|
PLATE 8H RECON 3.5*112MM
|
Facility
|
IP
|
$4,290.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,287.02 |
| Max. Negotiated Rate |
$4,118.45 |
| Rate for Payer: Aetna Commercial |
$3,303.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,346.24
|
| Rate for Payer: Cash Price |
$2,145.02
|
| Rate for Payer: Cigna Commercial |
$3,560.74
|
| Rate for Payer: First Health Commercial |
$4,075.55
|
| Rate for Payer: Humana Commercial |
$3,646.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,517.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,166.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,775.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,217.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,432.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,732.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,960.13
|
| Rate for Payer: PHCS Commercial |
$4,118.45
|
| Rate for Payer: United Healthcare All Payer |
$3,775.24
|
|
|
PLATE 8H STR
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE 8H STR
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE 9H 3.5*124MM SM FRAG
|
Facility
|
OP
|
$3,449.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.70 |
| Max. Negotiated Rate |
$3,311.04 |
| Rate for Payer: Aetna Commercial |
$2,655.73
|
| Rate for Payer: Anthem Medicaid |
$1,186.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,690.22
|
| Rate for Payer: Cash Price |
$1,724.50
|
| Rate for Payer: Cigna Commercial |
$2,862.67
|
| Rate for Payer: First Health Commercial |
$3,276.55
|
| Rate for Payer: Humana Commercial |
$2,931.65
|
| Rate for Payer: Humana KY Medicaid |
$1,186.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,198.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,828.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,545.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,209.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,035.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,586.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,759.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,000.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.81
|
| Rate for Payer: PHCS Commercial |
$3,311.04
|
| Rate for Payer: United Healthcare All Payer |
$3,035.12
|
|
|
PLATE 9H 3.5*124MM SM FRAG
|
Facility
|
IP
|
$3,449.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,034.70 |
| Max. Negotiated Rate |
$3,311.04 |
| Rate for Payer: Aetna Commercial |
$2,655.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,690.22
|
| Rate for Payer: Cash Price |
$1,724.50
|
| Rate for Payer: Cigna Commercial |
$2,862.67
|
| Rate for Payer: First Health Commercial |
$3,276.55
|
| Rate for Payer: Humana Commercial |
$2,931.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,828.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,545.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,035.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,586.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,759.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,000.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,379.81
|
| Rate for Payer: PHCS Commercial |
$3,311.04
|
| Rate for Payer: United Healthcare All Payer |
$3,035.12
|
|
|
PLATE ACE 4 HOLE LEFT
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE ACE 4 HOLE LEFT
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE ACE 6 HOLE LEFT
|
Facility
|
IP
|
$2,124.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.38 |
| Max. Negotiated Rate |
$2,039.62 |
| Rate for Payer: Aetna Commercial |
$1,635.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.19
|
| Rate for Payer: Cash Price |
$1,062.30
|
| Rate for Payer: Cigna Commercial |
$1,763.42
|
| Rate for Payer: First Health Commercial |
$2,018.37
|
| Rate for Payer: Humana Commercial |
$1,805.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.97
|
| Rate for Payer: PHCS Commercial |
$2,039.62
|
| Rate for Payer: United Healthcare All Payer |
$1,869.65
|
|
|
PLATE ACE 6 HOLE LEFT
|
Facility
|
OP
|
$2,124.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.38 |
| Max. Negotiated Rate |
$2,039.62 |
| Rate for Payer: Aetna Commercial |
$1,635.94
|
| Rate for Payer: Anthem Medicaid |
$730.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.19
|
| Rate for Payer: Cash Price |
$1,062.30
|
| Rate for Payer: Cigna Commercial |
$1,763.42
|
| Rate for Payer: First Health Commercial |
$2,018.37
|
| Rate for Payer: Humana Commercial |
$1,805.91
|
| Rate for Payer: Humana KY Medicaid |
$730.65
|
| Rate for Payer: Kentucky WC Medicaid |
$738.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.97
|
| Rate for Payer: PHCS Commercial |
$2,039.62
|
| Rate for Payer: United Healthcare All Payer |
$1,869.65
|
|
|
PLATE ACE 8-HOLE LEFT
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
PLATE ACE 8-HOLE LEFT
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$881.25 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$2,261.88
|
| Rate for Payer: Anthem Medicaid |
$1,010.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,291.25
|
| Rate for Payer: Cash Price |
$1,468.75
|
| Rate for Payer: Cigna Commercial |
$2,438.12
|
| Rate for Payer: First Health Commercial |
$2,790.62
|
| Rate for Payer: Humana Commercial |
$2,496.88
|
| Rate for Payer: Humana KY Medicaid |
$1,010.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,020.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,408.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,167.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$881.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,030.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,585.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,203.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,350.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,026.88
|
| Rate for Payer: PHCS Commercial |
$2,820.00
|
| Rate for Payer: United Healthcare All Payer |
$2,585.00
|
|
|
PLATE ACE 8-HOLE RIGHT
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE ACE 8-HOLE RIGHT
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE ACE (L) 4 HOLE RIGHT
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE ACE (L) 4 HOLE RIGHT
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE ACU-LOC 2 VDR EXT NEUTRL
|
Facility
|
OP
|
$4,036.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.88 |
| Max. Negotiated Rate |
$3,874.80 |
| Rate for Payer: Aetna Commercial |
$3,107.91
|
| Rate for Payer: Anthem Medicaid |
$1,388.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.28
|
| Rate for Payer: Cash Price |
$2,018.12
|
| Rate for Payer: Cigna Commercial |
$3,350.09
|
| Rate for Payer: First Health Commercial |
$3,834.44
|
| Rate for Payer: Humana Commercial |
$3,430.81
|
| Rate for Payer: Humana KY Medicaid |
$1,388.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,309.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,978.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,415.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,551.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,511.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.01
|
| Rate for Payer: PHCS Commercial |
$3,874.80
|
| Rate for Payer: United Healthcare All Payer |
$3,551.90
|
|
|
PLATE ACU-LOC 2 VDR EXT NEUTRL
|
Facility
|
IP
|
$4,036.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.88 |
| Max. Negotiated Rate |
$3,874.80 |
| Rate for Payer: Aetna Commercial |
$3,107.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.28
|
| Rate for Payer: Cash Price |
$2,018.12
|
| Rate for Payer: Cigna Commercial |
$3,350.09
|
| Rate for Payer: First Health Commercial |
$3,834.44
|
| Rate for Payer: Humana Commercial |
$3,430.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,309.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,978.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,210.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,551.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,511.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.01
|
| Rate for Payer: PHCS Commercial |
$3,874.80
|
| Rate for Payer: United Healthcare All Payer |
$3,551.90
|
|
|
PLATE ACU-LOC 2 VDR NAR L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR NAR L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG L
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG L
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG R
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR NAR LONG R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR NAR R
|
Facility
|
IP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
|
PLATE ACU-LOC 2 VDR NAR R
|
Facility
|
OP
|
$5,172.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,551.75 |
| Max. Negotiated Rate |
$4,965.60 |
| Rate for Payer: Aetna Commercial |
$3,982.82
|
| Rate for Payer: Anthem Medicaid |
$1,778.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,034.55
|
| Rate for Payer: Cash Price |
$2,586.25
|
| Rate for Payer: Cigna Commercial |
$4,293.18
|
| Rate for Payer: First Health Commercial |
$4,913.88
|
| Rate for Payer: Humana Commercial |
$4,396.62
|
| Rate for Payer: Humana KY Medicaid |
$1,778.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,796.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,241.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,817.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,551.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,814.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,551.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,879.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,138.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,500.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,569.03
|
| Rate for Payer: PHCS Commercial |
$4,965.60
|
| Rate for Payer: United Healthcare All Payer |
$4,551.80
|
|
