|
PLATE COMP LCK 3.5MM 272MM 18H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE COMP LCK 3.5MM 301MM 16H
|
Facility
|
OP
|
$5,094.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.24 |
| Max. Negotiated Rate |
$4,890.36 |
| Rate for Payer: Aetna Commercial |
$3,922.47
|
| Rate for Payer: Anthem Medicaid |
$1,751.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.41
|
| Rate for Payer: Cash Price |
$2,547.06
|
| Rate for Payer: Cigna Commercial |
$4,228.12
|
| Rate for Payer: First Health Commercial |
$4,839.41
|
| Rate for Payer: Humana Commercial |
$4,330.00
|
| Rate for Payer: Humana KY Medicaid |
$1,751.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,769.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,177.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,787.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.94
|
| Rate for Payer: PHCS Commercial |
$4,890.36
|
| Rate for Payer: United Healthcare All Payer |
$4,482.83
|
|
|
PLATE COMP LCK 3.5MM 301MM 16H
|
Facility
|
IP
|
$5,094.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.24 |
| Max. Negotiated Rate |
$4,890.36 |
| Rate for Payer: Aetna Commercial |
$3,922.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.41
|
| Rate for Payer: Cash Price |
$2,547.06
|
| Rate for Payer: Cigna Commercial |
$4,228.12
|
| Rate for Payer: First Health Commercial |
$4,839.41
|
| Rate for Payer: Humana Commercial |
$4,330.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,177.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.83
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.94
|
| Rate for Payer: PHCS Commercial |
$4,890.36
|
| Rate for Payer: United Healthcare All Payer |
$4,482.83
|
|
|
PLATE COMP LCK 3.5MM 301MM 20H
|
Facility
|
OP
|
$5,142.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.81 |
| Max. Negotiated Rate |
$4,936.98 |
| Rate for Payer: Aetna Commercial |
$3,959.87
|
| Rate for Payer: Anthem Medicaid |
$1,768.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,011.30
|
| Rate for Payer: Cash Price |
$2,571.34
|
| Rate for Payer: Cigna Commercial |
$4,268.43
|
| Rate for Payer: First Health Commercial |
$4,885.56
|
| Rate for Payer: Humana Commercial |
$4,371.29
|
| Rate for Payer: Humana KY Medicaid |
$1,768.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,786.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,217.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,795.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,804.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,525.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,857.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,114.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,474.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,548.46
|
| Rate for Payer: PHCS Commercial |
$4,936.98
|
| Rate for Payer: United Healthcare All Payer |
$4,525.57
|
|
|
PLATE COMP LCK 3.5MM 301MM 20H
|
Facility
|
IP
|
$5,142.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.81 |
| Max. Negotiated Rate |
$4,936.98 |
| Rate for Payer: Aetna Commercial |
$3,959.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,011.30
|
| Rate for Payer: Cash Price |
$2,571.34
|
| Rate for Payer: Cigna Commercial |
$4,268.43
|
| Rate for Payer: First Health Commercial |
$4,885.56
|
| Rate for Payer: Humana Commercial |
$4,371.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,217.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,795.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,525.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,857.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,114.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,474.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,548.46
|
| Rate for Payer: PHCS Commercial |
$4,936.98
|
| Rate for Payer: United Healthcare All Payer |
$4,525.57
|
|
|
PLATE COMP LCK 3.5MM 330MM 22H
|
Facility
|
IP
|
$5,142.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.81 |
| Max. Negotiated Rate |
$4,936.98 |
| Rate for Payer: Aetna Commercial |
$3,959.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,011.30
|
| Rate for Payer: Cash Price |
$2,571.34
|
| Rate for Payer: Cigna Commercial |
$4,268.43
|
| Rate for Payer: First Health Commercial |
$4,885.56
|
| Rate for Payer: Humana Commercial |
$4,371.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,217.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,795.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,525.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,857.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,114.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,474.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,548.46
|
| Rate for Payer: PHCS Commercial |
$4,936.98
|
| Rate for Payer: United Healthcare All Payer |
$4,525.57
|
|
|
PLATE COMP LCK 3.5MM 330MM 22H
|
Facility
|
OP
|
$5,142.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,542.81 |
| Max. Negotiated Rate |
$4,936.98 |
| Rate for Payer: Aetna Commercial |
$3,959.87
|
| Rate for Payer: Anthem Medicaid |
$1,768.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,011.30
|
| Rate for Payer: Cash Price |
$2,571.34
|
| Rate for Payer: Cigna Commercial |
$4,268.43
|
| Rate for Payer: First Health Commercial |
$4,885.56
|
| Rate for Payer: Humana Commercial |
$4,371.29
|
| Rate for Payer: Humana KY Medicaid |
$1,768.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,786.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,217.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,795.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,804.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,525.57
|
| Rate for Payer: Ohio Health Group HMO |
$3,857.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,114.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,474.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,548.46
|
| Rate for Payer: PHCS Commercial |
$4,936.98
|
| Rate for Payer: United Healthcare All Payer |
$4,525.57
|
|
|
PLATE COMP LCK 3.5MM 336MM 18H
|
Facility
|
IP
|
$5,614.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.31 |
| Max. Negotiated Rate |
$5,389.79 |
| Rate for Payer: Aetna Commercial |
$4,323.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.20
|
| Rate for Payer: Cash Price |
$2,807.18
|
| Rate for Payer: Cigna Commercial |
$4,659.92
|
| Rate for Payer: First Health Commercial |
$5,333.64
|
| Rate for Payer: Humana Commercial |
$4,772.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,873.91
|
| Rate for Payer: PHCS Commercial |
$5,389.79
|
| Rate for Payer: United Healthcare All Payer |
$4,940.64
|
|
|
PLATE COMP LCK 3.5MM 336MM 18H
|
Facility
|
OP
|
$5,614.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,684.31 |
| Max. Negotiated Rate |
$5,389.79 |
| Rate for Payer: Aetna Commercial |
$4,323.06
|
| Rate for Payer: Anthem Medicaid |
$1,930.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,379.20
|
| Rate for Payer: Cash Price |
$2,807.18
|
| Rate for Payer: Cigna Commercial |
$4,659.92
|
| Rate for Payer: First Health Commercial |
$5,333.64
|
| Rate for Payer: Humana Commercial |
$4,772.21
|
| Rate for Payer: Humana KY Medicaid |
$1,930.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,950.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,603.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,143.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,684.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,969.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,940.64
|
| Rate for Payer: Ohio Health Group HMO |
$4,210.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,491.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,884.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,873.91
|
| Rate for Payer: PHCS Commercial |
$5,389.79
|
| Rate for Payer: United Healthcare All Payer |
$4,940.64
|
|
|
PLATE COMP LCK 3.5MM 372MM 20H
|
Facility
|
OP
|
$7,213.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.07 |
| Max. Negotiated Rate |
$6,925.02 |
| Rate for Payer: Aetna Commercial |
$5,554.44
|
| Rate for Payer: Anthem Medicaid |
$2,480.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,626.58
|
| Rate for Payer: Cash Price |
$3,606.78
|
| Rate for Payer: Cigna Commercial |
$5,987.25
|
| Rate for Payer: First Health Commercial |
$6,852.88
|
| Rate for Payer: Humana Commercial |
$6,131.53
|
| Rate for Payer: Humana KY Medicaid |
$2,480.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,505.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,915.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,323.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,530.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,347.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,410.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,770.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,275.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,977.36
|
| Rate for Payer: PHCS Commercial |
$6,925.02
|
| Rate for Payer: United Healthcare All Payer |
$6,347.93
|
|
|
PLATE COMP LCK 3.5MM 372MM 20H
|
Facility
|
IP
|
$7,213.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.07 |
| Max. Negotiated Rate |
$6,925.02 |
| Rate for Payer: Aetna Commercial |
$5,554.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,626.58
|
| Rate for Payer: Cash Price |
$3,606.78
|
| Rate for Payer: Cigna Commercial |
$5,987.25
|
| Rate for Payer: First Health Commercial |
$6,852.88
|
| Rate for Payer: Humana Commercial |
$6,131.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,915.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,323.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,347.93
|
| Rate for Payer: Ohio Health Group HMO |
$5,410.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,770.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,275.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,977.36
|
| Rate for Payer: PHCS Commercial |
$6,925.02
|
| Rate for Payer: United Healthcare All Payer |
$6,347.93
|
|
|
PLATE COMP LCK 3.5MM 408MM 22H
|
Facility
|
IP
|
$7,638.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.69 |
| Max. Negotiated Rate |
$7,333.41 |
| Rate for Payer: Aetna Commercial |
$5,882.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,958.40
|
| Rate for Payer: Cash Price |
$3,819.48
|
| Rate for Payer: Cigna Commercial |
$6,340.35
|
| Rate for Payer: First Health Commercial |
$7,257.02
|
| Rate for Payer: Humana Commercial |
$6,493.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,263.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,637.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,291.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,722.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,729.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,111.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,645.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,270.89
|
| Rate for Payer: PHCS Commercial |
$7,333.41
|
| Rate for Payer: United Healthcare All Payer |
$6,722.29
|
|
|
PLATE COMP LCK 3.5MM 408MM 22H
|
Facility
|
OP
|
$7,638.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,291.69 |
| Max. Negotiated Rate |
$7,333.41 |
| Rate for Payer: Aetna Commercial |
$5,882.01
|
| Rate for Payer: Anthem Medicaid |
$2,627.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,958.40
|
| Rate for Payer: Cash Price |
$3,819.48
|
| Rate for Payer: Cigna Commercial |
$6,340.35
|
| Rate for Payer: First Health Commercial |
$7,257.02
|
| Rate for Payer: Humana Commercial |
$6,493.12
|
| Rate for Payer: Humana KY Medicaid |
$2,627.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,653.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,263.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,637.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,291.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,679.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,722.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,729.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,111.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,645.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,270.89
|
| Rate for Payer: PHCS Commercial |
$7,333.41
|
| Rate for Payer: United Healthcare All Payer |
$6,722.29
|
|
|
PLATE COMP LCK 3.5MM 67MM 4H
|
Facility
|
OP
|
$3,040.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.19 |
| Max. Negotiated Rate |
$2,919.00 |
| Rate for Payer: Aetna Commercial |
$2,341.28
|
| Rate for Payer: Anthem Medicaid |
$1,045.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,371.68
|
| Rate for Payer: Cash Price |
$1,520.31
|
| Rate for Payer: Cigna Commercial |
$2,523.71
|
| Rate for Payer: First Health Commercial |
$2,888.59
|
| Rate for Payer: Humana Commercial |
$2,584.53
|
| Rate for Payer: Humana KY Medicaid |
$1,045.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,056.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,493.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,243.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$912.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,066.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,675.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,280.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,432.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,645.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,098.03
|
| Rate for Payer: PHCS Commercial |
$2,919.00
|
| Rate for Payer: United Healthcare All Payer |
$2,675.75
|
|
|
PLATE COMP LCK 3.5MM 67MM 4H
|
Facility
|
IP
|
$3,040.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.19 |
| Max. Negotiated Rate |
$2,919.00 |
| Rate for Payer: Aetna Commercial |
$2,341.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,371.68
|
| Rate for Payer: Cash Price |
$1,520.31
|
| Rate for Payer: Cigna Commercial |
$2,523.71
|
| Rate for Payer: First Health Commercial |
$2,888.59
|
| Rate for Payer: Humana Commercial |
$2,584.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,493.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,243.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$912.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,675.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,280.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,432.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,645.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,098.03
|
| Rate for Payer: PHCS Commercial |
$2,919.00
|
| Rate for Payer: United Healthcare All Payer |
$2,675.75
|
|
|
PLATE COMP LCK 3.5MM 85MM 4H
|
Facility
|
OP
|
$3,248.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.62 |
| Max. Negotiated Rate |
$3,118.80 |
| Rate for Payer: Aetna Commercial |
$2,501.54
|
| Rate for Payer: Anthem Medicaid |
$1,117.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,534.03
|
| Rate for Payer: Cash Price |
$1,624.38
|
| Rate for Payer: Cigna Commercial |
$2,696.46
|
| Rate for Payer: First Health Commercial |
$3,086.31
|
| Rate for Payer: Humana Commercial |
$2,761.44
|
| Rate for Payer: Humana KY Medicaid |
$1,117.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,128.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,139.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,858.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,599.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,826.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,241.64
|
| Rate for Payer: PHCS Commercial |
$3,118.80
|
| Rate for Payer: United Healthcare All Payer |
$2,858.90
|
|
|
PLATE COMP LCK 3.5MM 85MM 4H
|
Facility
|
IP
|
$3,248.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.62 |
| Max. Negotiated Rate |
$3,118.80 |
| Rate for Payer: Aetna Commercial |
$2,501.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,534.03
|
| Rate for Payer: Cash Price |
$1,624.38
|
| Rate for Payer: Cigna Commercial |
$2,696.46
|
| Rate for Payer: First Health Commercial |
$3,086.31
|
| Rate for Payer: Humana Commercial |
$2,761.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,663.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,397.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$974.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,858.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,599.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,826.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,241.64
|
| Rate for Payer: PHCS Commercial |
$3,118.80
|
| Rate for Payer: United Healthcare All Payer |
$2,858.90
|
|
|
PLATE COMP LCK 3.5MM 96MM 6H
|
Facility
|
OP
|
$3,179.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.81 |
| Max. Negotiated Rate |
$3,052.20 |
| Rate for Payer: Aetna Commercial |
$2,448.12
|
| Rate for Payer: Anthem Medicaid |
$1,093.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,479.92
|
| Rate for Payer: Cash Price |
$1,589.69
|
| Rate for Payer: Cigna Commercial |
$2,638.89
|
| Rate for Payer: First Health Commercial |
$3,020.41
|
| Rate for Payer: Humana Commercial |
$2,702.47
|
| Rate for Payer: Humana KY Medicaid |
$1,093.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,104.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,797.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,384.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,543.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,766.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,193.77
|
| Rate for Payer: PHCS Commercial |
$3,052.20
|
| Rate for Payer: United Healthcare All Payer |
$2,797.85
|
|
|
PLATE COMP LCK 3.5MM 96MM 6H
|
Facility
|
IP
|
$3,179.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.81 |
| Max. Negotiated Rate |
$3,052.20 |
| Rate for Payer: Aetna Commercial |
$2,448.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,479.92
|
| Rate for Payer: Cash Price |
$1,589.69
|
| Rate for Payer: Cigna Commercial |
$2,638.89
|
| Rate for Payer: First Health Commercial |
$3,020.41
|
| Rate for Payer: Humana Commercial |
$2,702.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,797.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,384.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,543.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,766.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,193.77
|
| Rate for Payer: PHCS Commercial |
$3,052.20
|
| Rate for Payer: United Healthcare All Payer |
$2,797.85
|
|
|
PLATE COMP LCK 4.5*444 24H
|
Facility
|
OP
|
$7,936.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.82 |
| Max. Negotiated Rate |
$7,618.64 |
| Rate for Payer: Aetna Commercial |
$6,110.78
|
| Rate for Payer: Anthem Medicaid |
$2,729.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,190.14
|
| Rate for Payer: Cash Price |
$3,968.04
|
| Rate for Payer: Cigna Commercial |
$6,586.95
|
| Rate for Payer: First Health Commercial |
$7,539.28
|
| Rate for Payer: Humana Commercial |
$6,745.67
|
| Rate for Payer: Humana KY Medicaid |
$2,729.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,507.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,856.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,983.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,952.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,348.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,904.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.90
|
| Rate for Payer: PHCS Commercial |
$7,618.64
|
| Rate for Payer: United Healthcare All Payer |
$6,983.75
|
|
|
PLATE COMP LCK 4.5*444 24H
|
Facility
|
IP
|
$7,936.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.82 |
| Max. Negotiated Rate |
$7,618.64 |
| Rate for Payer: Aetna Commercial |
$6,110.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,190.14
|
| Rate for Payer: Cash Price |
$3,968.04
|
| Rate for Payer: Cigna Commercial |
$6,586.95
|
| Rate for Payer: First Health Commercial |
$7,539.28
|
| Rate for Payer: Humana Commercial |
$6,745.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,507.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,856.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,983.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,952.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,348.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,904.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.90
|
| Rate for Payer: PHCS Commercial |
$7,618.64
|
| Rate for Payer: United Healthcare All Payer |
$6,983.75
|
|
|
PLATE COMP LCK 4.5MM 10 193MM
|
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 4.5MM 10 193MM
|
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 4.5MM 12 229MM
|
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 4.5MM 12 229MM
|
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
|
|
