|
PLATE COMP LCK 3.5MM 121MM 6H
|
Facility
|
OP
|
$3,498.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.55 |
| Max. Negotiated Rate |
$3,358.56 |
| Rate for Payer: Aetna Commercial |
$2,693.84
|
| Rate for Payer: Anthem Medicaid |
$1,203.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,728.83
|
| Rate for Payer: Cash Price |
$1,749.25
|
| Rate for Payer: Cigna Commercial |
$2,903.76
|
| Rate for Payer: First Health Commercial |
$3,323.57
|
| Rate for Payer: Humana Commercial |
$2,973.72
|
| Rate for Payer: Humana KY Medicaid |
$1,203.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,868.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,581.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,049.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,078.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,623.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,798.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,043.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,413.97
|
| Rate for Payer: PHCS Commercial |
$3,358.56
|
| Rate for Payer: United Healthcare All Payer |
$3,078.68
|
|
|
PLATE COMP LCK 3.5MM 121MM 6H
|
Facility
|
IP
|
$3,498.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,049.55 |
| Max. Negotiated Rate |
$3,358.56 |
| Rate for Payer: Aetna Commercial |
$2,693.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,728.83
|
| Rate for Payer: Cash Price |
$1,749.25
|
| Rate for Payer: Cigna Commercial |
$2,903.76
|
| Rate for Payer: First Health Commercial |
$3,323.57
|
| Rate for Payer: Humana Commercial |
$2,973.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,868.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,581.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,049.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,078.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,623.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,798.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,043.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,413.97
|
| Rate for Payer: PHCS Commercial |
$3,358.56
|
| Rate for Payer: United Healthcare All Payer |
$3,078.68
|
|
|
PLATE COMP LCK 3.5MM 125MM 8H
|
Facility
|
IP
|
$3,290.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.11 |
| Max. Negotiated Rate |
$3,158.76 |
| Rate for Payer: Aetna Commercial |
$2,533.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.50
|
| Rate for Payer: Cash Price |
$1,645.19
|
| Rate for Payer: Cigna Commercial |
$2,731.02
|
| Rate for Payer: First Health Commercial |
$3,125.86
|
| Rate for Payer: Humana Commercial |
$2,796.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,698.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.36
|
| Rate for Payer: PHCS Commercial |
$3,158.76
|
| Rate for Payer: United Healthcare All Payer |
$2,895.53
|
|
|
PLATE COMP LCK 3.5MM 125MM 8H
|
Facility
|
OP
|
$3,290.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.11 |
| Max. Negotiated Rate |
$3,158.76 |
| Rate for Payer: Aetna Commercial |
$2,533.59
|
| Rate for Payer: Anthem Medicaid |
$1,131.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.50
|
| Rate for Payer: Cash Price |
$1,645.19
|
| Rate for Payer: Cigna Commercial |
$2,731.02
|
| Rate for Payer: First Health Commercial |
$3,125.86
|
| Rate for Payer: Humana Commercial |
$2,796.82
|
| Rate for Payer: Humana KY Medicaid |
$1,131.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,143.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,698.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.36
|
| Rate for Payer: PHCS Commercial |
$3,158.76
|
| Rate for Payer: United Healthcare All Payer |
$2,895.53
|
|
|
PLATE COMP LCK 3.5MM 140MM 7H
|
Facility
|
IP
|
$3,207.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.14 |
| Max. Negotiated Rate |
$3,078.84 |
| Rate for Payer: Aetna Commercial |
$2,469.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,501.55
|
| Rate for Payer: Cash Price |
$1,603.56
|
| Rate for Payer: Cigna Commercial |
$2,661.91
|
| Rate for Payer: First Health Commercial |
$3,046.76
|
| Rate for Payer: Humana Commercial |
$2,726.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,629.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,366.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,822.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,405.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,790.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.91
|
| Rate for Payer: PHCS Commercial |
$3,078.84
|
| Rate for Payer: United Healthcare All Payer |
$2,822.27
|
|
|
PLATE COMP LCK 3.5MM 140MM 7H
|
Facility
|
OP
|
$3,207.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$962.14 |
| Max. Negotiated Rate |
$3,078.84 |
| Rate for Payer: Aetna Commercial |
$2,469.48
|
| Rate for Payer: Anthem Medicaid |
$1,102.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,501.55
|
| Rate for Payer: Cash Price |
$1,603.56
|
| Rate for Payer: Cigna Commercial |
$2,661.91
|
| Rate for Payer: First Health Commercial |
$3,046.76
|
| Rate for Payer: Humana Commercial |
$2,726.05
|
| Rate for Payer: Humana KY Medicaid |
$1,102.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,114.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,629.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,366.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$962.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,125.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,822.27
|
| Rate for Payer: Ohio Health Group HMO |
$2,405.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,565.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,790.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,212.91
|
| Rate for Payer: PHCS Commercial |
$3,078.84
|
| Rate for Payer: United Healthcare All Payer |
$2,822.27
|
|
|
PLATE COMP LCK 3.5MM 154MM 10H
|
Facility
|
IP
|
$3,373.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.09 |
| Max. Negotiated Rate |
$3,238.68 |
| Rate for Payer: Aetna Commercial |
$2,597.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,631.42
|
| Rate for Payer: Cash Price |
$1,686.81
|
| Rate for Payer: Cigna Commercial |
$2,800.10
|
| Rate for Payer: First Health Commercial |
$3,204.94
|
| Rate for Payer: Humana Commercial |
$2,867.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,766.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,489.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,968.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,530.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,698.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,935.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,327.80
|
| Rate for Payer: PHCS Commercial |
$3,238.68
|
| Rate for Payer: United Healthcare All Payer |
$2,968.79
|
|
|
PLATE COMP LCK 3.5MM 154MM 10H
|
Facility
|
OP
|
$3,373.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.09 |
| Max. Negotiated Rate |
$3,238.68 |
| Rate for Payer: Aetna Commercial |
$2,597.69
|
| Rate for Payer: Anthem Medicaid |
$1,160.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,631.42
|
| Rate for Payer: Cash Price |
$1,686.81
|
| Rate for Payer: Cigna Commercial |
$2,800.10
|
| Rate for Payer: First Health Commercial |
$3,204.94
|
| Rate for Payer: Humana Commercial |
$2,867.58
|
| Rate for Payer: Humana KY Medicaid |
$1,160.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,172.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,766.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,489.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,968.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,530.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,698.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,935.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,327.80
|
| Rate for Payer: PHCS Commercial |
$3,238.68
|
| Rate for Payer: United Healthcare All Payer |
$2,968.79
|
|
|
PLATE COMP LCK 3.5MM 157MM 8H
|
Facility
|
OP
|
$3,935.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.67 |
| Max. Negotiated Rate |
$3,778.14 |
| Rate for Payer: Aetna Commercial |
$3,030.38
|
| Rate for Payer: Anthem Medicaid |
$1,353.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,069.74
|
| Rate for Payer: Cash Price |
$1,967.78
|
| Rate for Payer: Cigna Commercial |
$3,266.51
|
| Rate for Payer: First Health Commercial |
$3,738.78
|
| Rate for Payer: Humana Commercial |
$3,345.23
|
| Rate for Payer: Humana KY Medicaid |
$1,353.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,904.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,380.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,951.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,148.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,423.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,715.54
|
| Rate for Payer: PHCS Commercial |
$3,778.14
|
| Rate for Payer: United Healthcare All Payer |
$3,463.29
|
|
|
PLATE COMP LCK 3.5MM 157MM 8H
|
Facility
|
IP
|
$3,935.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,180.67 |
| Max. Negotiated Rate |
$3,778.14 |
| Rate for Payer: Aetna Commercial |
$3,030.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,069.74
|
| Rate for Payer: Cash Price |
$1,967.78
|
| Rate for Payer: Cigna Commercial |
$3,266.51
|
| Rate for Payer: First Health Commercial |
$3,738.78
|
| Rate for Payer: Humana Commercial |
$3,345.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,904.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,951.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,148.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,423.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,715.54
|
| Rate for Payer: PHCS Commercial |
$3,778.14
|
| Rate for Payer: United Healthcare All Payer |
$3,463.29
|
|
|
PLATE COMP LCK 3.5MM 183MM 12H
|
Facility
|
OP
|
$3,519.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.79 |
| Max. Negotiated Rate |
$3,378.54 |
| Rate for Payer: Aetna Commercial |
$2,709.87
|
| Rate for Payer: Anthem Medicaid |
$1,210.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,745.06
|
| Rate for Payer: Cash Price |
$1,759.66
|
| Rate for Payer: Cigna Commercial |
$2,921.03
|
| Rate for Payer: First Health Commercial |
$3,343.34
|
| Rate for Payer: Humana Commercial |
$2,991.41
|
| Rate for Payer: Humana KY Medicaid |
$1,210.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,222.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,597.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,428.32
|
| Rate for Payer: PHCS Commercial |
$3,378.54
|
| Rate for Payer: United Healthcare All Payer |
$3,096.99
|
|
|
PLATE COMP LCK 3.5MM 183MM 12H
|
Facility
|
IP
|
$3,519.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.79 |
| Max. Negotiated Rate |
$3,378.54 |
| Rate for Payer: Aetna Commercial |
$2,709.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,745.06
|
| Rate for Payer: Cash Price |
$1,759.66
|
| Rate for Payer: Cigna Commercial |
$2,921.03
|
| Rate for Payer: First Health Commercial |
$3,343.34
|
| Rate for Payer: Humana Commercial |
$2,991.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,885.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,597.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,055.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,096.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,639.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,815.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,061.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,428.32
|
| Rate for Payer: PHCS Commercial |
$3,378.54
|
| Rate for Payer: United Healthcare All Payer |
$3,096.99
|
|
|
PLATE COMP LCK 3.5MM 193MM 10H
|
Facility
|
OP
|
$4,254.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.41 |
| Max. Negotiated Rate |
$4,084.50 |
| Rate for Payer: Aetna Commercial |
$3,276.11
|
| Rate for Payer: Anthem Medicaid |
$1,463.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.66
|
| Rate for Payer: Cash Price |
$2,127.34
|
| Rate for Payer: Cigna Commercial |
$3,531.39
|
| Rate for Payer: First Health Commercial |
$4,041.96
|
| Rate for Payer: Humana Commercial |
$3,616.49
|
| Rate for Payer: Humana KY Medicaid |
$1,463.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,478.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,492.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,744.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,191.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.74
|
| Rate for Payer: PHCS Commercial |
$4,084.50
|
| Rate for Payer: United Healthcare All Payer |
$3,744.13
|
|
|
PLATE COMP LCK 3.5MM 193MM 10H
|
Facility
|
IP
|
$4,254.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.41 |
| Max. Negotiated Rate |
$4,084.50 |
| Rate for Payer: Aetna Commercial |
$3,276.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.66
|
| Rate for Payer: Cash Price |
$2,127.34
|
| Rate for Payer: Cigna Commercial |
$3,531.39
|
| Rate for Payer: First Health Commercial |
$4,041.96
|
| Rate for Payer: Humana Commercial |
$3,616.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,744.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,191.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.74
|
| Rate for Payer: PHCS Commercial |
$4,084.50
|
| Rate for Payer: United Healthcare All Payer |
$3,744.13
|
|
|
PLATE COMP LCK 3.5MM 212MM 14H
|
Facility
|
OP
|
$4,337.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.38 |
| Max. Negotiated Rate |
$4,164.42 |
| Rate for Payer: Aetna Commercial |
$3,340.21
|
| Rate for Payer: Anthem Medicaid |
$1,491.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,383.59
|
| Rate for Payer: Cash Price |
$2,168.97
|
| Rate for Payer: Cigna Commercial |
$3,600.49
|
| Rate for Payer: First Health Commercial |
$4,121.04
|
| Rate for Payer: Humana Commercial |
$3,687.25
|
| Rate for Payer: Humana KY Medicaid |
$1,491.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,521.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.18
|
| Rate for Payer: PHCS Commercial |
$4,164.42
|
| Rate for Payer: United Healthcare All Payer |
$3,817.39
|
|
|
PLATE COMP LCK 3.5MM 212MM 14H
|
Facility
|
IP
|
$4,337.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.38 |
| Max. Negotiated Rate |
$4,164.42 |
| Rate for Payer: Aetna Commercial |
$3,340.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,383.59
|
| Rate for Payer: Cash Price |
$2,168.97
|
| Rate for Payer: Cigna Commercial |
$3,600.49
|
| Rate for Payer: First Health Commercial |
$4,121.04
|
| Rate for Payer: Humana Commercial |
$3,687.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.18
|
| Rate for Payer: PHCS Commercial |
$4,164.42
|
| Rate for Payer: United Healthcare All Payer |
$3,817.39
|
|
|
PLATE COMP LCK 3.5MM 214MM 14H
|
Facility
|
IP
|
$4,337.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.38 |
| Max. Negotiated Rate |
$4,164.42 |
| Rate for Payer: Aetna Commercial |
$3,340.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,383.59
|
| Rate for Payer: Cash Price |
$2,168.97
|
| Rate for Payer: Cigna Commercial |
$3,600.49
|
| Rate for Payer: First Health Commercial |
$4,121.04
|
| Rate for Payer: Humana Commercial |
$3,687.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.18
|
| Rate for Payer: PHCS Commercial |
$4,164.42
|
| Rate for Payer: United Healthcare All Payer |
$3,817.39
|
|
|
PLATE COMP LCK 3.5MM 214MM 14H
|
Facility
|
OP
|
$4,337.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.38 |
| Max. Negotiated Rate |
$4,164.42 |
| Rate for Payer: Aetna Commercial |
$3,340.21
|
| Rate for Payer: Anthem Medicaid |
$1,491.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,383.59
|
| Rate for Payer: Cash Price |
$2,168.97
|
| Rate for Payer: Cigna Commercial |
$3,600.49
|
| Rate for Payer: First Health Commercial |
$4,121.04
|
| Rate for Payer: Humana Commercial |
$3,687.25
|
| Rate for Payer: Humana KY Medicaid |
$1,491.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,521.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.39
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.18
|
| Rate for Payer: PHCS Commercial |
$4,164.42
|
| Rate for Payer: United Healthcare All Payer |
$3,817.39
|
|
|
PLATE COMP LCK 3.5MM 229MM 12H
|
Facility
|
IP
|
$4,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,372.14 |
| Max. Negotiated Rate |
$4,390.86 |
| Rate for Payer: Aetna Commercial |
$3,521.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,567.57
|
| Rate for Payer: Cash Price |
$2,286.91
|
| Rate for Payer: Cigna Commercial |
$3,796.26
|
| Rate for Payer: First Health Commercial |
$4,345.12
|
| Rate for Payer: Humana Commercial |
$3,887.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,750.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,979.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,155.93
|
| Rate for Payer: PHCS Commercial |
$4,390.86
|
| Rate for Payer: United Healthcare All Payer |
$4,024.95
|
|
|
PLATE COMP LCK 3.5MM 229MM 12H
|
Facility
|
OP
|
$4,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,372.14 |
| Max. Negotiated Rate |
$4,390.86 |
| Rate for Payer: Aetna Commercial |
$3,521.83
|
| Rate for Payer: Anthem Medicaid |
$1,572.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,567.57
|
| Rate for Payer: Cash Price |
$2,286.91
|
| Rate for Payer: Cigna Commercial |
$3,796.26
|
| Rate for Payer: First Health Commercial |
$4,345.12
|
| Rate for Payer: Humana Commercial |
$3,887.74
|
| Rate for Payer: Humana KY Medicaid |
$1,572.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,750.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,979.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,155.93
|
| Rate for Payer: PHCS Commercial |
$4,390.86
|
| Rate for Payer: United Healthcare All Payer |
$4,024.95
|
|
|
PLATE COMP LCK 3.5MM 243MM 16H
|
Facility
|
IP
|
$4,511.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.41 |
| Max. Negotiated Rate |
$4,330.92 |
| Rate for Payer: Aetna Commercial |
$3,473.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,518.88
|
| Rate for Payer: Cash Price |
$2,255.69
|
| Rate for Payer: Cigna Commercial |
$3,744.45
|
| Rate for Payer: First Health Commercial |
$4,285.81
|
| Rate for Payer: Humana Commercial |
$3,834.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,699.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,329.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,353.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,970.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,383.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,609.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,924.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,112.85
|
| Rate for Payer: PHCS Commercial |
$4,330.92
|
| Rate for Payer: United Healthcare All Payer |
$3,970.01
|
|
|
PLATE COMP LCK 3.5MM 243MM 16H
|
Facility
|
OP
|
$4,511.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,353.41 |
| Max. Negotiated Rate |
$4,330.92 |
| Rate for Payer: Aetna Commercial |
$3,473.76
|
| Rate for Payer: Anthem Medicaid |
$1,551.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,518.88
|
| Rate for Payer: Cash Price |
$2,255.69
|
| Rate for Payer: Cigna Commercial |
$3,744.45
|
| Rate for Payer: First Health Commercial |
$4,285.81
|
| Rate for Payer: Humana Commercial |
$3,834.67
|
| Rate for Payer: Humana KY Medicaid |
$1,551.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,567.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,699.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,329.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,353.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,582.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,970.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,383.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,609.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,924.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,112.85
|
| Rate for Payer: PHCS Commercial |
$4,330.92
|
| Rate for Payer: United Healthcare All Payer |
$3,970.01
|
|
|
PLATE COMP LCK 3.5MM 265MM 14H
|
Facility
|
OP
|
$4,865.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,459.56 |
| Max. Negotiated Rate |
$4,670.58 |
| Rate for Payer: Aetna Commercial |
$3,746.20
|
| Rate for Payer: Anthem Medicaid |
$1,673.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,794.85
|
| Rate for Payer: Cash Price |
$2,432.59
|
| Rate for Payer: Cigna Commercial |
$4,038.11
|
| Rate for Payer: First Health Commercial |
$4,621.93
|
| Rate for Payer: Humana Commercial |
$4,135.41
|
| Rate for Payer: Humana KY Medicaid |
$1,673.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,690.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,989.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,590.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,459.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,706.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,281.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,892.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,232.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,356.98
|
| Rate for Payer: PHCS Commercial |
$4,670.58
|
| Rate for Payer: United Healthcare All Payer |
$4,281.37
|
|
|
PLATE COMP LCK 3.5MM 265MM 14H
|
Facility
|
IP
|
$4,865.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,459.56 |
| Max. Negotiated Rate |
$4,670.58 |
| Rate for Payer: Aetna Commercial |
$3,746.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,794.85
|
| Rate for Payer: Cash Price |
$2,432.59
|
| Rate for Payer: Cigna Commercial |
$4,038.11
|
| Rate for Payer: First Health Commercial |
$4,621.93
|
| Rate for Payer: Humana Commercial |
$4,135.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,989.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,590.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,459.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,281.37
|
| Rate for Payer: Ohio Health Group HMO |
$3,648.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,892.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,232.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,356.98
|
| Rate for Payer: PHCS Commercial |
$4,670.58
|
| Rate for Payer: United Healthcare All Payer |
$4,281.37
|
|
|
PLATE COMP LCK 3.5MM 272MM 18H
|
Facility
|
OP
|
$4,830.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.15 |
| Max. Negotiated Rate |
$4,637.28 |
| Rate for Payer: Aetna Commercial |
$3,719.49
|
| Rate for Payer: Anthem Medicaid |
$1,661.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,767.79
|
| Rate for Payer: Cash Price |
$2,415.25
|
| Rate for Payer: Cigna Commercial |
$4,009.32
|
| Rate for Payer: First Health Commercial |
$4,588.98
|
| Rate for Payer: Humana Commercial |
$4,105.93
|
| Rate for Payer: Humana KY Medicaid |
$1,661.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,678.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,961.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,564.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,449.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,250.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,622.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,864.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,202.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,333.05
|
| Rate for Payer: PHCS Commercial |
$4,637.28
|
| Rate for Payer: United Healthcare All Payer |
$4,250.84
|
|
