|
PLATE COMP 8H 3.5*119 71829408
|
Facility
|
OP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.39 |
| Max. Negotiated Rate |
$1,826.88 |
| Rate for Payer: Aetna Commercial |
$1,465.31
|
| Rate for Payer: Anthem Medicaid |
$654.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,484.34
|
| Rate for Payer: Cash Price |
$951.50
|
| Rate for Payer: Cigna Commercial |
$1,579.49
|
| Rate for Payer: First Health Commercial |
$1,807.85
|
| Rate for Payer: Humana Commercial |
$1,617.55
|
| Rate for Payer: Humana KY Medicaid |
$654.44
|
| Rate for Payer: Kentucky WC Medicaid |
$661.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$667.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,427.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.93
|
| Rate for Payer: PHCS Commercial |
$1,826.88
|
| Rate for Payer: United Healthcare All Payer |
$1,674.64
|
|
|
PLATE COMP 8H 3.5*119 71829408
|
Facility
|
IP
|
$1,903.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.39 |
| Max. Negotiated Rate |
$1,826.88 |
| Rate for Payer: Aetna Commercial |
$1,465.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,484.34
|
| Rate for Payer: Cash Price |
$951.50
|
| Rate for Payer: Cigna Commercial |
$1,579.49
|
| Rate for Payer: First Health Commercial |
$1,807.85
|
| Rate for Payer: Humana Commercial |
$1,617.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,560.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,404.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,674.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,427.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.93
|
| Rate for Payer: PHCS Commercial |
$1,826.88
|
| Rate for Payer: United Healthcare All Payer |
$1,674.64
|
|
|
PLATE COMP 9H 3.5*132 71829409
|
Facility
|
IP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
PLATE COMP 9H 3.5*132 71829409
|
Facility
|
OP
|
$1,934.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.48 |
| Max. Negotiated Rate |
$1,857.12 |
| Rate for Payer: Aetna Commercial |
$1,489.56
|
| Rate for Payer: Anthem Medicaid |
$665.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.91
|
| Rate for Payer: Cash Price |
$967.25
|
| Rate for Payer: Cigna Commercial |
$1,605.64
|
| Rate for Payer: First Health Commercial |
$1,837.78
|
| Rate for Payer: Humana Commercial |
$1,644.32
|
| Rate for Payer: Humana KY Medicaid |
$665.27
|
| Rate for Payer: Kentucky WC Medicaid |
$672.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.70
|
| Rate for Payer: PHCS Commercial |
$1,857.12
|
| Rate for Payer: United Healthcare All Payer |
$1,702.36
|
|
|
PLATE COMP CABLE 9H 260MM
|
Facility
|
OP
|
$5,493.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.16 |
| Max. Negotiated Rate |
$5,273.76 |
| Rate for Payer: Aetna Commercial |
$4,230.00
|
| Rate for Payer: Anthem Medicaid |
$1,889.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,284.93
|
| Rate for Payer: Cash Price |
$2,746.75
|
| Rate for Payer: Cigna Commercial |
$4,559.60
|
| Rate for Payer: First Health Commercial |
$5,218.82
|
| Rate for Payer: Humana Commercial |
$4,669.48
|
| Rate for Payer: Humana KY Medicaid |
$1,889.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,504.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,054.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,927.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,834.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,120.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.98
|
| Rate for Payer: PHCS Commercial |
$5,273.76
|
| Rate for Payer: United Healthcare All Payer |
$4,834.28
|
|
|
PLATE COMP CABLE 9H 260MM
|
Facility
|
IP
|
$5,493.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.16 |
| Max. Negotiated Rate |
$5,273.76 |
| Rate for Payer: Aetna Commercial |
$4,230.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,284.93
|
| Rate for Payer: Cash Price |
$2,746.75
|
| Rate for Payer: Cigna Commercial |
$4,559.60
|
| Rate for Payer: First Health Commercial |
$5,218.82
|
| Rate for Payer: Humana Commercial |
$4,669.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,504.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,054.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,834.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,120.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.98
|
| Rate for Payer: PHCS Commercial |
$5,273.76
|
| Rate for Payer: United Healthcare All Payer |
$4,834.28
|
|
|
PLATE COMP LCK 3.5MM 111MM 7H
|
Facility
|
IP
|
$3,248.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.36 |
| Max. Negotiated Rate |
$3,118.99 |
| Rate for Payer: Aetna Commercial |
$2,501.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,534.18
|
| Rate for Payer: Cash Price |
$1,624.47
|
| Rate for Payer: Cigna Commercial |
$2,696.63
|
| Rate for Payer: First Health Commercial |
$3,086.50
|
| Rate for Payer: Humana Commercial |
$2,761.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,664.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.17
|
| Rate for Payer: PHCS Commercial |
$3,118.99
|
| Rate for Payer: United Healthcare All Payer |
$2,859.08
|
|
|
PLATE COMP LCK 3.5MM 111MM 7H
|
Facility
|
OP
|
$3,248.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.36 |
| Max. Negotiated Rate |
$3,118.99 |
| Rate for Payer: Anthem Medicaid |
$1,117.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,534.18
|
| Rate for Payer: Cash Price |
$1,624.47
|
| Rate for Payer: Cigna Commercial |
$2,696.63
|
| Rate for Payer: First Health Commercial |
$3,086.50
|
| Rate for Payer: Humana Commercial |
$2,761.61
|
| Rate for Payer: Humana KY Medicaid |
$1,117.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,664.14
|
| Rate for Payer: Aetna Commercial |
$2,501.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,007.17
|
| Rate for Payer: PHCS Commercial |
$3,118.99
|
| Rate for Payer: United Healthcare All Payer |
$2,859.08
|
|
|
PLATE COMP LCK 3.5MM 121MM 6H
|
Facility
|
OP
|
$3,598.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.82 |
| Max. Negotiated Rate |
$3,454.66 |
| Rate for Payer: Aetna Commercial |
$2,770.92
|
| Rate for Payer: Anthem Medicaid |
$1,237.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,806.91
|
| Rate for Payer: Cash Price |
$1,799.30
|
| Rate for Payer: Cigna Commercial |
$2,986.84
|
| Rate for Payer: First Health Commercial |
$3,418.67
|
| Rate for Payer: Humana Commercial |
$3,058.81
|
| Rate for Payer: Humana KY Medicaid |
$1,237.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,250.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,950.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,655.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,079.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,262.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,166.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,698.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,115.57
|
| Rate for Payer: PHCS Commercial |
$3,454.66
|
| Rate for Payer: United Healthcare All Payer |
$3,166.77
|
|
|
PLATE COMP LCK 3.5MM 121MM 6H
|
Facility
|
IP
|
$3,598.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.82 |
| Max. Negotiated Rate |
$3,454.66 |
| Rate for Payer: Aetna Commercial |
$2,770.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,806.91
|
| Rate for Payer: Cash Price |
$1,799.30
|
| Rate for Payer: Cigna Commercial |
$2,986.84
|
| Rate for Payer: First Health Commercial |
$3,418.67
|
| Rate for Payer: Humana Commercial |
$3,058.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,950.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,655.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,079.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,166.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,698.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$719.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$467.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,115.57
|
| Rate for Payer: PHCS Commercial |
$3,454.66
|
| Rate for Payer: United Healthcare All Payer |
$3,166.77
|
|
|
PLATE COMP LCK 3.5MM 125MM 8H
|
Facility
|
OP
|
$3,404.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.18 |
| Rate for Payer: Aetna Commercial |
$2,621.35
|
| Rate for Payer: Anthem Medicaid |
$1,170.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.39
|
| Rate for Payer: Cash Price |
$1,702.17
|
| Rate for Payer: Cigna Commercial |
$2,825.61
|
| Rate for Payer: First Health Commercial |
$3,234.13
|
| Rate for Payer: Humana Commercial |
$2,893.70
|
| Rate for Payer: Humana KY Medicaid |
$1,170.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.35
|
| Rate for Payer: PHCS Commercial |
$3,268.18
|
| Rate for Payer: United Healthcare All Payer |
$2,995.83
|
|
|
PLATE COMP LCK 3.5MM 125MM 8H
|
Facility
|
IP
|
$3,404.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.57 |
| Max. Negotiated Rate |
$3,268.18 |
| Rate for Payer: Aetna Commercial |
$2,621.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.39
|
| Rate for Payer: Cash Price |
$1,702.17
|
| Rate for Payer: Cigna Commercial |
$2,825.61
|
| Rate for Payer: First Health Commercial |
$3,234.13
|
| Rate for Payer: Humana Commercial |
$2,893.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.35
|
| Rate for Payer: PHCS Commercial |
$3,268.18
|
| Rate for Payer: United Healthcare All Payer |
$2,995.83
|
|
|
PLATE COMP LCK 3.5MM 140MM 7H
|
Facility
|
OP
|
$3,326.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.46 |
| Max. Negotiated Rate |
$3,193.58 |
| Rate for Payer: Aetna Commercial |
$2,561.52
|
| Rate for Payer: Anthem Medicaid |
$1,144.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,594.79
|
| Rate for Payer: Cash Price |
$1,663.33
|
| Rate for Payer: Cigna Commercial |
$2,761.12
|
| Rate for Payer: First Health Commercial |
$3,160.32
|
| Rate for Payer: Humana Commercial |
$2,827.65
|
| Rate for Payer: Humana KY Medicaid |
$1,144.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,155.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,727.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,166.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,927.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,494.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.26
|
| Rate for Payer: PHCS Commercial |
$3,193.58
|
| Rate for Payer: United Healthcare All Payer |
$2,927.45
|
|
|
PLATE COMP LCK 3.5MM 140MM 7H
|
Facility
|
IP
|
$3,326.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$432.46 |
| Max. Negotiated Rate |
$3,193.58 |
| Rate for Payer: Aetna Commercial |
$2,561.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,594.79
|
| Rate for Payer: Cash Price |
$1,663.33
|
| Rate for Payer: Cigna Commercial |
$2,761.12
|
| Rate for Payer: First Health Commercial |
$3,160.32
|
| Rate for Payer: Humana Commercial |
$2,827.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,727.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,455.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$998.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,927.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,494.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$665.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$432.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,031.26
|
| Rate for Payer: PHCS Commercial |
$3,193.58
|
| Rate for Payer: United Healthcare All Payer |
$2,927.45
|
|
|
PLATE COMP LCK 3.5MM 154MM 10H
|
Facility
|
IP
|
$3,482.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.67 |
| Max. Negotiated Rate |
$3,342.77 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.00
|
| Rate for Payer: Cash Price |
$1,741.03
|
| Rate for Payer: Cigna Commercial |
$2,890.10
|
| Rate for Payer: First Health Commercial |
$3,307.95
|
| Rate for Payer: Humana Commercial |
$2,959.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,855.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,064.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,611.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.44
|
| Rate for Payer: PHCS Commercial |
$3,342.77
|
| Rate for Payer: United Healthcare All Payer |
$3,064.20
|
|
|
PLATE COMP LCK 3.5MM 154MM 10H
|
Facility
|
OP
|
$3,482.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.67 |
| Max. Negotiated Rate |
$3,342.77 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: Anthem Medicaid |
$1,197.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.00
|
| Rate for Payer: Cash Price |
$1,741.03
|
| Rate for Payer: Cigna Commercial |
$2,890.10
|
| Rate for Payer: First Health Commercial |
$3,307.95
|
| Rate for Payer: Humana Commercial |
$2,959.74
|
| Rate for Payer: Humana KY Medicaid |
$1,197.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,855.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,064.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,611.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.44
|
| Rate for Payer: PHCS Commercial |
$3,342.77
|
| Rate for Payer: United Healthcare All Payer |
$3,064.20
|
|
|
PLATE COMP LCK 3.5MM 157MM 8H
|
Facility
|
OP
|
$4,006.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.85 |
| Max. Negotiated Rate |
$3,846.26 |
| Rate for Payer: Anthem Medicaid |
$1,377.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,125.09
|
| Rate for Payer: Cash Price |
$2,003.26
|
| Rate for Payer: Cigna Commercial |
$3,325.41
|
| Rate for Payer: First Health Commercial |
$3,806.19
|
| Rate for Payer: Humana Commercial |
$3,405.54
|
| Rate for Payer: Humana KY Medicaid |
$1,377.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,391.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.35
|
| Rate for Payer: Aetna Commercial |
$3,085.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,405.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.74
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.02
|
| Rate for Payer: PHCS Commercial |
$3,846.26
|
| Rate for Payer: United Healthcare All Payer |
$3,525.74
|
|
|
PLATE COMP LCK 3.5MM 157MM 8H
|
Facility
|
IP
|
$4,006.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.85 |
| Max. Negotiated Rate |
$3,846.26 |
| Rate for Payer: Aetna Commercial |
$3,085.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,125.09
|
| Rate for Payer: Cash Price |
$2,003.26
|
| Rate for Payer: Cigna Commercial |
$3,325.41
|
| Rate for Payer: First Health Commercial |
$3,806.19
|
| Rate for Payer: Humana Commercial |
$3,405.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.74
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.02
|
| Rate for Payer: PHCS Commercial |
$3,846.26
|
| Rate for Payer: United Healthcare All Payer |
$3,525.74
|
|
|
PLATE COMP LCK 3.5MM 183MM 12H
|
Facility
|
OP
|
$3,618.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.34 |
| Max. Negotiated Rate |
$3,473.30 |
| Rate for Payer: Aetna Commercial |
$2,785.88
|
| Rate for Payer: Anthem Medicaid |
$1,244.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,822.06
|
| Rate for Payer: Cash Price |
$1,809.01
|
| Rate for Payer: Cigna Commercial |
$3,002.96
|
| Rate for Payer: First Health Commercial |
$3,437.12
|
| Rate for Payer: Humana Commercial |
$3,075.32
|
| Rate for Payer: Humana KY Medicaid |
$1,244.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,670.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.59
|
| Rate for Payer: PHCS Commercial |
$3,473.30
|
| Rate for Payer: United Healthcare All Payer |
$3,183.86
|
|
|
PLATE COMP LCK 3.5MM 183MM 12H
|
Facility
|
IP
|
$3,618.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.34 |
| Max. Negotiated Rate |
$3,473.30 |
| Rate for Payer: Aetna Commercial |
$2,785.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,822.06
|
| Rate for Payer: Cash Price |
$1,809.01
|
| Rate for Payer: Cigna Commercial |
$3,002.96
|
| Rate for Payer: First Health Commercial |
$3,437.12
|
| Rate for Payer: Humana Commercial |
$3,075.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,966.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,670.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,183.86
|
| Rate for Payer: Ohio Health Group HMO |
$2,713.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,121.59
|
| Rate for Payer: PHCS Commercial |
$3,473.30
|
| Rate for Payer: United Healthcare All Payer |
$3,183.86
|
|
|
PLATE COMP LCK 3.5MM 193MM 10H
|
Facility
|
OP
|
$4,304.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.57 |
| Max. Negotiated Rate |
$4,132.20 |
| Rate for Payer: Aetna Commercial |
$3,314.37
|
| Rate for Payer: Anthem Medicaid |
$1,480.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.42
|
| Rate for Payer: Cash Price |
$2,152.19
|
| Rate for Payer: Cigna Commercial |
$3,572.64
|
| Rate for Payer: First Health Commercial |
$4,089.16
|
| Rate for Payer: Humana Commercial |
$3,658.72
|
| Rate for Payer: Humana KY Medicaid |
$1,480.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,509.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.36
|
| Rate for Payer: PHCS Commercial |
$4,132.20
|
| Rate for Payer: United Healthcare All Payer |
$3,787.85
|
|
|
PLATE COMP LCK 3.5MM 193MM 10H
|
Facility
|
IP
|
$4,304.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.57 |
| Max. Negotiated Rate |
$4,132.20 |
| Rate for Payer: Aetna Commercial |
$3,314.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.42
|
| Rate for Payer: Cash Price |
$2,152.19
|
| Rate for Payer: Cigna Commercial |
$3,572.64
|
| Rate for Payer: First Health Commercial |
$4,089.16
|
| Rate for Payer: Humana Commercial |
$3,658.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.36
|
| Rate for Payer: PHCS Commercial |
$4,132.20
|
| Rate for Payer: United Healthcare All Payer |
$3,787.85
|
|
|
PLATE COMP LCK 3.5MM 212MM 14H
|
Facility
|
OP
|
$4,382.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.67 |
| Max. Negotiated Rate |
$4,206.80 |
| Rate for Payer: Aetna Commercial |
$3,374.20
|
| Rate for Payer: Anthem Medicaid |
$1,507.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.02
|
| Rate for Payer: Cash Price |
$2,191.04
|
| Rate for Payer: Cigna Commercial |
$3,637.13
|
| Rate for Payer: First Health Commercial |
$4,162.98
|
| Rate for Payer: Humana Commercial |
$3,724.77
|
| Rate for Payer: Humana KY Medicaid |
$1,507.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.44
|
| Rate for Payer: PHCS Commercial |
$4,206.80
|
| Rate for Payer: United Healthcare All Payer |
$3,856.23
|
|
|
PLATE COMP LCK 3.5MM 212MM 14H
|
Facility
|
IP
|
$4,382.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.67 |
| Max. Negotiated Rate |
$4,206.80 |
| Rate for Payer: Aetna Commercial |
$3,374.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.02
|
| Rate for Payer: Cash Price |
$2,191.04
|
| Rate for Payer: Cigna Commercial |
$3,637.13
|
| Rate for Payer: First Health Commercial |
$4,162.98
|
| Rate for Payer: Humana Commercial |
$3,724.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.44
|
| Rate for Payer: PHCS Commercial |
$4,206.80
|
| Rate for Payer: United Healthcare All Payer |
$3,856.23
|
|
|
PLATE COMP LCK 3.5MM 214MM 14H
|
Facility
|
OP
|
$4,382.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.67 |
| Max. Negotiated Rate |
$4,206.80 |
| Rate for Payer: Aetna Commercial |
$3,374.20
|
| Rate for Payer: Anthem Medicaid |
$1,507.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.02
|
| Rate for Payer: Cash Price |
$2,191.04
|
| Rate for Payer: Cigna Commercial |
$3,637.13
|
| Rate for Payer: First Health Commercial |
$4,162.98
|
| Rate for Payer: Humana Commercial |
$3,724.77
|
| Rate for Payer: Humana KY Medicaid |
$1,507.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,233.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.44
|
| Rate for Payer: PHCS Commercial |
$4,206.80
|
| Rate for Payer: United Healthcare All Payer |
$3,856.23
|
|
