|
PLATE CMF 2.7 8H 60MM
|
Facility
|
IP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
|
|
PLATE CMF 2.7 ANGLE 6H 40MM
|
Facility
|
IP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.7 ANGLE 6H 40MM
|
Facility
|
OP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem Medicaid |
$1,102.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Humana KY Medicaid |
$1,102.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,124.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.7 CRVD 4H 39MM
|
Facility
|
IP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.7 CRVD 4H 39MM
|
Facility
|
OP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem Medicaid |
$1,102.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Humana KY Medicaid |
$1,102.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,124.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.7 CRVD 6H 49MM
|
Facility
|
OP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem Medicaid |
$1,102.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Humana KY Medicaid |
$1,102.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,124.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.7 CRVD 6H 49MM
|
Facility
|
IP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE COLUMN FUSION 3.5MM
|
Facility
|
IP
|
$7,907.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.92 |
| Max. Negotiated Rate |
$7,590.80 |
| Rate for Payer: Aetna Commercial |
$6,088.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,167.52
|
| Rate for Payer: Cash Price |
$3,953.54
|
| Rate for Payer: Cigna Commercial |
$6,562.88
|
| Rate for Payer: First Health Commercial |
$7,511.73
|
| Rate for Payer: Humana Commercial |
$6,721.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,483.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,835.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,372.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,958.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,930.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,581.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,451.19
|
| Rate for Payer: PHCS Commercial |
$7,590.80
|
| Rate for Payer: United Healthcare All Payer |
$6,958.23
|
|
|
PLATE COLUMN FUSION 3.5MM
|
Facility
|
OP
|
$7,907.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,027.92 |
| Max. Negotiated Rate |
$7,590.80 |
| Rate for Payer: Kentucky WC Medicaid |
$2,746.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,483.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,835.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,372.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,773.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,958.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,930.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,581.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,451.19
|
| Rate for Payer: PHCS Commercial |
$7,590.80
|
| Rate for Payer: United Healthcare All Payer |
$6,958.23
|
| Rate for Payer: Aetna Commercial |
$6,088.45
|
| Rate for Payer: Anthem Medicaid |
$2,719.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,167.52
|
| Rate for Payer: Cash Price |
$3,953.54
|
| Rate for Payer: Cigna Commercial |
$6,562.88
|
| Rate for Payer: First Health Commercial |
$7,511.73
|
| Rate for Payer: Humana Commercial |
$6,721.02
|
| Rate for Payer: Humana KY Medicaid |
$2,719.24
|
|
|
PLATE COM LK 3.5MM 4H 67MM
|
Facility
|
IP
|
$3,171.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.26 |
| Max. Negotiated Rate |
$3,044.40 |
| Rate for Payer: Aetna Commercial |
$2,441.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.58
|
| Rate for Payer: Cash Price |
$1,585.62
|
| Rate for Payer: Cigna Commercial |
$2,632.14
|
| Rate for Payer: First Health Commercial |
$3,012.69
|
| Rate for Payer: Humana Commercial |
$2,695.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.09
|
| Rate for Payer: PHCS Commercial |
$3,044.40
|
| Rate for Payer: United Healthcare All Payer |
$2,790.70
|
|
|
PLATE COM LK 3.5MM 4H 67MM
|
Facility
|
OP
|
$3,171.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.26 |
| Max. Negotiated Rate |
$3,044.40 |
| Rate for Payer: Aetna Commercial |
$2,441.86
|
| Rate for Payer: Anthem Medicaid |
$1,090.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.58
|
| Rate for Payer: Cash Price |
$1,585.62
|
| Rate for Payer: Cigna Commercial |
$2,632.14
|
| Rate for Payer: First Health Commercial |
$3,012.69
|
| Rate for Payer: Humana Commercial |
$2,695.56
|
| Rate for Payer: Humana KY Medicaid |
$1,090.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,101.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,112.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.09
|
| Rate for Payer: PHCS Commercial |
$3,044.40
|
| Rate for Payer: United Healthcare All Payer |
$2,790.70
|
|
|
PLATE COMP 10H 3.5*145
|
Facility
|
IP
|
$1,941.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.40 |
| Max. Negotiated Rate |
$1,863.84 |
| Rate for Payer: Aetna Commercial |
$1,494.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,514.37
|
| Rate for Payer: Cash Price |
$970.75
|
| Rate for Payer: Cigna Commercial |
$1,611.44
|
| Rate for Payer: First Health Commercial |
$1,844.42
|
| Rate for Payer: Humana Commercial |
$1,650.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.86
|
| Rate for Payer: PHCS Commercial |
$1,863.84
|
| Rate for Payer: United Healthcare All Payer |
$1,708.52
|
|
|
PLATE COMP 10H 3.5*145
|
Facility
|
OP
|
$1,941.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.40 |
| Max. Negotiated Rate |
$1,863.84 |
| Rate for Payer: Aetna Commercial |
$1,494.96
|
| Rate for Payer: Anthem Medicaid |
$667.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,514.37
|
| Rate for Payer: Cash Price |
$970.75
|
| Rate for Payer: Cigna Commercial |
$1,611.44
|
| Rate for Payer: First Health Commercial |
$1,844.42
|
| Rate for Payer: Humana Commercial |
$1,650.28
|
| Rate for Payer: Humana KY Medicaid |
$667.68
|
| Rate for Payer: Kentucky WC Medicaid |
$674.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,432.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$681.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,708.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$601.86
|
| Rate for Payer: PHCS Commercial |
$1,863.84
|
| Rate for Payer: United Healthcare All Payer |
$1,708.52
|
|
|
PLATE COMP 1/3 TUB 3 H 3.5MM
|
Facility
|
IP
|
$4,685.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.14 |
| Max. Negotiated Rate |
$4,498.27 |
| Rate for Payer: Aetna Commercial |
$3,607.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.85
|
| Rate for Payer: Cash Price |
$2,342.85
|
| Rate for Payer: Cigna Commercial |
$3,889.13
|
| Rate for Payer: First Health Commercial |
$4,451.42
|
| Rate for Payer: Humana Commercial |
$3,982.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,842.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,458.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,123.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,514.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.57
|
| Rate for Payer: PHCS Commercial |
$4,498.27
|
| Rate for Payer: United Healthcare All Payer |
$4,123.42
|
|
|
PLATE COMP 1/3 TUB 3 H 3.5MM
|
Facility
|
OP
|
$4,685.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.14 |
| Max. Negotiated Rate |
$4,498.27 |
| Rate for Payer: Aetna Commercial |
$3,607.99
|
| Rate for Payer: Anthem Medicaid |
$1,611.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,654.85
|
| Rate for Payer: Cash Price |
$2,342.85
|
| Rate for Payer: Cigna Commercial |
$3,889.13
|
| Rate for Payer: First Health Commercial |
$4,451.42
|
| Rate for Payer: Humana Commercial |
$3,982.84
|
| Rate for Payer: Humana KY Medicaid |
$1,611.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,627.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,842.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,458.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,405.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,643.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,123.42
|
| Rate for Payer: Ohio Health Group HMO |
$3,514.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.57
|
| Rate for Payer: PHCS Commercial |
$4,498.27
|
| Rate for Payer: United Healthcare All Payer |
$4,123.42
|
|
|
PLATE COMP 1/3 TUB 5 H 3.5MM
|
Facility
|
OP
|
$4,963.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.31 |
| Max. Negotiated Rate |
$4,765.39 |
| Rate for Payer: Aetna Commercial |
$3,822.24
|
| Rate for Payer: Anthem Medicaid |
$1,707.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,871.88
|
| Rate for Payer: Cash Price |
$2,481.98
|
| Rate for Payer: Cigna Commercial |
$4,120.08
|
| Rate for Payer: First Health Commercial |
$4,715.75
|
| Rate for Payer: Humana Commercial |
$4,219.36
|
| Rate for Payer: Humana KY Medicaid |
$1,707.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,724.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,070.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,489.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,741.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,722.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.82
|
| Rate for Payer: PHCS Commercial |
$4,765.39
|
| Rate for Payer: United Healthcare All Payer |
$4,368.28
|
|
|
PLATE COMP 1/3 TUB 5 H 3.5MM
|
Facility
|
IP
|
$4,963.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.31 |
| Max. Negotiated Rate |
$4,765.39 |
| Rate for Payer: Aetna Commercial |
$3,822.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,871.88
|
| Rate for Payer: Cash Price |
$2,481.98
|
| Rate for Payer: Cigna Commercial |
$4,120.08
|
| Rate for Payer: First Health Commercial |
$4,715.75
|
| Rate for Payer: Humana Commercial |
$4,219.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,070.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,489.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,722.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.82
|
| Rate for Payer: PHCS Commercial |
$4,765.39
|
| Rate for Payer: United Healthcare All Payer |
$4,368.28
|
|
|
PLATE COMP 1/3 TUB 7 H 3.5MM
|
Facility
|
IP
|
$5,103.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$4,898.96 |
| Rate for Payer: Humana Commercial |
$4,337.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,184.53
|
| Rate for Payer: Aetna Commercial |
$3,929.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,980.40
|
| Rate for Payer: Cash Price |
$2,551.54
|
| Rate for Payer: Cigna Commercial |
$4,235.56
|
| Rate for Payer: First Health Commercial |
$4,847.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,490.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,827.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.95
|
| Rate for Payer: PHCS Commercial |
$4,898.96
|
| Rate for Payer: United Healthcare All Payer |
$4,490.71
|
|
|
PLATE COMP 1/3 TUB 7 H 3.5MM
|
Facility
|
OP
|
$5,103.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$4,898.96 |
| Rate for Payer: Aetna Commercial |
$3,929.37
|
| Rate for Payer: Anthem Medicaid |
$1,754.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,980.40
|
| Rate for Payer: Cash Price |
$2,551.54
|
| Rate for Payer: Cigna Commercial |
$4,235.56
|
| Rate for Payer: First Health Commercial |
$4,847.93
|
| Rate for Payer: Humana Commercial |
$4,337.62
|
| Rate for Payer: Humana KY Medicaid |
$1,754.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,772.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,184.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,790.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,490.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,827.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.95
|
| Rate for Payer: PHCS Commercial |
$4,898.96
|
| Rate for Payer: United Healthcare All Payer |
$4,490.71
|
|
|
PLATE COMP 3.5*106 7H
|
Facility
|
IP
|
$1,900.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.05 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,463.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.30
|
| Rate for Payer: Cash Price |
$950.19
|
| Rate for Payer: Cigna Commercial |
$1,577.32
|
| Rate for Payer: First Health Commercial |
$1,805.36
|
| Rate for Payer: Humana Commercial |
$1,615.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.12
|
| Rate for Payer: PHCS Commercial |
$1,824.36
|
| Rate for Payer: United Healthcare All Payer |
$1,672.33
|
|
|
PLATE COMP 3.5*106 7H
|
Facility
|
OP
|
$1,900.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.05 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,463.29
|
| Rate for Payer: Anthem Medicaid |
$653.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.30
|
| Rate for Payer: Cash Price |
$950.19
|
| Rate for Payer: Cigna Commercial |
$1,577.32
|
| Rate for Payer: First Health Commercial |
$1,805.36
|
| Rate for Payer: Humana Commercial |
$1,615.32
|
| Rate for Payer: Humana KY Medicaid |
$653.54
|
| Rate for Payer: Kentucky WC Medicaid |
$660.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.12
|
| Rate for Payer: PHCS Commercial |
$1,824.36
|
| Rate for Payer: United Healthcare All Payer |
$1,672.33
|
|
|
PLATE COMP 3.5*119 8H
|
Facility
|
IP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE COMP 3.5*119 8H
|
Facility
|
OP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Anthem Medicaid |
$662.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Humana KY Medicaid |
$662.45
|
| Rate for Payer: Kentucky WC Medicaid |
$669.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE COMP 3.5*132 9H
|
Facility
|
IP
|
$1,932.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$1,855.44 |
| Rate for Payer: Aetna Commercial |
$1,488.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.54
|
| Rate for Payer: Cash Price |
$966.38
|
| Rate for Payer: Cigna Commercial |
$1,604.18
|
| Rate for Payer: First Health Commercial |
$1,836.11
|
| Rate for Payer: Humana Commercial |
$1,642.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.15
|
| Rate for Payer: PHCS Commercial |
$1,855.44
|
| Rate for Payer: United Healthcare All Payer |
$1,700.82
|
|
|
PLATE COMP 3.5*132 9H
|
Facility
|
OP
|
$1,932.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$1,855.44 |
| Rate for Payer: Aetna Commercial |
$1,488.22
|
| Rate for Payer: Anthem Medicaid |
$664.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.54
|
| Rate for Payer: Cash Price |
$966.38
|
| Rate for Payer: Cigna Commercial |
$1,604.18
|
| Rate for Payer: First Health Commercial |
$1,836.11
|
| Rate for Payer: Humana Commercial |
$1,642.84
|
| Rate for Payer: Humana KY Medicaid |
$664.67
|
| Rate for Payer: Kentucky WC Medicaid |
$671.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.15
|
| Rate for Payer: PHCS Commercial |
$1,855.44
|
| Rate for Payer: United Healthcare All Payer |
$1,700.82
|
|
