|
PLATE LK CLAV INF MD 8H 96MM
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK CLAV INF MD 8H 96MM
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
|
|
PLATE LK CLAV SP DS 84M R SHT
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SP DS 84M R SHT
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SUP 109MM L
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SUP 109MM L
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SUP 109MM R
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SUP 109MM R
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SUP 10H 121M L
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SUP 10H 121M L
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
|
|
PLATE LK CLAV SUP 8H 97M L
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK CLAV SUP 8H 97M L
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK CLAV SUP DIS 84 L SHT
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV SUP DIS 84 L SHT
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK DIS CLAV INF 81MM
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK DIS CLAV INF 81MM
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK HUM PLD 11H 157MM L
|
Facility
|
IP
|
$7,803.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.47 |
| Max. Negotiated Rate |
$7,491.46 |
| Rate for Payer: Aetna Commercial |
$6,008.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,086.81
|
| Rate for Payer: Cash Price |
$3,901.80
|
| Rate for Payer: Cigna Commercial |
$6,476.99
|
| Rate for Payer: First Health Commercial |
$7,413.42
|
| Rate for Payer: Humana Commercial |
$6,633.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,398.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,759.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,341.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,867.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,852.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,419.12
|
| Rate for Payer: PHCS Commercial |
$7,491.46
|
| Rate for Payer: United Healthcare All Payer |
$6,867.17
|
|
|
PLATE LK HUM PLD 11H 157MM L
|
Facility
|
OP
|
$7,803.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.47 |
| Max. Negotiated Rate |
$7,491.46 |
| Rate for Payer: Aetna Commercial |
$6,008.77
|
| Rate for Payer: Anthem Medicaid |
$2,683.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,086.81
|
| Rate for Payer: Cash Price |
$3,901.80
|
| Rate for Payer: Cigna Commercial |
$6,476.99
|
| Rate for Payer: First Health Commercial |
$7,413.42
|
| Rate for Payer: Humana Commercial |
$6,633.06
|
| Rate for Payer: Humana KY Medicaid |
$2,683.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,710.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,398.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,759.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,341.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,737.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,867.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,852.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,419.12
|
| Rate for Payer: PHCS Commercial |
$7,491.46
|
| Rate for Payer: United Healthcare All Payer |
$6,867.17
|
|
|
PLATE LK HUM PLD 11H 157MM R
|
Facility
|
IP
|
$7,803.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.47 |
| Max. Negotiated Rate |
$7,491.46 |
| Rate for Payer: Aetna Commercial |
$6,008.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,086.81
|
| Rate for Payer: Cash Price |
$3,901.80
|
| Rate for Payer: Cigna Commercial |
$6,476.99
|
| Rate for Payer: First Health Commercial |
$7,413.42
|
| Rate for Payer: Humana Commercial |
$6,633.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,398.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,759.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,341.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,867.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,852.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,419.12
|
| Rate for Payer: PHCS Commercial |
$7,491.46
|
| Rate for Payer: United Healthcare All Payer |
$6,867.17
|
|
|
PLATE LK HUM PLD 11H 157MM R
|
Facility
|
OP
|
$7,803.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.47 |
| Max. Negotiated Rate |
$7,491.46 |
| Rate for Payer: Aetna Commercial |
$6,008.77
|
| Rate for Payer: Anthem Medicaid |
$2,683.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,086.81
|
| Rate for Payer: Cash Price |
$3,901.80
|
| Rate for Payer: Cigna Commercial |
$6,476.99
|
| Rate for Payer: First Health Commercial |
$7,413.42
|
| Rate for Payer: Humana Commercial |
$6,633.06
|
| Rate for Payer: Humana KY Medicaid |
$2,683.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,710.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,398.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,759.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,341.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,737.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,867.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,852.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,419.12
|
| Rate for Payer: PHCS Commercial |
$7,491.46
|
| Rate for Payer: United Healthcare All Payer |
$6,867.17
|
|
|
PLATE LK HUM PLD 15H 207MM L
|
Facility
|
OP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem Medicaid |
$2,730.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Humana KY Medicaid |
$2,730.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE LK HUM PLD 15H 207MM L
|
Facility
|
IP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE LK HUM PLD 15H 207MM R
|
Facility
|
IP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE LK HUM PLD 15H 207MM R
|
Facility
|
OP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem Medicaid |
$2,730.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Humana KY Medicaid |
$2,730.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE LK HUM PLD 5H 80MM L
|
Facility
|
OP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem Medicaid |
$2,335.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Humana KY Medicaid |
$2,335.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,382.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
