|
PLATE HUM LK PRX 7H L 3.5*140
|
Facility
|
IP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
|
|
PLATE HUM LK PRX 7H L 4.5*144
|
Facility
|
OP
|
$8,688.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.46 |
| Max. Negotiated Rate |
$8,340.65 |
| Rate for Payer: Aetna Commercial |
$6,689.90
|
| Rate for Payer: Anthem Medicaid |
$2,987.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,776.78
|
| Rate for Payer: Cash Price |
$4,344.09
|
| Rate for Payer: Cigna Commercial |
$7,211.19
|
| Rate for Payer: First Health Commercial |
$8,253.77
|
| Rate for Payer: Humana Commercial |
$7,384.95
|
| Rate for Payer: Humana KY Medicaid |
$2,987.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,018.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,124.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,411.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,606.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,047.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,516.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.34
|
| Rate for Payer: PHCS Commercial |
$8,340.65
|
| Rate for Payer: United Healthcare All Payer |
$7,645.60
|
|
|
PLATE HUM LK PRX 7H L 4.5*144
|
Facility
|
IP
|
$8,688.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.46 |
| Max. Negotiated Rate |
$8,340.65 |
| Rate for Payer: Aetna Commercial |
$6,689.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,776.78
|
| Rate for Payer: Cash Price |
$4,344.09
|
| Rate for Payer: Cigna Commercial |
$7,211.19
|
| Rate for Payer: First Health Commercial |
$8,253.77
|
| Rate for Payer: Humana Commercial |
$7,384.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,124.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,411.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,606.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,645.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,516.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.34
|
| Rate for Payer: PHCS Commercial |
$8,340.65
|
| Rate for Payer: United Healthcare All Payer |
$7,645.60
|
|
|
PLATE HUM LK PRX 7H R 4.5*144
|
Facility
|
OP
|
$8,688.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.51 |
| Max. Negotiated Rate |
$8,341.00 |
| Rate for Payer: Aetna Commercial |
$6,690.18
|
| Rate for Payer: Anthem Medicaid |
$2,987.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,777.06
|
| Rate for Payer: Cash Price |
$4,344.27
|
| Rate for Payer: Cigna Commercial |
$7,211.49
|
| Rate for Payer: First Health Commercial |
$8,254.11
|
| Rate for Payer: Humana Commercial |
$7,385.26
|
| Rate for Payer: Humana KY Medicaid |
$2,987.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,018.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,124.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,412.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,606.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,047.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,645.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,516.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.45
|
| Rate for Payer: PHCS Commercial |
$8,341.00
|
| Rate for Payer: United Healthcare All Payer |
$7,645.92
|
|
|
PLATE HUM LK PRX 7H R 4.5*144
|
Facility
|
IP
|
$8,688.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,129.51 |
| Max. Negotiated Rate |
$8,341.00 |
| Rate for Payer: Aetna Commercial |
$6,690.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,777.06
|
| Rate for Payer: Cash Price |
$4,344.27
|
| Rate for Payer: Cigna Commercial |
$7,211.49
|
| Rate for Payer: First Health Commercial |
$8,254.11
|
| Rate for Payer: Humana Commercial |
$7,385.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,124.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,412.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,606.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,645.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,516.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,737.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,129.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,693.45
|
| Rate for Payer: PHCS Commercial |
$8,341.00
|
| Rate for Payer: United Healthcare All Payer |
$7,645.92
|
|
|
PLATE HUM LK PRX 9H L 3.5*165
|
Facility
|
OP
|
$8,161.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.99 |
| Max. Negotiated Rate |
$7,835.02 |
| Rate for Payer: Aetna Commercial |
$6,284.34
|
| Rate for Payer: Anthem Medicaid |
$2,806.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,365.95
|
| Rate for Payer: Cash Price |
$4,080.74
|
| Rate for Payer: Cigna Commercial |
$6,774.03
|
| Rate for Payer: First Health Commercial |
$7,753.41
|
| Rate for Payer: Humana Commercial |
$6,937.26
|
| Rate for Payer: Humana KY Medicaid |
$2,806.73
|
| Rate for Payer: Kentucky WC Medicaid |
$2,835.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,023.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,448.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,863.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,182.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,121.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.06
|
| Rate for Payer: PHCS Commercial |
$7,835.02
|
| Rate for Payer: United Healthcare All Payer |
$7,182.10
|
|
|
PLATE HUM LK PRX 9H L 3.5*165
|
Facility
|
IP
|
$8,161.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.99 |
| Max. Negotiated Rate |
$7,835.02 |
| Rate for Payer: Aetna Commercial |
$6,284.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,365.95
|
| Rate for Payer: Cash Price |
$4,080.74
|
| Rate for Payer: Cigna Commercial |
$6,774.03
|
| Rate for Payer: First Health Commercial |
$7,753.41
|
| Rate for Payer: Humana Commercial |
$6,937.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,023.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,448.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,182.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,121.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,530.06
|
| Rate for Payer: PHCS Commercial |
$7,835.02
|
| Rate for Payer: United Healthcare All Payer |
$7,182.10
|
|
|
PLATE HUM LK PRX 9H L 4.5*169
|
Facility
|
OP
|
$8,917.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,159.31 |
| Max. Negotiated Rate |
$8,561.05 |
| Rate for Payer: Aetna Commercial |
$6,866.68
|
| Rate for Payer: Anthem Medicaid |
$3,066.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,955.85
|
| Rate for Payer: Cash Price |
$4,458.88
|
| Rate for Payer: Cigna Commercial |
$7,401.74
|
| Rate for Payer: First Health Commercial |
$8,471.87
|
| Rate for Payer: Humana Commercial |
$7,580.10
|
| Rate for Payer: Humana KY Medicaid |
$3,066.82
|
| Rate for Payer: Kentucky WC Medicaid |
$3,098.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,312.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,581.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,128.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,847.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,688.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,783.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,159.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,764.51
|
| Rate for Payer: PHCS Commercial |
$8,561.05
|
| Rate for Payer: United Healthcare All Payer |
$7,847.63
|
|
|
PLATE HUM LK PRX 9H L 4.5*169
|
Facility
|
IP
|
$8,917.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,159.31 |
| Max. Negotiated Rate |
$8,561.05 |
| Rate for Payer: Aetna Commercial |
$6,866.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,955.85
|
| Rate for Payer: Cash Price |
$4,458.88
|
| Rate for Payer: Cigna Commercial |
$7,401.74
|
| Rate for Payer: First Health Commercial |
$8,471.87
|
| Rate for Payer: Humana Commercial |
$7,580.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,312.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,581.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,675.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,847.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,688.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,783.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,159.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,764.51
|
| Rate for Payer: PHCS Commercial |
$8,561.05
|
| Rate for Payer: United Healthcare All Payer |
$7,847.63
|
|
|
PLATE INF CLAV MED 6H 73MM
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE INF CLAV MED 6H 73MM
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE INF CLAV MED 7H 85MM
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE INF CLAV MED 7H 85MM
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE INNER DIA SF U 105MM
|
Facility
|
IP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
|
|
PLATE INNER DIA SF U 105MM
|
Facility
|
OP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem Medicaid |
$2,979.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Humana KY Medicaid |
$2,979.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 130MM
|
Facility
|
IP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 130MM
|
Facility
|
OP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem Medicaid |
$2,979.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Humana KY Medicaid |
$2,979.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 155MM
|
Facility
|
OP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem Medicaid |
$2,979.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Humana KY Medicaid |
$2,979.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 155MM
|
Facility
|
IP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 180MM
|
Facility
|
OP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem Medicaid |
$2,979.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Humana KY Medicaid |
$2,979.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 180MM
|
Facility
|
IP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 80MM
|
Facility
|
IP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
|
|
PLATE INNER DIA SF U 80MM
|
Facility
|
OP
|
$8,664.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,126.43 |
| Max. Negotiated Rate |
$8,318.23 |
| Rate for Payer: Humana Commercial |
$7,365.10
|
| Rate for Payer: Humana KY Medicaid |
$2,979.83
|
| Rate for Payer: Kentucky WC Medicaid |
$3,010.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,105.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,394.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,599.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,039.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,625.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,498.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,732.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,126.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,686.09
|
| Rate for Payer: PHCS Commercial |
$8,318.23
|
| Rate for Payer: United Healthcare All Payer |
$7,625.04
|
| Rate for Payer: Aetna Commercial |
$6,671.91
|
| Rate for Payer: Anthem Medicaid |
$2,979.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,758.56
|
| Rate for Payer: Cash Price |
$4,332.41
|
| Rate for Payer: Cigna Commercial |
$7,191.80
|
| Rate for Payer: First Health Commercial |
$8,231.58
|
|
|
PLATE INTERM 100^55MM
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 100^55MM
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
