|
PLATE COMP LCK 4.5MM 14 265MM
|
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 4.5MM 14 265MM
|
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 4.5MM 4 85MM
|
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 4.5MM 4 85MM
|
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 4.5MM 6 121MM
|
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 4.5MM 6 121MM
|
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 4.5MM 8 157MM
|
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 4.5MM 8 157MM
|
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 LK 3.5MM 10H 154MM
|
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 LK 3.5MM 10H 154MM
|
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 LK 3.5MM 12H 183MM
|
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 LK 3.5MM 12H 183MM
|
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 LK 3.5MM 4H 67MM
|
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 LK 3.5MM 4H 67MM
|
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 LK 3.5MM 6H 96MM
|
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 LK 3.5MM 6H 96MM
|
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 LK 3.5MM 7H 111MM
|
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 LK 3.5MM 7H 111MM
|
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
|
|
|
PLATE COMP LK 3.5MM 8H 125MM
|
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 LK 3.5MM 8H 125MM
|
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 LK 3.5MM 9H 140MM
|
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 LK 3.5MM 9H 140MM
|
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 COMPRESSION 1.3MM 6H
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE COMPRESSION 1.3MM 6H
|
Facility
|
OP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem Medicaid |
$1,136.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Humana KY Medicaid |
$1,136.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,148.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,159.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE COMPRESSION 2.0MM 4H
|
Facility
|
IP
|
$3,147.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.14 |
| Max. Negotiated Rate |
$3,021.24 |
| Rate for Payer: Aetna Commercial |
$2,423.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,454.75
|
| Rate for Payer: Cash Price |
$1,573.56
|
| Rate for Payer: Cigna Commercial |
$2,612.11
|
| Rate for Payer: First Health Commercial |
$2,989.76
|
| Rate for Payer: Humana Commercial |
$2,675.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,517.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,737.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.51
|
| Rate for Payer: PHCS Commercial |
$3,021.24
|
| Rate for Payer: United Healthcare All Payer |
$2,769.47
|
|
