|
PLATE LCK STERNAL 4H STR T=1.8
|
Facility
|
OP
|
$4,112.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.57 |
| Max. Negotiated Rate |
$3,947.57 |
| Rate for Payer: Aetna Commercial |
$3,166.28
|
| Rate for Payer: Anthem Medicaid |
$1,414.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.40
|
| Rate for Payer: Cash Price |
$2,056.02
|
| Rate for Payer: Cigna Commercial |
$3,413.00
|
| Rate for Payer: First Health Commercial |
$3,906.45
|
| Rate for Payer: Humana Commercial |
$3,495.24
|
| Rate for Payer: Humana KY Medicaid |
$1,414.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,428.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,233.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,442.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.74
|
| Rate for Payer: PHCS Commercial |
$3,947.57
|
| Rate for Payer: United Healthcare All Payer |
$3,618.60
|
|
|
PLATE LCK STERNAL 4H STR T=1.8
|
Facility
|
IP
|
$4,112.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.57 |
| Max. Negotiated Rate |
$3,947.57 |
| Rate for Payer: Aetna Commercial |
$3,166.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,207.40
|
| Rate for Payer: Cash Price |
$2,056.02
|
| Rate for Payer: Cigna Commercial |
$3,413.00
|
| Rate for Payer: First Health Commercial |
$3,906.45
|
| Rate for Payer: Humana Commercial |
$3,495.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,371.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,034.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,233.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,618.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,084.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$822.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$534.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,274.74
|
| Rate for Payer: PHCS Commercial |
$3,947.57
|
| Rate for Payer: United Healthcare All Payer |
$3,618.60
|
|
|
PLATE LCK STERNAL 4H STR T=2.0
|
Facility
|
OP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem Medicaid |
$1,643.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Humana KY Medicaid |
$1,643.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LCK STERNAL 4H STR T=2.0
|
Facility
|
IP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LCK STERNAL 6H STR T=1.8
|
Facility
|
IP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE LCK STERNAL 6H STR T=1.8
|
Facility
|
OP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem Medicaid |
$1,480.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Humana KY Medicaid |
$1,480.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,509.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE LCK STERNAL 7H JLT T=1.8
|
Facility
|
OP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem Medicaid |
$1,643.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Humana KY Medicaid |
$1,643.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LCK STERNAL 7H JLT T=1.8
|
Facility
|
IP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
|
|
PLATE LCK STERNAL 8H STR T=1.8
|
Facility
|
OP
|
$4,493.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.12 |
| Max. Negotiated Rate |
$4,313.47 |
| Rate for Payer: Aetna Commercial |
$3,459.76
|
| Rate for Payer: Anthem Medicaid |
$1,545.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.70
|
| Rate for Payer: Cash Price |
$2,246.60
|
| Rate for Payer: Cigna Commercial |
$3,729.36
|
| Rate for Payer: First Health Commercial |
$4,268.54
|
| Rate for Payer: Humana Commercial |
$3,819.22
|
| Rate for Payer: Humana KY Medicaid |
$1,545.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,560.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,576.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,954.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$898.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,392.89
|
| Rate for Payer: PHCS Commercial |
$4,313.47
|
| Rate for Payer: United Healthcare All Payer |
$3,954.02
|
|
|
PLATE LCK STERNAL 8H STR T=1.8
|
Facility
|
IP
|
$4,493.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.12 |
| Max. Negotiated Rate |
$4,313.47 |
| Rate for Payer: Aetna Commercial |
$3,459.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,504.70
|
| Rate for Payer: Cash Price |
$2,246.60
|
| Rate for Payer: Cigna Commercial |
$3,729.36
|
| Rate for Payer: First Health Commercial |
$4,268.54
|
| Rate for Payer: Humana Commercial |
$3,819.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,684.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,315.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,347.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,954.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,369.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$898.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,392.89
|
| Rate for Payer: PHCS Commercial |
$4,313.47
|
| Rate for Payer: United Healthcare All Payer |
$3,954.02
|
|
|
PLATE LCK STRNAL 10H BDY T=1.5
|
Facility
|
OP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem Medicaid |
$1,643.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Humana KY Medicaid |
$1,643.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LCK STRNAL 10H BDY T=1.5
|
Facility
|
IP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LCK STRNAL 10H BDY T=1.8
|
Facility
|
OP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem Medicaid |
$1,643.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Humana KY Medicaid |
$1,643.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LCK STRNAL 10H BDY T=1.8
|
Facility
|
IP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LCK STRNAL 10H STR T=1.8
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE LCK STRNAL 10H STR T=1.8
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
|
|
PLATE LCK STRNAL 20H STR T=1.0
|
Facility
|
IP
|
$5,570.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.16 |
| Max. Negotiated Rate |
$5,347.68 |
| Rate for Payer: Aetna Commercial |
$4,289.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,344.99
|
| Rate for Payer: Cash Price |
$2,785.25
|
| Rate for Payer: Cigna Commercial |
$4,623.52
|
| Rate for Payer: First Health Commercial |
$5,291.98
|
| Rate for Payer: Humana Commercial |
$4,734.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,567.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,111.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,671.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,902.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,177.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,726.86
|
| Rate for Payer: PHCS Commercial |
$5,347.68
|
| Rate for Payer: United Healthcare All Payer |
$4,902.04
|
|
|
PLATE LCK STRNAL 20H STR T=1.0
|
Facility
|
OP
|
$5,570.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.16 |
| Max. Negotiated Rate |
$5,347.68 |
| Rate for Payer: Aetna Commercial |
$4,289.28
|
| Rate for Payer: Anthem Medicaid |
$1,915.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,344.99
|
| Rate for Payer: Cash Price |
$2,785.25
|
| Rate for Payer: Cigna Commercial |
$4,623.52
|
| Rate for Payer: First Health Commercial |
$5,291.98
|
| Rate for Payer: Humana Commercial |
$4,734.92
|
| Rate for Payer: Humana KY Medicaid |
$1,915.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,935.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,567.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,111.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,671.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,954.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,902.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,177.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,114.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,726.86
|
| Rate for Payer: PHCS Commercial |
$5,347.68
|
| Rate for Payer: United Healthcare All Payer |
$4,902.04
|
|
|
PLATE LCK STRNAL 20H STR T=2.0
|
Facility
|
OP
|
$7,184.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.97 |
| Max. Negotiated Rate |
$6,897.00 |
| Rate for Payer: Aetna Commercial |
$5,531.97
|
| Rate for Payer: Anthem Medicaid |
$2,470.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.82
|
| Rate for Payer: Cash Price |
$3,592.19
|
| Rate for Payer: Cigna Commercial |
$5,963.04
|
| Rate for Payer: First Health Commercial |
$6,825.16
|
| Rate for Payer: Humana Commercial |
$6,106.72
|
| Rate for Payer: Humana KY Medicaid |
$2,470.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,495.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,891.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,302.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,520.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,322.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,388.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,227.16
|
| Rate for Payer: PHCS Commercial |
$6,897.00
|
| Rate for Payer: United Healthcare All Payer |
$6,322.25
|
|
|
PLATE LCK STRNAL 20H STR T=2.0
|
Facility
|
IP
|
$7,184.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.97 |
| Max. Negotiated Rate |
$6,897.00 |
| Rate for Payer: Aetna Commercial |
$5,531.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.82
|
| Rate for Payer: Cash Price |
$3,592.19
|
| Rate for Payer: Cigna Commercial |
$5,963.04
|
| Rate for Payer: First Health Commercial |
$6,825.16
|
| Rate for Payer: Humana Commercial |
$6,106.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,891.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,302.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,322.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,388.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,227.16
|
| Rate for Payer: PHCS Commercial |
$6,897.00
|
| Rate for Payer: United Healthcare All Payer |
$6,322.25
|
|
|
PLATE LCK STRNL 14H LDDR 53*19
|
Facility
|
IP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE LCK STRNL 14H LDDR 53*19
|
Facility
|
OP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem Medicaid |
$2,317.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Humana KY Medicaid |
$2,317.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE LCK STRNL 18H LDDR 53*19
|
Facility
|
OP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem Medicaid |
$2,317.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Humana KY Medicaid |
$2,317.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE LCK STRNL 18H LDDR 53*19
|
Facility
|
IP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE LCK TUB 10H 3.5*133
|
Facility
|
IP
|
$1,966.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.58 |
| Max. Negotiated Rate |
$1,887.36 |
| Rate for Payer: Aetna Commercial |
$1,513.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,533.48
|
| Rate for Payer: Cash Price |
$983.00
|
| Rate for Payer: Cigna Commercial |
$1,631.78
|
| Rate for Payer: First Health Commercial |
$1,867.70
|
| Rate for Payer: Humana Commercial |
$1,671.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,730.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,474.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.46
|
| Rate for Payer: PHCS Commercial |
$1,887.36
|
| Rate for Payer: United Healthcare All Payer |
$1,730.08
|
|
