.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,043.84
|
| Rate for Payer: Cash Price |
$1,951.18
|
| Rate for Payer: Cigna Commercial |
$3,238.96
|
| Rate for Payer: First Health Commercial |
$3,707.24
|
| Rate for Payer: Humana Commercial |
$3,317.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,434.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,926.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$780.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$507.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,209.73
|
| Rate for Payer: PHCS Commercial |
$3,746.27
|
| Rate for Payer: United Healthcare All Payer |
$3,434.08
|
|
|
PLATE 4.5 BROAD LCP 11H 206MM
|
Facility
|
OP
|
$4,016.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.12 |
| Max. Negotiated Rate |
$3,855.64 |
| Rate for Payer: Aetna Commercial |
$3,092.54
|
| Rate for Payer: Anthem Medicaid |
$1,381.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,132.71
|
| Rate for Payer: Cash Price |
$2,008.14
|
| Rate for Payer: Cigna Commercial |
$3,333.52
|
| Rate for Payer: First Health Commercial |
$3,815.48
|
| Rate for Payer: Humana Commercial |
$3,413.85
|
| Rate for Payer: Humana KY Medicaid |
$1,381.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,395.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,293.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,204.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,408.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,534.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,012.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$803.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.05
|
| Rate for Payer: PHCS Commercial |
$3,855.64
|
| Rate for Payer: United Healthcare All Payer |
$3,534.34
|
|
|
PLATE 4.5 BROAD LCP 11H 206MM
|
Facility
|
IP
|
$4,016.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$522.12 |
| Max. Negotiated Rate |
$3,855.64 |
| Rate for Payer: Aetna Commercial |
$3,092.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,132.71
|
| Rate for Payer: Cash Price |
$2,008.14
|
| Rate for Payer: Cigna Commercial |
$3,333.52
|
| Rate for Payer: First Health Commercial |
$3,815.48
|
| Rate for Payer: Humana Commercial |
$3,413.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,293.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,964.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,204.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,534.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,012.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$803.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$522.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,245.05
|
| Rate for Payer: PHCS Commercial |
$3,855.64
|
| Rate for Payer: United Healthcare All Payer |
$3,534.34
|
|
|
PLATE 4.5 BROAD LCP 12H 224MM
|
Facility
|
IP
|
$4,126.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.50 |
| Max. Negotiated Rate |
$3,961.88 |
| Rate for Payer: Aetna Commercial |
$3,177.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,219.03
|
| Rate for Payer: Cash Price |
$2,063.48
|
| Rate for Payer: Cigna Commercial |
$3,425.38
|
| Rate for Payer: First Health Commercial |
$3,920.61
|
| Rate for Payer: Humana Commercial |
$3,507.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,384.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,045.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,631.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,095.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.36
|
| Rate for Payer: PHCS Commercial |
$3,961.88
|
| Rate for Payer: United Healthcare All Payer |
$3,631.72
|
|
|
PLATE 4.5 BROAD LCP 12H 224MM
|
Facility
|
OP
|
$4,126.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.50 |
| Max. Negotiated Rate |
$3,961.88 |
| Rate for Payer: Aetna Commercial |
$3,177.76
|
| Rate for Payer: Anthem Medicaid |
$1,419.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,219.03
|
| Rate for Payer: Cash Price |
$2,063.48
|
| Rate for Payer: Cigna Commercial |
$3,425.38
|
| Rate for Payer: First Health Commercial |
$3,920.61
|
| Rate for Payer: Humana Commercial |
$3,507.92
|
| Rate for Payer: Humana KY Medicaid |
$1,419.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,384.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,045.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,631.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,095.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.36
|
| Rate for Payer: PHCS Commercial |
$3,961.88
|
| Rate for Payer: United Healthcare All Payer |
$3,631.72
|
|
