|
PLATE COMP 3.5MM 6 93MM
|
Facility
|
IP
|
$1,869.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.83 |
| Max. Negotiated Rate |
$1,794.65 |
| Rate for Payer: Aetna Commercial |
$1,439.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.16
|
| Rate for Payer: Cash Price |
$934.72
|
| Rate for Payer: Cigna Commercial |
$1,551.63
|
| Rate for Payer: First Health Commercial |
$1,775.96
|
| Rate for Payer: Humana Commercial |
$1,589.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,532.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,379.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.91
|
| Rate for Payer: PHCS Commercial |
$1,794.65
|
| Rate for Payer: United Healthcare All Payer |
$1,645.10
|
|
|
PLATE COMP 3.5MM 7 106MM
|
Facility
|
OP
|
$1,897.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.26 |
| Max. Negotiated Rate |
$1,821.65 |
| Rate for Payer: Aetna Commercial |
$1,461.11
|
| Rate for Payer: Anthem Medicaid |
$652.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,480.09
|
| Rate for Payer: Cash Price |
$948.78
|
| Rate for Payer: Cigna Commercial |
$1,574.97
|
| Rate for Payer: First Health Commercial |
$1,802.67
|
| Rate for Payer: Humana Commercial |
$1,612.92
|
| Rate for Payer: Humana KY Medicaid |
$652.57
|
| Rate for Payer: Kentucky WC Medicaid |
$659.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,400.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$665.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,423.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,518.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.31
|
| Rate for Payer: PHCS Commercial |
$1,821.65
|
| Rate for Payer: United Healthcare All Payer |
$1,669.84
|
|
|
PLATE COMP 3.5MM 7 106MM
|
Facility
|
IP
|
$1,897.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.26 |
| Max. Negotiated Rate |
$1,821.65 |
| Rate for Payer: Aetna Commercial |
$1,461.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,480.09
|
| Rate for Payer: Cash Price |
$948.78
|
| Rate for Payer: Cigna Commercial |
$1,574.97
|
| Rate for Payer: First Health Commercial |
$1,802.67
|
| Rate for Payer: Humana Commercial |
$1,612.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,555.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,400.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$569.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,669.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,423.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,518.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,650.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.31
|
| Rate for Payer: PHCS Commercial |
$1,821.65
|
| Rate for Payer: United Healthcare All Payer |
$1,669.84
|
|
|
PLATE COMP 3.5MM 8 119MM
|
Facility
|
OP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem Medicaid |
$662.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Humana KY Medicaid |
$662.24
|
| Rate for Payer: Kentucky WC Medicaid |
$668.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE COMP 3.5MM 8 119MM
|
Facility
|
IP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE COMP 3.5MM 9 132MM
|
Facility
|
OP
|
$1,932.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.81 |
| Max. Negotiated Rate |
$1,855.39 |
| Rate for Payer: Aetna Commercial |
$1,488.18
|
| Rate for Payer: Anthem Medicaid |
$664.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.51
|
| Rate for Payer: Cash Price |
$966.35
|
| Rate for Payer: Cigna Commercial |
$1,604.14
|
| Rate for Payer: First Health Commercial |
$1,836.07
|
| Rate for Payer: Humana Commercial |
$1,642.80
|
| Rate for Payer: Humana KY Medicaid |
$664.66
|
| Rate for Payer: Kentucky WC Medicaid |
$671.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.56
|
| Rate for Payer: PHCS Commercial |
$1,855.39
|
| Rate for Payer: United Healthcare All Payer |
$1,700.78
|
|
|
PLATE COMP 3.5MM 9 132MM
|
Facility
|
IP
|
$1,932.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.81 |
| Max. Negotiated Rate |
$1,855.39 |
| Rate for Payer: Aetna Commercial |
$1,488.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.51
|
| Rate for Payer: Cash Price |
$966.35
|
| Rate for Payer: Cigna Commercial |
$1,604.14
|
| Rate for Payer: First Health Commercial |
$1,836.07
|
| Rate for Payer: Humana Commercial |
$1,642.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,681.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.56
|
| Rate for Payer: PHCS Commercial |
$1,855.39
|
| Rate for Payer: United Healthcare All Payer |
$1,700.78
|
|
|
PLATE COMP 3H 3.5*54 71829403
|
Facility
|
IP
|
$1,778.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.64 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Aetna Commercial |
$1,369.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,387.46
|
| Rate for Payer: Cash Price |
$889.40
|
| Rate for Payer: Cigna Commercial |
$1,476.40
|
| Rate for Payer: First Health Commercial |
$1,689.86
|
| Rate for Payer: Humana Commercial |
$1,511.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,458.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,312.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,565.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,334.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,423.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,547.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,227.37
|
| Rate for Payer: PHCS Commercial |
$1,707.65
|
| Rate for Payer: United Healthcare All Payer |
$1,565.34
|
|
|
PLATE COMP 3H 3.5*54 71829403
|
Facility
|
OP
|
$1,778.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.64 |
| Max. Negotiated Rate |
$1,707.65 |
| Rate for Payer: Aetna Commercial |
$1,369.68
|
| Rate for Payer: Anthem Medicaid |
$611.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,387.46
|
| Rate for Payer: Cash Price |
$889.40
|
| Rate for Payer: Cigna Commercial |
$1,476.40
|
| Rate for Payer: First Health Commercial |
$1,689.86
|
| Rate for Payer: Humana Commercial |
$1,511.98
|
| Rate for Payer: Humana KY Medicaid |
$611.73
|
| Rate for Payer: Kentucky WC Medicaid |
$617.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,458.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,312.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$624.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,565.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,334.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,423.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,547.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,227.37
|
| Rate for Payer: PHCS Commercial |
$1,707.65
|
| Rate for Payer: United Healthcare All Payer |
$1,565.34
|
|
|
PLATE COMP 4H 3.5*67 71829404
|
Facility
|
IP
|
$1,786.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.92 |
| Max. Negotiated Rate |
$1,714.94 |
| Rate for Payer: Aetna Commercial |
$1,375.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,393.39
|
| Rate for Payer: Cash Price |
$893.20
|
| Rate for Payer: Cigna Commercial |
$1,482.71
|
| Rate for Payer: First Health Commercial |
$1,697.08
|
| Rate for Payer: Humana Commercial |
$1,518.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,464.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,318.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,572.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,339.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.62
|
| Rate for Payer: PHCS Commercial |
$1,714.94
|
| Rate for Payer: United Healthcare All Payer |
$1,572.03
|
|
|
PLATE COMP 4H 3.5*67 71829404
|
Facility
|
OP
|
$1,786.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.92 |
| Max. Negotiated Rate |
$1,714.94 |
| Rate for Payer: Aetna Commercial |
$1,375.53
|
| Rate for Payer: Anthem Medicaid |
$614.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,393.39
|
| Rate for Payer: Cash Price |
$893.20
|
| Rate for Payer: Cigna Commercial |
$1,482.71
|
| Rate for Payer: First Health Commercial |
$1,697.08
|
| Rate for Payer: Humana Commercial |
$1,518.44
|
| Rate for Payer: Humana KY Medicaid |
$614.34
|
| Rate for Payer: Kentucky WC Medicaid |
$620.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,464.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,318.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$626.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,572.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,339.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,429.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,554.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.62
|
| Rate for Payer: PHCS Commercial |
$1,714.94
|
| Rate for Payer: United Healthcare All Payer |
$1,572.03
|
|
|
PLATE COMP 5H 3.5*80 71829405
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem Medicaid |
$623.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Humana KY Medicaid |
$623.49
|
| Rate for Payer: Kentucky WC Medicaid |
$629.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
PLATE COMP 5H 3.5*80 71829405
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.90 |
| Max. Negotiated Rate |
$1,740.48 |
| Rate for Payer: Aetna Commercial |
$1,396.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.14
|
| Rate for Payer: Cash Price |
$906.50
|
| Rate for Payer: Cigna Commercial |
$1,504.79
|
| Rate for Payer: First Health Commercial |
$1,722.35
|
| Rate for Payer: Humana Commercial |
$1,541.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,337.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,250.97
|
| Rate for Payer: PHCS Commercial |
$1,740.48
|
| Rate for Payer: United Healthcare All Payer |
$1,595.44
|
|
|
PLATE COMP 6H 3.5*93 71829406
|
Facility
|
OP
|
$1,854.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.44 |
| Max. Negotiated Rate |
$1,780.61 |
| Rate for Payer: Aetna Commercial |
$1,428.20
|
| Rate for Payer: Anthem Medicaid |
$637.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.74
|
| Rate for Payer: Cash Price |
$927.40
|
| Rate for Payer: Cigna Commercial |
$1,539.48
|
| Rate for Payer: First Health Commercial |
$1,762.06
|
| Rate for Payer: Humana Commercial |
$1,576.58
|
| Rate for Payer: Humana KY Medicaid |
$637.87
|
| Rate for Payer: Kentucky WC Medicaid |
$644.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,483.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,613.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.81
|
| Rate for Payer: PHCS Commercial |
$1,780.61
|
| Rate for Payer: United Healthcare All Payer |
$1,632.22
|
|
|
PLATE COMP 6H 3.5*93 71829406
|
Facility
|
IP
|
$1,854.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.44 |
| Max. Negotiated Rate |
$1,780.61 |
| Rate for Payer: Aetna Commercial |
$1,428.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.74
|
| Rate for Payer: Cash Price |
$927.40
|
| Rate for Payer: Cigna Commercial |
$1,539.48
|
| Rate for Payer: First Health Commercial |
$1,762.06
|
| Rate for Payer: Humana Commercial |
$1,576.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,520.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,368.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,483.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,613.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,279.81
|
| Rate for Payer: PHCS Commercial |
$1,780.61
|
| Rate for Payer: United Healthcare All Payer |
$1,632.22
|
|
|
PLATE COMP 7H 3.5*106 71829407
|
Facility
|
OP
|
$1,873.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.14 |
| Max. Negotiated Rate |
$1,798.85 |
| Rate for Payer: Aetna Commercial |
$1,442.83
|
| Rate for Payer: Anthem Medicaid |
$644.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.56
|
| Rate for Payer: Cash Price |
$936.90
|
| Rate for Payer: Cigna Commercial |
$1,555.25
|
| Rate for Payer: First Health Commercial |
$1,780.11
|
| Rate for Payer: Humana Commercial |
$1,592.73
|
| Rate for Payer: Humana KY Medicaid |
$644.40
|
| Rate for Payer: Kentucky WC Medicaid |
$650.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.92
|
| Rate for Payer: PHCS Commercial |
$1,798.85
|
| Rate for Payer: United Healthcare All Payer |
$1,648.94
|
|
|
PLATE COMP 7H 3.5*106 71829407
|
Facility
|
IP
|
$1,873.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.14 |
| Max. Negotiated Rate |
$1,798.85 |
| Rate for Payer: Aetna Commercial |
$1,442.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,461.56
|
| Rate for Payer: Cash Price |
$936.90
|
| Rate for Payer: Cigna Commercial |
$1,555.25
|
| Rate for Payer: First Health Commercial |
$1,780.11
|
| Rate for Payer: Humana Commercial |
$1,592.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,536.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,382.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,648.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,499.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,292.92
|
| Rate for Payer: PHCS Commercial |
$1,798.85
|
| Rate for Payer: United Healthcare All Payer |
$1,648.94
|
|
|
PLATE COMP 8H 3.5*119 71829408
|
Facility
|
IP
|
$1,900.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.12 |
| Max. Negotiated Rate |
$1,824.38 |
| Rate for Payer: Aetna Commercial |
$1,463.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.31
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cigna Commercial |
$1,577.33
|
| Rate for Payer: First Health Commercial |
$1,805.38
|
| Rate for Payer: Humana Commercial |
$1,615.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.28
|
| Rate for Payer: PHCS Commercial |
$1,824.38
|
| Rate for Payer: United Healthcare All Payer |
$1,672.35
|
|
|
PLATE COMP 8H 3.5*119 71829408
|
Facility
|
OP
|
$1,900.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.12 |
| Max. Negotiated Rate |
$1,824.38 |
| Rate for Payer: Aetna Commercial |
$1,463.31
|
| Rate for Payer: Anthem Medicaid |
$653.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.31
|
| Rate for Payer: Cash Price |
$950.20
|
| Rate for Payer: Cigna Commercial |
$1,577.33
|
| Rate for Payer: First Health Commercial |
$1,805.38
|
| Rate for Payer: Humana Commercial |
$1,615.34
|
| Rate for Payer: Humana KY Medicaid |
$653.55
|
| Rate for Payer: Kentucky WC Medicaid |
$660.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,520.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,653.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,311.28
|
| Rate for Payer: PHCS Commercial |
$1,824.38
|
| Rate for Payer: United Healthcare All Payer |
$1,672.35
|
|
|
PLATE COMP 9H 3.5*132 71829409
|
Facility
|
OP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem Medicaid |
$665.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Humana KY Medicaid |
$665.31
|
| Rate for Payer: Kentucky WC Medicaid |
$672.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
PLATE COMP 9H 3.5*132 71829409
|
Facility
|
IP
|
$1,934.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.38 |
| Max. Negotiated Rate |
$1,857.22 |
| Rate for Payer: Aetna Commercial |
$1,489.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,508.99
|
| Rate for Payer: Cash Price |
$967.30
|
| Rate for Payer: Cigna Commercial |
$1,605.72
|
| Rate for Payer: First Health Commercial |
$1,837.87
|
| Rate for Payer: Humana Commercial |
$1,644.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,586.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,427.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$580.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,702.45
|
| Rate for Payer: Ohio Health Group HMO |
$1,450.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,547.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.87
|
| Rate for Payer: PHCS Commercial |
$1,857.22
|
| Rate for Payer: United Healthcare All Payer |
$1,702.45
|
|
|
PLATE COMP CABLE 9H 260MM
|
Facility
|
OP
|
$5,528.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.62 |
| Max. Negotiated Rate |
$5,307.60 |
| Rate for Payer: Aetna Commercial |
$4,257.14
|
| Rate for Payer: Anthem Medicaid |
$1,901.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,312.43
|
| Rate for Payer: Cash Price |
$2,764.38
|
| Rate for Payer: Cigna Commercial |
$4,588.86
|
| Rate for Payer: First Health Commercial |
$5,252.31
|
| Rate for Payer: Humana Commercial |
$4,699.44
|
| Rate for Payer: Humana KY Medicaid |
$1,901.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,920.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,533.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,080.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,939.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,865.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,146.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,423.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,810.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,814.84
|
| Rate for Payer: PHCS Commercial |
$5,307.60
|
| Rate for Payer: United Healthcare All Payer |
$4,865.30
|
|
|
PLATE COMP CABLE 9H 260MM
|
Facility
|
IP
|
$5,528.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.62 |
| Max. Negotiated Rate |
$5,307.60 |
| Rate for Payer: Aetna Commercial |
$4,257.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,312.43
|
| Rate for Payer: Cash Price |
$2,764.38
|
| Rate for Payer: Cigna Commercial |
$4,588.86
|
| Rate for Payer: First Health Commercial |
$5,252.31
|
| Rate for Payer: Humana Commercial |
$4,699.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,533.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,080.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,865.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,146.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,423.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,810.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,814.84
|
| Rate for Payer: PHCS Commercial |
$5,307.60
|
| Rate for Payer: United Healthcare All Payer |
$4,865.30
|
|
|
PLATE COMP LCK 3.5MM 111MM 7H
|
Facility
|
OP
|
$3,123.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.16 |
| Max. Negotiated Rate |
$2,998.92 |
| Rate for Payer: Aetna Commercial |
$2,405.39
|
| Rate for Payer: Anthem Medicaid |
$1,074.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.63
|
| Rate for Payer: Cash Price |
$1,561.94
|
| Rate for Payer: Cigna Commercial |
$2,592.82
|
| Rate for Payer: First Health Commercial |
$2,967.69
|
| Rate for Payer: Humana Commercial |
$2,655.30
|
| Rate for Payer: Humana KY Medicaid |
$1,074.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,085.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,561.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,095.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,717.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,155.48
|
| Rate for Payer: PHCS Commercial |
$2,998.92
|
| Rate for Payer: United Healthcare All Payer |
$2,749.01
|
|
|
PLATE COMP LCK 3.5MM 111MM 7H
|
Facility
|
IP
|
$3,123.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.16 |
| Max. Negotiated Rate |
$2,998.92 |
| Rate for Payer: Aetna Commercial |
$2,405.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,436.63
|
| Rate for Payer: Cash Price |
$1,561.94
|
| Rate for Payer: Cigna Commercial |
$2,592.82
|
| Rate for Payer: First Health Commercial |
$2,967.69
|
| Rate for Payer: Humana Commercial |
$2,655.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,561.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,305.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,749.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,342.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,717.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,155.48
|
| Rate for Payer: PHCS Commercial |
$2,998.92
|
| Rate for Payer: United Healthcare All Payer |
$2,749.01
|
|
