|
PLATE COMP LCK 3.5MM 214MM 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 229MM 12H
|
Facility
|
IP
|
$4,602.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.29 |
| Max. Negotiated Rate |
$4,418.14 |
| Rate for Payer: Aetna Commercial |
$3,543.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,589.74
|
| Rate for Payer: Cash Price |
$2,301.11
|
| Rate for Payer: Cigna Commercial |
$3,819.85
|
| Rate for Payer: First Health Commercial |
$4,372.12
|
| Rate for Payer: Humana Commercial |
$3,911.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,773.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,396.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,049.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,451.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.69
|
| Rate for Payer: PHCS Commercial |
$4,418.14
|
| Rate for Payer: United Healthcare All Payer |
$4,049.96
|
|
|
PLATE COMP LCK 3.5MM 229MM 12H
|
Facility
|
OP
|
$4,602.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.29 |
| Max. Negotiated Rate |
$4,418.14 |
| Rate for Payer: Anthem Medicaid |
$1,582.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,589.74
|
| Rate for Payer: Cash Price |
$2,301.11
|
| Rate for Payer: Cigna Commercial |
$3,819.85
|
| Rate for Payer: First Health Commercial |
$4,372.12
|
| Rate for Payer: Humana Commercial |
$3,911.90
|
| Rate for Payer: Humana KY Medicaid |
$1,582.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,773.83
|
| Rate for Payer: Aetna Commercial |
$3,543.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,396.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,614.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,049.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,451.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.69
|
| Rate for Payer: PHCS Commercial |
$4,418.14
|
| Rate for Payer: United Healthcare All Payer |
$4,049.96
|
|
|
PLATE COMP LCK 3.5MM 243MM 16H
|
Facility
|
OP
|
$4,543.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.71 |
| Max. Negotiated Rate |
$4,362.19 |
| Rate for Payer: Aetna Commercial |
$3,498.84
|
| Rate for Payer: Anthem Medicaid |
$1,562.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.28
|
| Rate for Payer: Cash Price |
$2,271.98
|
| Rate for Payer: Cigna Commercial |
$3,771.48
|
| Rate for Payer: First Health Commercial |
$4,316.75
|
| Rate for Payer: Humana Commercial |
$3,862.36
|
| Rate for Payer: Humana KY Medicaid |
$1,562.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,578.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,407.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$908.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.62
|
| Rate for Payer: PHCS Commercial |
$4,362.19
|
| Rate for Payer: United Healthcare All Payer |
$3,998.68
|
|
|
PLATE COMP LCK 3.5MM 243MM 16H
|
Facility
|
IP
|
$4,543.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.71 |
| Max. Negotiated Rate |
$4,362.19 |
| Rate for Payer: Aetna Commercial |
$3,498.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,544.28
|
| Rate for Payer: Cash Price |
$2,271.98
|
| Rate for Payer: Cigna Commercial |
$3,771.48
|
| Rate for Payer: First Health Commercial |
$4,316.75
|
| Rate for Payer: Humana Commercial |
$3,862.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,726.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,353.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,998.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,407.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$908.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$590.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,408.62
|
| Rate for Payer: PHCS Commercial |
$4,362.19
|
| Rate for Payer: United Healthcare All Payer |
$3,998.68
|
|
|
PLATE COMP LCK 3.5MM 265MM 14H
|
Facility
|
OP
|
$4,874.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$4,679.21 |
| Rate for Payer: Aetna Commercial |
$3,753.12
|
| Rate for Payer: Anthem Medicaid |
$1,676.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,801.86
|
| Rate for Payer: Cash Price |
$2,437.09
|
| Rate for Payer: Cigna Commercial |
$4,045.57
|
| Rate for Payer: First Health Commercial |
$4,630.47
|
| Rate for Payer: Humana Commercial |
$4,143.05
|
| Rate for Payer: Humana KY Medicaid |
$1,676.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,693.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,996.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,597.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,709.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,289.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,655.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,511.00
|
| Rate for Payer: PHCS Commercial |
$4,679.21
|
| Rate for Payer: United Healthcare All Payer |
$4,289.28
|
|
|
PLATE COMP LCK 3.5MM 265MM 14H
|
Facility
|
IP
|
$4,874.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.64 |
| Max. Negotiated Rate |
$4,679.21 |
| Rate for Payer: Aetna Commercial |
$3,753.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,801.86
|
| Rate for Payer: Cash Price |
$2,437.09
|
| Rate for Payer: Cigna Commercial |
$4,045.57
|
| Rate for Payer: First Health Commercial |
$4,630.47
|
| Rate for Payer: Humana Commercial |
$4,143.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,996.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,597.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,289.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,655.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$974.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$633.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,511.00
|
| Rate for Payer: PHCS Commercial |
$4,679.21
|
| Rate for Payer: United Healthcare All Payer |
$4,289.28
|
|
|
PLATE COMP LCK 3.5MM 272MM 18H
|
Facility
|
OP
|
$4,841.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.43 |
| Max. Negotiated Rate |
$4,648.13 |
| Rate for Payer: Aetna Commercial |
$3,728.19
|
| Rate for Payer: Anthem Medicaid |
$1,665.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,776.60
|
| Rate for Payer: Cash Price |
$2,420.90
|
| Rate for Payer: Cigna Commercial |
$4,018.69
|
| Rate for Payer: First Health Commercial |
$4,599.71
|
| Rate for Payer: Humana Commercial |
$4,115.53
|
| Rate for Payer: Humana KY Medicaid |
$1,665.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,682.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,970.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,573.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,698.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,260.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,631.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.96
|
| Rate for Payer: PHCS Commercial |
$4,648.13
|
| Rate for Payer: United Healthcare All Payer |
$4,260.78
|
|
|
PLATE COMP LCK 3.5MM 272MM 18H
|
Facility
|
IP
|
$4,841.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.43 |
| Max. Negotiated Rate |
$4,648.13 |
| Rate for Payer: Aetna Commercial |
$3,728.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,776.60
|
| Rate for Payer: Cash Price |
$2,420.90
|
| Rate for Payer: Cigna Commercial |
$4,018.69
|
| Rate for Payer: First Health Commercial |
$4,599.71
|
| Rate for Payer: Humana Commercial |
$4,115.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,970.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,573.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,452.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,260.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,631.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.96
|
| Rate for Payer: PHCS Commercial |
$4,648.13
|
| Rate for Payer: United Healthcare All Payer |
$4,260.78
|
|
|
PLATE COMP LCK 3.5MM 301MM 16H
|
Facility
|
OP
|
$5,087.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.42 |
| Max. Negotiated Rate |
$4,884.34 |
| Rate for Payer: Aetna Commercial |
$3,917.64
|
| Rate for Payer: Anthem Medicaid |
$1,749.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.52
|
| Rate for Payer: Cash Price |
$2,543.93
|
| Rate for Payer: Cigna Commercial |
$4,222.92
|
| Rate for Payer: First Health Commercial |
$4,833.46
|
| Rate for Payer: Humana Commercial |
$4,324.67
|
| Rate for Payer: Humana KY Medicaid |
$1,749.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,172.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.23
|
| Rate for Payer: PHCS Commercial |
$4,884.34
|
| Rate for Payer: United Healthcare All Payer |
$4,477.31
|
|
|
PLATE COMP LCK 3.5MM 301MM 16H
|
Facility
|
IP
|
$5,087.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.42 |
| Max. Negotiated Rate |
$4,884.34 |
| Rate for Payer: Aetna Commercial |
$3,917.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.52
|
| Rate for Payer: Cash Price |
$2,543.93
|
| Rate for Payer: Cigna Commercial |
$4,222.92
|
| Rate for Payer: First Health Commercial |
$4,833.46
|
| Rate for Payer: Humana Commercial |
$4,324.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,172.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.31
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.23
|
| Rate for Payer: PHCS Commercial |
$4,884.34
|
| Rate for Payer: United Healthcare All Payer |
$4,477.31
|
|
|
PLATE COMP LCK 3.5MM 301MM 20H
|
Facility
|
OP
|
$5,133.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.31 |
| Max. Negotiated Rate |
$4,927.85 |
| Rate for Payer: Cash Price |
$2,566.59
|
| Rate for Payer: Cigna Commercial |
$4,260.54
|
| Rate for Payer: First Health Commercial |
$4,876.52
|
| Rate for Payer: Humana Commercial |
$4,363.20
|
| Rate for Payer: Humana KY Medicaid |
$1,765.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,783.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,209.21
|
| Rate for Payer: Anthem Medicaid |
$1,765.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,003.88
|
| Rate for Payer: Aetna Commercial |
$3,952.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,788.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,800.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,517.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,849.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,026.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,591.29
|
| Rate for Payer: PHCS Commercial |
$4,927.85
|
| Rate for Payer: United Healthcare All Payer |
$4,517.20
|
|
|
PLATE COMP LCK 3.5MM 301MM 20H
|
Facility
|
IP
|
$5,133.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.31 |
| Max. Negotiated Rate |
$4,927.85 |
| Rate for Payer: Aetna Commercial |
$3,952.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,003.88
|
| Rate for Payer: Cash Price |
$2,566.59
|
| Rate for Payer: Cigna Commercial |
$4,260.54
|
| Rate for Payer: First Health Commercial |
$4,876.52
|
| Rate for Payer: Humana Commercial |
$4,363.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,209.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,788.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,517.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,849.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,026.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,591.29
|
| Rate for Payer: PHCS Commercial |
$4,927.85
|
| Rate for Payer: United Healthcare All Payer |
$4,517.20
|
|
|
PLATE COMP LCK 3.5MM 330MM 22H
|
Facility
|
IP
|
$5,133.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.31 |
| Max. Negotiated Rate |
$4,927.85 |
| Rate for Payer: Aetna Commercial |
$3,952.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,003.88
|
| Rate for Payer: Cash Price |
$2,566.59
|
| Rate for Payer: Cigna Commercial |
$4,260.54
|
| Rate for Payer: First Health Commercial |
$4,876.52
|
| Rate for Payer: Humana Commercial |
$4,363.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,209.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,788.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,517.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,849.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,026.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,591.29
|
| Rate for Payer: PHCS Commercial |
$4,927.85
|
| Rate for Payer: United Healthcare All Payer |
$4,517.20
|
|
|
PLATE COMP LCK 3.5MM 330MM 22H
|
Facility
|
OP
|
$5,133.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$667.31 |
| Max. Negotiated Rate |
$4,927.85 |
| Rate for Payer: Aetna Commercial |
$3,952.55
|
| Rate for Payer: Anthem Medicaid |
$1,765.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,003.88
|
| Rate for Payer: Cash Price |
$2,566.59
|
| Rate for Payer: Cigna Commercial |
$4,260.54
|
| Rate for Payer: First Health Commercial |
$4,876.52
|
| Rate for Payer: Humana Commercial |
$4,363.20
|
| Rate for Payer: Humana KY Medicaid |
$1,765.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,783.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,209.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,788.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,539.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,800.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,517.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,849.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,026.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$667.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,591.29
|
| Rate for Payer: PHCS Commercial |
$4,927.85
|
| Rate for Payer: United Healthcare All Payer |
$4,517.20
|
|
|
PLATE COMP LCK 3.5MM 336MM 18H
|
Facility
|
IP
|
$5,573.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.54 |
| Max. Negotiated Rate |
$5,350.46 |
| Rate for Payer: Aetna Commercial |
$4,291.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.25
|
| Rate for Payer: Cash Price |
$2,786.70
|
| Rate for Payer: Cigna Commercial |
$4,625.92
|
| Rate for Payer: First Health Commercial |
$5,294.73
|
| Rate for Payer: Humana Commercial |
$4,737.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.59
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.75
|
| Rate for Payer: PHCS Commercial |
$5,350.46
|
| Rate for Payer: United Healthcare All Payer |
$4,904.59
|
|
|
PLATE COMP LCK 3.5MM 336MM 18H
|
Facility
|
OP
|
$5,573.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.54 |
| Max. Negotiated Rate |
$5,350.46 |
| Rate for Payer: Aetna Commercial |
$4,291.52
|
| Rate for Payer: Anthem Medicaid |
$1,916.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.25
|
| Rate for Payer: Cash Price |
$2,786.70
|
| Rate for Payer: Cigna Commercial |
$4,625.92
|
| Rate for Payer: First Health Commercial |
$5,294.73
|
| Rate for Payer: Humana Commercial |
$4,737.39
|
| Rate for Payer: Humana KY Medicaid |
$1,916.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.59
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,727.75
|
| Rate for Payer: PHCS Commercial |
$5,350.46
|
| Rate for Payer: United Healthcare All Payer |
$4,904.59
|
|
|
PLATE COMP LCK 3.5MM 372MM 20H
|
Facility
|
OP
|
$7,013.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.76 |
| Max. Negotiated Rate |
$6,733.02 |
| Rate for Payer: Aetna Commercial |
$5,400.44
|
| Rate for Payer: Anthem Medicaid |
$2,411.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,470.58
|
| Rate for Payer: Cash Price |
$3,506.78
|
| Rate for Payer: Cigna Commercial |
$5,821.25
|
| Rate for Payer: First Health Commercial |
$6,662.88
|
| Rate for Payer: Humana Commercial |
$5,961.53
|
| Rate for Payer: Humana KY Medicaid |
$2,411.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,436.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,751.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,176.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,171.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,260.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,402.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$911.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.20
|
| Rate for Payer: PHCS Commercial |
$6,733.02
|
| Rate for Payer: United Healthcare All Payer |
$6,171.93
|
|
|
PLATE COMP LCK 3.5MM 372MM 20H
|
Facility
|
IP
|
$7,013.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$911.76 |
| Max. Negotiated Rate |
$6,733.02 |
| Rate for Payer: Aetna Commercial |
$5,400.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,470.58
|
| Rate for Payer: Cash Price |
$3,506.78
|
| Rate for Payer: Cigna Commercial |
$5,821.25
|
| Rate for Payer: First Health Commercial |
$6,662.88
|
| Rate for Payer: Humana Commercial |
$5,961.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,751.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,176.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,171.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,260.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,402.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$911.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.20
|
| Rate for Payer: PHCS Commercial |
$6,733.02
|
| Rate for Payer: United Healthcare All Payer |
$6,171.93
|
|
|
PLATE COMP LCK 3.5MM 408MM 22H
|
Facility
|
OP
|
$7,438.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.07 |
| Max. Negotiated Rate |
$7,141.41 |
| Rate for Payer: Aetna Commercial |
$5,728.01
|
| Rate for Payer: Anthem Medicaid |
$2,558.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,802.40
|
| Rate for Payer: Cash Price |
$3,719.48
|
| Rate for Payer: Cigna Commercial |
$6,174.35
|
| Rate for Payer: First Health Commercial |
$7,067.02
|
| Rate for Payer: Humana Commercial |
$6,323.12
|
| Rate for Payer: Humana KY Medicaid |
$2,558.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,584.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,099.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,489.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,231.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,609.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,546.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,579.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,487.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.08
|
| Rate for Payer: PHCS Commercial |
$7,141.41
|
| Rate for Payer: United Healthcare All Payer |
$6,546.29
|
|
|
PLATE COMP LCK 3.5MM 408MM 22H
|
Facility
|
IP
|
$7,438.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.07 |
| Max. Negotiated Rate |
$7,141.41 |
| Rate for Payer: Aetna Commercial |
$5,728.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,802.40
|
| Rate for Payer: Cash Price |
$3,719.48
|
| Rate for Payer: Cigna Commercial |
$6,174.35
|
| Rate for Payer: First Health Commercial |
$7,067.02
|
| Rate for Payer: Humana Commercial |
$6,323.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,099.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,489.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,231.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,546.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,579.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,487.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.08
|
| Rate for Payer: PHCS Commercial |
$7,141.41
|
| Rate for Payer: United Healthcare All Payer |
$6,546.29
|
|
|
PLATE COMP LCK 3.5MM 67MM 4H
|
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: 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: Aetna Commercial |
$2,441.86
|
| 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 LCK 3.5MM 67MM 4H
|
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 COMP LCK 3.5MM 85MM 4H
|
Facility
|
IP
|
$3,365.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.52 |
| Max. Negotiated Rate |
$3,230.88 |
| Rate for Payer: Aetna Commercial |
$2,591.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,625.09
|
| Rate for Payer: Cash Price |
$1,682.75
|
| Rate for Payer: Cigna Commercial |
$2,793.36
|
| Rate for Payer: First Health Commercial |
$3,197.22
|
| Rate for Payer: Humana Commercial |
$2,860.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,759.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,483.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,961.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,524.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.30
|
| Rate for Payer: PHCS Commercial |
$3,230.88
|
| Rate for Payer: United Healthcare All Payer |
$2,961.64
|
|
|
PLATE COMP LCK 3.5MM 85MM 4H
|
Facility
|
OP
|
$3,365.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.52 |
| Max. Negotiated Rate |
$3,230.88 |
| Rate for Payer: Aetna Commercial |
$2,591.44
|
| Rate for Payer: Anthem Medicaid |
$1,157.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,625.09
|
| Rate for Payer: Cash Price |
$1,682.75
|
| Rate for Payer: Cigna Commercial |
$2,793.36
|
| Rate for Payer: First Health Commercial |
$3,197.22
|
| Rate for Payer: Humana Commercial |
$2,860.68
|
| Rate for Payer: Humana KY Medicaid |
$1,157.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,169.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,759.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,483.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,009.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,180.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,961.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,524.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,043.30
|
| Rate for Payer: PHCS Commercial |
$3,230.88
|
| Rate for Payer: United Healthcare All Payer |
$2,961.64
|
|
