|
PLATE LCK TUB 10H 3.5*133
|
Facility
|
OP
|
$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 Medicaid |
$676.11
|
| 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: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| 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: Molina Healthcare Medicaid |
$689.67
|
| 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
|
|
|
PLATE LCK TUB 4H 3.5*57
|
Facility
|
OP
|
$1,920.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.66 |
| Max. Negotiated Rate |
$1,843.68 |
| Rate for Payer: Aetna Commercial |
$1,478.78
|
| Rate for Payer: Anthem Medicaid |
$660.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.99
|
| Rate for Payer: Cash Price |
$960.25
|
| Rate for Payer: Cigna Commercial |
$1,594.02
|
| Rate for Payer: First Health Commercial |
$1,824.48
|
| Rate for Payer: Humana Commercial |
$1,632.42
|
| Rate for Payer: Humana KY Medicaid |
$660.46
|
| Rate for Payer: Kentucky WC Medicaid |
$667.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.36
|
| Rate for Payer: PHCS Commercial |
$1,843.68
|
| Rate for Payer: United Healthcare All Payer |
$1,690.04
|
|
|
PLATE LCK TUB 4H 3.5*57
|
Facility
|
IP
|
$1,920.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.66 |
| Max. Negotiated Rate |
$1,843.68 |
| Rate for Payer: Aetna Commercial |
$1,478.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.99
|
| Rate for Payer: Cash Price |
$960.25
|
| Rate for Payer: Cigna Commercial |
$1,594.02
|
| Rate for Payer: First Health Commercial |
$1,824.48
|
| Rate for Payer: Humana Commercial |
$1,632.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.36
|
| Rate for Payer: PHCS Commercial |
$1,843.68
|
| Rate for Payer: United Healthcare All Payer |
$1,690.04
|
|
|
PLATE LCK TUB 6H 3.5*82
|
Facility
|
OP
|
$1,920.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.66 |
| Max. Negotiated Rate |
$1,843.68 |
| Rate for Payer: Aetna Commercial |
$1,478.78
|
| Rate for Payer: Anthem Medicaid |
$660.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.99
|
| Rate for Payer: Cash Price |
$960.25
|
| Rate for Payer: Cigna Commercial |
$1,594.02
|
| Rate for Payer: First Health Commercial |
$1,824.48
|
| Rate for Payer: Humana Commercial |
$1,632.42
|
| Rate for Payer: Humana KY Medicaid |
$660.46
|
| Rate for Payer: Kentucky WC Medicaid |
$667.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.36
|
| Rate for Payer: PHCS Commercial |
$1,843.68
|
| Rate for Payer: United Healthcare All Payer |
$1,690.04
|
|
|
PLATE LCK TUB 6H 3.5*82
|
Facility
|
IP
|
$1,920.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.66 |
| Max. Negotiated Rate |
$1,843.68 |
| Rate for Payer: Aetna Commercial |
$1,478.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.99
|
| Rate for Payer: Cash Price |
$960.25
|
| Rate for Payer: Cigna Commercial |
$1,594.02
|
| Rate for Payer: First Health Commercial |
$1,824.48
|
| Rate for Payer: Humana Commercial |
$1,632.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,690.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.36
|
| Rate for Payer: PHCS Commercial |
$1,843.68
|
| Rate for Payer: United Healthcare All Payer |
$1,690.04
|
|
|
PLATE LCK TUB 8H 3.5*107
|
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
|
|
|
PLATE LCK TUB 8H 3.5*107
|
Facility
|
OP
|
$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 Medicaid |
$676.11
|
| 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: Humana KY Medicaid |
$676.11
|
| Rate for Payer: Kentucky WC Medicaid |
$682.99
|
| 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: Molina Healthcare Medicaid |
$689.67
|
| 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
|
|
|
PLATE L CONN 12H 235MM
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.39 |
| Max. Negotiated Rate |
$2,978.88 |
| Rate for Payer: Aetna Commercial |
$2,389.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,420.34
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,575.49
|
| Rate for Payer: First Health Commercial |
$2,947.85
|
| Rate for Payer: Humana Commercial |
$2,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,730.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.93
|
| Rate for Payer: PHCS Commercial |
$2,978.88
|
| Rate for Payer: United Healthcare All Payer |
$2,730.64
|
|
|
PLATE L CONN 12H 235MM
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.39 |
| Max. Negotiated Rate |
$2,978.88 |
| Rate for Payer: Anthem Medicaid |
$1,067.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,420.34
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,575.49
|
| Rate for Payer: First Health Commercial |
$2,947.85
|
| Rate for Payer: Humana Commercial |
$2,637.55
|
| Rate for Payer: Humana KY Medicaid |
$1,067.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,077.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,088.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,730.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.93
|
| Rate for Payer: PHCS Commercial |
$2,978.88
|
| Rate for Payer: United Healthcare All Payer |
$2,730.64
|
| Rate for Payer: Aetna Commercial |
$2,389.31
|
|
|
PLATE L CONN 17H 335MM LG
|
Facility
|
OP
|
$3,299.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.87 |
| Max. Negotiated Rate |
$3,167.04 |
| Rate for Payer: Aetna Commercial |
$2,540.23
|
| Rate for Payer: Anthem Medicaid |
$1,134.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,573.22
|
| Rate for Payer: Cash Price |
$1,649.50
|
| Rate for Payer: Cigna Commercial |
$2,738.17
|
| Rate for Payer: First Health Commercial |
$3,134.05
|
| Rate for Payer: Humana Commercial |
$2,804.15
|
| Rate for Payer: Humana KY Medicaid |
$1,134.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,705.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,434.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,903.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,474.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.69
|
| Rate for Payer: PHCS Commercial |
$3,167.04
|
| Rate for Payer: United Healthcare All Payer |
$2,903.12
|
|
|
PLATE L CONN 17H 335MM LG
|
Facility
|
IP
|
$3,299.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.87 |
| Max. Negotiated Rate |
$3,167.04 |
| Rate for Payer: Aetna Commercial |
$2,540.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,573.22
|
| Rate for Payer: Cash Price |
$1,649.50
|
| Rate for Payer: Cigna Commercial |
$2,738.17
|
| Rate for Payer: First Health Commercial |
$3,134.05
|
| Rate for Payer: Humana Commercial |
$2,804.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,705.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,434.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$989.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,903.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,474.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$659.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,022.69
|
| Rate for Payer: PHCS Commercial |
$3,167.04
|
| Rate for Payer: United Healthcare All Payer |
$2,903.12
|
|
|
PLATE L CONN 8H 155MM LG
|
Facility
|
IP
|
$3,103.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.39 |
| Max. Negotiated Rate |
$2,978.88 |
| Rate for Payer: Aetna Commercial |
$2,389.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,420.34
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,575.49
|
| Rate for Payer: First Health Commercial |
$2,947.85
|
| Rate for Payer: Humana Commercial |
$2,637.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,730.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.93
|
| Rate for Payer: PHCS Commercial |
$2,978.88
|
| Rate for Payer: United Healthcare All Payer |
$2,730.64
|
|
|
PLATE L CONN 8H 155MM LG
|
Facility
|
OP
|
$3,103.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.39 |
| Max. Negotiated Rate |
$2,978.88 |
| Rate for Payer: Aetna Commercial |
$2,389.31
|
| Rate for Payer: Anthem Medicaid |
$1,067.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,420.34
|
| Rate for Payer: Cash Price |
$1,551.50
|
| Rate for Payer: Cigna Commercial |
$2,575.49
|
| Rate for Payer: First Health Commercial |
$2,947.85
|
| Rate for Payer: Humana Commercial |
$2,637.55
|
| Rate for Payer: Humana KY Medicaid |
$1,067.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,077.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,290.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$930.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,088.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,730.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,327.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$620.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$403.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$961.93
|
| Rate for Payer: PHCS Commercial |
$2,978.88
|
| Rate for Payer: United Healthcare All Payer |
$2,730.64
|
|
|
PLATE LCP 1/3 TUB 9H 105MM
|
Facility
|
IP
|
$1,993.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.19 |
| Max. Negotiated Rate |
$1,914.04 |
| Rate for Payer: Aetna Commercial |
$1,535.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,555.16
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$1,654.85
|
| Rate for Payer: First Health Commercial |
$1,894.10
|
| Rate for Payer: Humana Commercial |
$1,694.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,495.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.07
|
| Rate for Payer: PHCS Commercial |
$1,914.04
|
| Rate for Payer: United Healthcare All Payer |
$1,754.54
|
|
|
PLATE LCP 1/3 TUB 9H 105MM
|
Facility
|
OP
|
$1,993.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.19 |
| Max. Negotiated Rate |
$1,914.04 |
| Rate for Payer: Aetna Commercial |
$1,535.22
|
| Rate for Payer: Anthem Medicaid |
$685.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,555.16
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$1,654.85
|
| Rate for Payer: First Health Commercial |
$1,894.10
|
| Rate for Payer: Humana Commercial |
$1,694.72
|
| Rate for Payer: Humana KY Medicaid |
$685.66
|
| Rate for Payer: Kentucky WC Medicaid |
$692.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,495.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.07
|
| Rate for Payer: PHCS Commercial |
$1,914.04
|
| Rate for Payer: United Healthcare All Payer |
$1,754.54
|
|
|
PLATE LCP DIS HUM 3.5MM 6H R
|
Facility
|
OP
|
$8,448.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.26 |
| Max. Negotiated Rate |
$8,110.23 |
| Rate for Payer: Aetna Commercial |
$6,505.08
|
| Rate for Payer: Anthem Medicaid |
$2,905.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,589.56
|
| Rate for Payer: Cash Price |
$4,224.08
|
| Rate for Payer: Cigna Commercial |
$7,011.97
|
| Rate for Payer: First Health Commercial |
$8,025.75
|
| Rate for Payer: Humana Commercial |
$7,180.94
|
| Rate for Payer: Humana KY Medicaid |
$2,905.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,934.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,927.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,234.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,963.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,434.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,336.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,689.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,618.93
|
| Rate for Payer: PHCS Commercial |
$8,110.23
|
| Rate for Payer: United Healthcare All Payer |
$7,434.38
|
|
|
PLATE LCP DIS HUM 3.5MM 6H R
|
Facility
|
IP
|
$8,448.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.26 |
| Max. Negotiated Rate |
$8,110.23 |
| Rate for Payer: Aetna Commercial |
$6,505.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,589.56
|
| Rate for Payer: Cash Price |
$4,224.08
|
| Rate for Payer: Cigna Commercial |
$7,011.97
|
| Rate for Payer: First Health Commercial |
$8,025.75
|
| Rate for Payer: Humana Commercial |
$7,180.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,927.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,234.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,434.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,336.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,689.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,618.93
|
| Rate for Payer: PHCS Commercial |
$8,110.23
|
| Rate for Payer: United Healthcare All Payer |
$7,434.38
|
|
|
PLATE LCP LAT DIS FIB 3.5 5H R
|
Facility
|
IP
|
$4,482.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.67 |
| Max. Negotiated Rate |
$4,302.76 |
| Rate for Payer: Aetna Commercial |
$3,451.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.99
|
| Rate for Payer: Cash Price |
$2,241.02
|
| Rate for Payer: Cigna Commercial |
$3,720.09
|
| Rate for Payer: First Health Commercial |
$4,257.94
|
| Rate for Payer: Humana Commercial |
$3,809.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,675.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,944.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.43
|
| Rate for Payer: PHCS Commercial |
$4,302.76
|
| Rate for Payer: United Healthcare All Payer |
$3,944.20
|
|
|
PLATE LCP LAT DIS FIB 3.5 5H R
|
Facility
|
OP
|
$4,482.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.67 |
| Max. Negotiated Rate |
$4,302.76 |
| Rate for Payer: Aetna Commercial |
$3,451.17
|
| Rate for Payer: Anthem Medicaid |
$1,541.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.99
|
| Rate for Payer: Cash Price |
$2,241.02
|
| Rate for Payer: Cigna Commercial |
$3,720.09
|
| Rate for Payer: First Health Commercial |
$4,257.94
|
| Rate for Payer: Humana Commercial |
$3,809.73
|
| Rate for Payer: Humana KY Medicaid |
$1,541.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,557.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,675.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,944.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.43
|
| Rate for Payer: PHCS Commercial |
$4,302.76
|
| Rate for Payer: United Healthcare All Payer |
$3,944.20
|
|
|
PLATE LCP LAT DIS FIB 3.5 7H L
|
Facility
|
OP
|
$4,655.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$4,469.14 |
| Rate for Payer: Aetna Commercial |
$3,584.62
|
| Rate for Payer: Anthem Medicaid |
$1,600.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,631.17
|
| Rate for Payer: Cash Price |
$2,327.68
|
| Rate for Payer: Cigna Commercial |
$3,863.94
|
| Rate for Payer: First Health Commercial |
$4,422.58
|
| Rate for Payer: Humana Commercial |
$3,957.05
|
| Rate for Payer: Humana KY Medicaid |
$1,600.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,633.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.16
|
| Rate for Payer: PHCS Commercial |
$4,469.14
|
| Rate for Payer: United Healthcare All Payer |
$4,096.71
|
|
|
PLATE LCP LAT DIS FIB 3.5 7H L
|
Facility
|
IP
|
$4,655.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.20 |
| Max. Negotiated Rate |
$4,469.14 |
| Rate for Payer: Aetna Commercial |
$3,584.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,631.17
|
| Rate for Payer: Cash Price |
$2,327.68
|
| Rate for Payer: Cigna Commercial |
$3,863.94
|
| Rate for Payer: First Health Commercial |
$4,422.58
|
| Rate for Payer: Humana Commercial |
$3,957.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.16
|
| Rate for Payer: PHCS Commercial |
$4,469.14
|
| Rate for Payer: United Healthcare All Payer |
$4,096.71
|
|
|
PLATE LCP M DS TB 3.5*116 L 4H
|
Facility
|
OP
|
$8,385.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.11 |
| Max. Negotiated Rate |
$8,050.03 |
| Rate for Payer: Aetna Commercial |
$6,456.80
|
| Rate for Payer: Anthem Medicaid |
$2,883.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,540.65
|
| Rate for Payer: Cash Price |
$4,192.72
|
| Rate for Payer: Cigna Commercial |
$6,959.92
|
| Rate for Payer: First Health Commercial |
$7,966.18
|
| Rate for Payer: Humana Commercial |
$7,127.63
|
| Rate for Payer: Humana KY Medicaid |
$2,883.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,913.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,677.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,090.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.49
|
| Rate for Payer: PHCS Commercial |
$8,050.03
|
| Rate for Payer: United Healthcare All Payer |
$7,379.20
|
|
|
PLATE LCP M DS TB 3.5*116 L 4H
|
Facility
|
IP
|
$8,385.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,090.11 |
| Max. Negotiated Rate |
$8,050.03 |
| Rate for Payer: Humana Commercial |
$7,127.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,876.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,188.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,379.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,289.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,677.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,090.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.49
|
| Rate for Payer: PHCS Commercial |
$8,050.03
|
| Rate for Payer: United Healthcare All Payer |
$7,379.20
|
| Rate for Payer: Aetna Commercial |
$6,456.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,540.65
|
| Rate for Payer: Cash Price |
$4,192.72
|
| Rate for Payer: Cigna Commercial |
$6,959.92
|
| Rate for Payer: First Health Commercial |
$7,966.18
|
|
|
PLATE LCP M DS TB 3.5*116 R 4H
|
Facility
|
IP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
|
|
PLATE LCP M DS TB 3.5*116 R 4H
|
Facility
|
OP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem Medicaid |
$3,661.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Humana KY Medicaid |
$3,661.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,698.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,734.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
|
