|
PLATE CLAV INF MED 7H 85MM
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV INF MED 8H 96MM
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV INF MED 8H 96MM
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV NRW PROF 8H LRG L
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAV NRW PROF 8H LRG L
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAV NRW PROF 8H STR L
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAV NRW PROF 8H STR L
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAV NRW PROF 8H STR R
|
Facility
|
IP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAV NRW PROF 8H STR R
|
Facility
|
OP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem Medicaid |
$1,722.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Humana KY Medicaid |
$1,722.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE CLAV SUP DIST 109MM L
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP DIST 109MM L
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP DIST 109MM R
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP DIST 109MM R
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP MED 10 171MM L
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 10 171MM L
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 10H 121MM R
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP MED 10H 121MM R
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE CLAV SUP MED 6H 73MM R
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 6H 73MM R
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 7H 85MM L
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 7H 85MM L
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 7H 85MM R
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 7H 85MM R
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 8 97MM L
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE CLAV SUP MED 8 97MM L
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
