|
PLATE COMP LCK 3.5MM 96MM 6H
|
Facility
|
IP
|
$3,300.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$3,168.72 |
| Rate for Payer: Aetna Commercial |
$2,541.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.58
|
| Rate for Payer: Cash Price |
$1,650.38
|
| Rate for Payer: Cigna Commercial |
$2,739.62
|
| Rate for Payer: First Health Commercial |
$3,135.71
|
| Rate for Payer: Humana Commercial |
$2,805.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.23
|
| Rate for Payer: PHCS Commercial |
$3,168.72
|
| Rate for Payer: United Healthcare All Payer |
$2,904.66
|
|
|
PLATE COMP LCK 3.5MM 96MM 6H
|
Facility
|
OP
|
$3,300.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$3,168.72 |
| Rate for Payer: Aetna Commercial |
$2,541.58
|
| Rate for Payer: Anthem Medicaid |
$1,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.58
|
| Rate for Payer: Cash Price |
$1,650.38
|
| Rate for Payer: Cigna Commercial |
$2,739.62
|
| Rate for Payer: First Health Commercial |
$3,135.71
|
| Rate for Payer: Humana Commercial |
$2,805.64
|
| Rate for Payer: Humana KY Medicaid |
$1,135.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.23
|
| Rate for Payer: PHCS Commercial |
$3,168.72
|
| Rate for Payer: United Healthcare All Payer |
$2,904.66
|
|
|
PLATE COMP LCK 4.5*444 24H
|
Facility
|
IP
|
$7,736.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.69 |
| Max. Negotiated Rate |
$7,426.64 |
| Rate for Payer: Aetna Commercial |
$5,956.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,034.14
|
| Rate for Payer: Cash Price |
$3,868.04
|
| Rate for Payer: Cigna Commercial |
$6,420.95
|
| Rate for Payer: First Health Commercial |
$7,349.28
|
| Rate for Payer: Humana Commercial |
$6,575.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,343.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,709.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,807.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,802.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,398.18
|
| Rate for Payer: PHCS Commercial |
$7,426.64
|
| Rate for Payer: United Healthcare All Payer |
$6,807.75
|
|
|
PLATE COMP LCK 4.5*444 24H
|
Facility
|
OP
|
$7,736.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.69 |
| Max. Negotiated Rate |
$7,426.64 |
| Rate for Payer: Aetna Commercial |
$5,956.78
|
| Rate for Payer: Anthem Medicaid |
$2,660.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,034.14
|
| Rate for Payer: Cash Price |
$3,868.04
|
| Rate for Payer: Cigna Commercial |
$6,420.95
|
| Rate for Payer: First Health Commercial |
$7,349.28
|
| Rate for Payer: Humana Commercial |
$6,575.67
|
| Rate for Payer: Humana KY Medicaid |
$2,660.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,687.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,343.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,709.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,713.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,807.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,802.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,398.18
|
| Rate for Payer: PHCS Commercial |
$7,426.64
|
| Rate for Payer: United Healthcare All Payer |
$6,807.75
|
|
|
PLATE COMP LCK 4.5MM 10 193MM
|
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 4.5MM 10 193MM
|
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 4.5MM 12 229MM
|
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 4.5MM 12 229MM
|
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 4.5MM 14 265MM
|
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 4.5MM 14 265MM
|
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 4.5MM 4 85MM
|
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 4.5MM 4 85MM
|
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
|
|
|
PLATE COMP LCK 4.5MM 6 121MM
|
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 4.5MM 6 121MM
|
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 4.5MM 8 157MM
|
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: Aetna Commercial |
$3,085.02
|
| 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: 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 4.5MM 8 157MM
|
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 LK 3.5MM 10H 154MM
|
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: 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: Aetna Commercial |
$2,681.18
|
| 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 LK 3.5MM 10H 154MM
|
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 LK 3.5MM 12H 183MM
|
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 LK 3.5MM 12H 183MM
|
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 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 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 COMP LK 3.5MM 6H 96MM
|
Facility
|
OP
|
$3,300.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$3,168.72 |
| Rate for Payer: Aetna Commercial |
$2,541.58
|
| Rate for Payer: Anthem Medicaid |
$1,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.58
|
| Rate for Payer: Cash Price |
$1,650.38
|
| Rate for Payer: Cigna Commercial |
$2,739.62
|
| Rate for Payer: First Health Commercial |
$3,135.71
|
| Rate for Payer: Humana Commercial |
$2,805.64
|
| Rate for Payer: Humana KY Medicaid |
$1,135.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.23
|
| Rate for Payer: PHCS Commercial |
$3,168.72
|
| Rate for Payer: United Healthcare All Payer |
$2,904.66
|
|
|
PLATE COMP LK 3.5MM 6H 96MM
|
Facility
|
IP
|
$3,300.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$3,168.72 |
| Rate for Payer: Aetna Commercial |
$2,541.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.58
|
| Rate for Payer: Cash Price |
$1,650.38
|
| Rate for Payer: Cigna Commercial |
$2,739.62
|
| Rate for Payer: First Health Commercial |
$3,135.71
|
| Rate for Payer: Humana Commercial |
$2,805.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.23
|
| Rate for Payer: PHCS Commercial |
$3,168.72
|
| Rate for Payer: United Healthcare All Payer |
$2,904.66
|
|
|
PLATE COMP LK 3.5MM 7H 111MM
|
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: Aetna Commercial |
$2,501.69
|
| 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: 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
|
|
