|
PLATE 3 HOLE SHAFT T
|
Facility
|
OP
|
$787.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.25 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna Commercial |
$606.38
|
| Rate for Payer: Anthem Medicaid |
$270.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$614.25
|
| Rate for Payer: Cash Price |
$393.75
|
| Rate for Payer: Cigna Commercial |
$653.62
|
| Rate for Payer: First Health Commercial |
$748.12
|
| Rate for Payer: Humana Commercial |
$669.38
|
| Rate for Payer: Humana KY Medicaid |
$270.82
|
| Rate for Payer: Kentucky WC Medicaid |
$273.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$645.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$581.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$236.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$276.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$693.00
|
| Rate for Payer: Ohio Health Group HMO |
$590.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$630.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$685.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$543.38
|
| Rate for Payer: PHCS Commercial |
$756.00
|
| Rate for Payer: United Healthcare All Payer |
$693.00
|
|
|
PLATE 40MM LONG
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
PLATE 40MM LONG
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
PLATE 4.5/5.0 TI CANN 10H STR
|
Facility
|
IP
|
$1,987.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.34 |
| Max. Negotiated Rate |
$1,908.29 |
| Rate for Payer: Aetna Commercial |
$1,530.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,550.48
|
| Rate for Payer: Cash Price |
$993.90
|
| Rate for Payer: Cigna Commercial |
$1,649.87
|
| Rate for Payer: First Health Commercial |
$1,888.41
|
| Rate for Payer: Humana Commercial |
$1,689.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,749.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,590.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,371.58
|
| Rate for Payer: PHCS Commercial |
$1,908.29
|
| Rate for Payer: United Healthcare All Payer |
$1,749.26
|
|
|
PLATE 4.5/5.0 TI CANN 10H STR
|
Facility
|
OP
|
$1,987.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.34 |
| Max. Negotiated Rate |
$1,908.29 |
| Rate for Payer: Aetna Commercial |
$1,530.61
|
| Rate for Payer: Anthem Medicaid |
$683.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,550.48
|
| Rate for Payer: Cash Price |
$993.90
|
| Rate for Payer: Cigna Commercial |
$1,649.87
|
| Rate for Payer: First Health Commercial |
$1,888.41
|
| Rate for Payer: Humana Commercial |
$1,689.63
|
| Rate for Payer: Humana KY Medicaid |
$683.60
|
| Rate for Payer: Kentucky WC Medicaid |
$690.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,749.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,490.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,590.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,729.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,371.58
|
| Rate for Payer: PHCS Commercial |
$1,908.29
|
| Rate for Payer: United Healthcare All Payer |
$1,749.26
|
|
|
PLATE 4.5/5.0 TI CANN 6H STR
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
PLATE 4.5/5.0 TI CANN 6H STR
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
PLATE 4.5/5.0 TI CANN 8H STR
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem Medicaid |
$630.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Humana KY Medicaid |
$630.02
|
| Rate for Payer: Kentucky WC Medicaid |
$636.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
PLATE 4.5/5.0 TI CANN 8H STR
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
PLATE 4.5 BROAD LCP 10H 188MM
|
Facility
|
IP
|
$3,823.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,147.19 |
| Max. Negotiated Rate |
$3,671.00 |
| Rate for Payer: Aetna Commercial |
$2,944.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,982.69
|
| Rate for Payer: Cash Price |
$1,911.98
|
| Rate for Payer: Cigna Commercial |
$3,173.89
|
| Rate for Payer: First Health Commercial |
$3,632.76
|
| Rate for Payer: Humana Commercial |
$3,250.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,135.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,147.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,867.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,059.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,326.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,638.53
|
| Rate for Payer: PHCS Commercial |
$3,671.00
|
| Rate for Payer: United Healthcare All Payer |
$3,365.08
|
|
|
PLATE 4.5 BROAD LCP 10H 188MM
|
Facility
|
OP
|
$3,823.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,147.19 |
| Max. Negotiated Rate |
$3,671.00 |
| Rate for Payer: Aetna Commercial |
$2,944.45
|
| Rate for Payer: Anthem Medicaid |
$1,315.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,982.69
|
| Rate for Payer: Cash Price |
$1,911.98
|
| Rate for Payer: Cigna Commercial |
$3,173.89
|
| Rate for Payer: First Health Commercial |
$3,632.76
|
| Rate for Payer: Humana Commercial |
$3,250.37
|
| Rate for Payer: Humana KY Medicaid |
$1,315.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,328.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,135.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,822.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,147.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,365.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,867.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,059.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,326.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,638.53
|
| Rate for Payer: PHCS Commercial |
$3,671.00
|
| Rate for Payer: United Healthcare All Payer |
$3,365.08
|
|
|
PLATE 4.5 BROAD LCP 11H 206MM
|
Facility
|
OP
|
$3,946.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.81 |
| Max. Negotiated Rate |
$3,788.18 |
| Rate for Payer: Aetna Commercial |
$3,038.44
|
| Rate for Payer: Anthem Medicaid |
$1,357.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,077.90
|
| Rate for Payer: Cash Price |
$1,973.01
|
| Rate for Payer: Cigna Commercial |
$3,275.20
|
| Rate for Payer: First Health Commercial |
$3,748.72
|
| Rate for Payer: Humana Commercial |
$3,354.12
|
| Rate for Payer: Humana KY Medicaid |
$1,357.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,370.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,235.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,384.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,472.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,959.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,156.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,433.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,722.75
|
| Rate for Payer: PHCS Commercial |
$3,788.18
|
| Rate for Payer: United Healthcare All Payer |
$3,472.50
|
|
|
PLATE 4.5 BROAD LCP 11H 206MM
|
Facility
|
IP
|
$3,946.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.81 |
| Max. Negotiated Rate |
$3,788.18 |
| Rate for Payer: Aetna Commercial |
$3,038.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,077.90
|
| Rate for Payer: Cash Price |
$1,973.01
|
| Rate for Payer: Cigna Commercial |
$3,275.20
|
| Rate for Payer: First Health Commercial |
$3,748.72
|
| Rate for Payer: Humana Commercial |
$3,354.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,235.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,912.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,183.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,472.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,959.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,156.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,433.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,722.75
|
| Rate for Payer: PHCS Commercial |
$3,788.18
|
| Rate for Payer: United Healthcare All Payer |
$3,472.50
|
|
|
PLATE 4.5 BROAD LCP 12H 224MM
|
Facility
|
OP
|
$4,064.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.38 |
| Max. Negotiated Rate |
$3,902.02 |
| Rate for Payer: Aetna Commercial |
$3,129.74
|
| Rate for Payer: Anthem Medicaid |
$1,397.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,170.39
|
| Rate for Payer: Cash Price |
$2,032.30
|
| Rate for Payer: Cigna Commercial |
$3,373.62
|
| Rate for Payer: First Health Commercial |
$3,861.37
|
| Rate for Payer: Humana Commercial |
$3,454.91
|
| Rate for Payer: Humana KY Medicaid |
$1,397.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,332.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,999.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,576.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,048.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,251.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,536.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,804.57
|
| Rate for Payer: PHCS Commercial |
$3,902.02
|
| Rate for Payer: United Healthcare All Payer |
$3,576.85
|
|
|
PLATE 4.5 BROAD LCP 12H 224MM
|
Facility
|
IP
|
$4,064.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.38 |
| Max. Negotiated Rate |
$3,902.02 |
| Rate for Payer: Aetna Commercial |
$3,129.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,170.39
|
| Rate for Payer: Cash Price |
$2,032.30
|
| Rate for Payer: Cigna Commercial |
$3,373.62
|
| Rate for Payer: First Health Commercial |
$3,861.37
|
| Rate for Payer: Humana Commercial |
$3,454.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,332.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,999.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,576.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,048.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,251.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,536.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,804.57
|
| Rate for Payer: PHCS Commercial |
$3,902.02
|
| Rate for Payer: United Healthcare All Payer |
$3,576.85
|
|
|
PLATE 4.5 BROAD LCP 14H 260MM
|
Facility
|
OP
|
$4,305.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.57 |
| Max. Negotiated Rate |
$4,133.03 |
| Rate for Payer: Aetna Commercial |
$3,315.03
|
| Rate for Payer: Anthem Medicaid |
$1,480.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,358.09
|
| Rate for Payer: Cash Price |
$2,152.62
|
| Rate for Payer: Cigna Commercial |
$3,573.35
|
| Rate for Payer: First Health Commercial |
$4,089.98
|
| Rate for Payer: Humana Commercial |
$3,659.45
|
| Rate for Payer: Humana KY Medicaid |
$1,480.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,530.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,177.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,510.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,788.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,444.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,745.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,970.62
|
| Rate for Payer: PHCS Commercial |
$4,133.03
|
| Rate for Payer: United Healthcare All Payer |
$3,788.61
|
|
|
PLATE 4.5 BROAD LCP 14H 260MM
|
Facility
|
IP
|
$4,305.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.57 |
| Max. Negotiated Rate |
$4,133.03 |
| Rate for Payer: Aetna Commercial |
$3,315.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,358.09
|
| Rate for Payer: Cash Price |
$2,152.62
|
| Rate for Payer: Cigna Commercial |
$3,573.35
|
| Rate for Payer: First Health Commercial |
$4,089.98
|
| Rate for Payer: Humana Commercial |
$3,659.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,530.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,177.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,788.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,444.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,745.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,970.62
|
| Rate for Payer: PHCS Commercial |
$4,133.03
|
| Rate for Payer: United Healthcare All Payer |
$3,788.61
|
|
|
PLATE 4.5 BROAD LCP 16H 296MM
|
Facility
|
IP
|
$4,807.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.23 |
| Max. Negotiated Rate |
$4,615.14 |
| Rate for Payer: Aetna Commercial |
$3,701.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.80
|
| Rate for Payer: Cash Price |
$2,403.72
|
| Rate for Payer: Cigna Commercial |
$3,990.18
|
| Rate for Payer: First Health Commercial |
$4,567.07
|
| Rate for Payer: Humana Commercial |
$4,086.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.13
|
| Rate for Payer: PHCS Commercial |
$4,615.14
|
| Rate for Payer: United Healthcare All Payer |
$4,230.55
|
|
|
PLATE 4.5 BROAD LCP 16H 296MM
|
Facility
|
OP
|
$4,807.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,442.23 |
| Max. Negotiated Rate |
$4,615.14 |
| Rate for Payer: Aetna Commercial |
$3,701.73
|
| Rate for Payer: Anthem Medicaid |
$1,653.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.80
|
| Rate for Payer: Cash Price |
$2,403.72
|
| Rate for Payer: Cigna Commercial |
$3,990.18
|
| Rate for Payer: First Health Commercial |
$4,567.07
|
| Rate for Payer: Humana Commercial |
$4,086.32
|
| Rate for Payer: Humana KY Medicaid |
$1,653.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,670.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,845.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,182.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,317.13
|
| Rate for Payer: PHCS Commercial |
$4,615.14
|
| Rate for Payer: United Healthcare All Payer |
$4,230.55
|
|
|
PLATE 4.5 BROAD LCP 6H 116MM
|
Facility
|
OP
|
$3,290.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.11 |
| Max. Negotiated Rate |
$3,158.76 |
| Rate for Payer: Aetna Commercial |
$2,533.59
|
| Rate for Payer: Anthem Medicaid |
$1,131.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.50
|
| Rate for Payer: Cash Price |
$1,645.19
|
| Rate for Payer: Cigna Commercial |
$2,731.02
|
| Rate for Payer: First Health Commercial |
$3,125.86
|
| Rate for Payer: Humana Commercial |
$2,796.82
|
| Rate for Payer: Humana KY Medicaid |
$1,131.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,143.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,698.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.36
|
| Rate for Payer: PHCS Commercial |
$3,158.76
|
| Rate for Payer: United Healthcare All Payer |
$2,895.53
|
|
|
PLATE 4.5 BROAD LCP 6H 116MM
|
Facility
|
IP
|
$3,290.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.11 |
| Max. Negotiated Rate |
$3,158.76 |
| Rate for Payer: Aetna Commercial |
$2,533.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.50
|
| Rate for Payer: Cash Price |
$1,645.19
|
| Rate for Payer: Cigna Commercial |
$2,731.02
|
| Rate for Payer: First Health Commercial |
$3,125.86
|
| Rate for Payer: Humana Commercial |
$2,796.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,698.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.36
|
| Rate for Payer: PHCS Commercial |
$3,158.76
|
| Rate for Payer: United Healthcare All Payer |
$2,895.53
|
|
|
PLATE 4.5 BROAD LCP 7H 134MM
|
Facility
|
IP
|
$3,367.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.13 |
| Max. Negotiated Rate |
$3,232.42 |
| Rate for Payer: Aetna Commercial |
$2,592.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.34
|
| Rate for Payer: Cash Price |
$1,683.55
|
| Rate for Payer: Cigna Commercial |
$2,794.69
|
| Rate for Payer: First Health Commercial |
$3,198.74
|
| Rate for Payer: Humana Commercial |
$2,862.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,484.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,693.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,929.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,323.30
|
| Rate for Payer: PHCS Commercial |
$3,232.42
|
| Rate for Payer: United Healthcare All Payer |
$2,963.05
|
|
|
PLATE 4.5 BROAD LCP 7H 134MM
|
Facility
|
OP
|
$3,367.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.13 |
| Max. Negotiated Rate |
$3,232.42 |
| Rate for Payer: Aetna Commercial |
$2,592.67
|
| Rate for Payer: Anthem Medicaid |
$1,157.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.34
|
| Rate for Payer: Cash Price |
$1,683.55
|
| Rate for Payer: Cigna Commercial |
$2,794.69
|
| Rate for Payer: First Health Commercial |
$3,198.74
|
| Rate for Payer: Humana Commercial |
$2,862.03
|
| Rate for Payer: Humana KY Medicaid |
$1,157.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,169.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,484.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,693.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,929.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,323.30
|
| Rate for Payer: PHCS Commercial |
$3,232.42
|
| Rate for Payer: United Healthcare All Payer |
$2,963.05
|
|
|
PLATE 4.5 BROAD LCP 8H 152MM
|
Facility
|
OP
|
$3,569.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.81 |
| Max. Negotiated Rate |
$3,426.60 |
| Rate for Payer: Aetna Commercial |
$2,748.42
|
| Rate for Payer: Anthem Medicaid |
$1,227.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,784.12
|
| Rate for Payer: Cash Price |
$1,784.69
|
| Rate for Payer: Cigna Commercial |
$2,962.59
|
| Rate for Payer: First Health Commercial |
$3,390.91
|
| Rate for Payer: Humana Commercial |
$3,033.97
|
| Rate for Payer: Humana KY Medicaid |
$1,227.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,926.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,252.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,141.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,677.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,855.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,105.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,462.87
|
| Rate for Payer: PHCS Commercial |
$3,426.60
|
| Rate for Payer: United Healthcare All Payer |
$3,141.05
|
|
|
PLATE 4.5 BROAD LCP 8H 152MM
|
Facility
|
IP
|
$3,569.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.81 |
| Max. Negotiated Rate |
$3,426.60 |
| Rate for Payer: Aetna Commercial |
$2,748.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,784.12
|
| Rate for Payer: Cash Price |
$1,784.69
|
| Rate for Payer: Cigna Commercial |
$2,962.59
|
| Rate for Payer: First Health Commercial |
$3,390.91
|
| Rate for Payer: Humana Commercial |
$3,033.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,926.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,141.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,677.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,855.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,105.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,462.87
|
| Rate for Payer: PHCS Commercial |
$3,426.60
|
| Rate for Payer: United Healthcare All Payer |
$3,141.05
|
|
