|
PLATE MTP V2 5H L
|
Facility
|
OP
|
$9,415.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.06 |
| Max. Negotiated Rate |
$9,039.21 |
| Rate for Payer: Aetna Commercial |
$7,250.20
|
| Rate for Payer: Anthem Medicaid |
$3,238.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,344.36
|
| Rate for Payer: Cash Price |
$4,707.92
|
| Rate for Payer: Cigna Commercial |
$7,815.15
|
| Rate for Payer: First Health Commercial |
$8,945.05
|
| Rate for Payer: Humana Commercial |
$8,003.46
|
| Rate for Payer: Humana KY Medicaid |
$3,238.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,271.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,720.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,948.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,824.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,303.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,285.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,061.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,883.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,918.91
|
| Rate for Payer: PHCS Commercial |
$9,039.21
|
| Rate for Payer: United Healthcare All Payer |
$8,285.94
|
|
|
PLATE MTP VI T8 6H L
|
Facility
|
IP
|
$9,415.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.06 |
| Max. Negotiated Rate |
$9,039.21 |
| Rate for Payer: Aetna Commercial |
$7,250.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,344.36
|
| Rate for Payer: Cash Price |
$4,707.92
|
| Rate for Payer: Cigna Commercial |
$7,815.15
|
| Rate for Payer: First Health Commercial |
$8,945.05
|
| Rate for Payer: Humana Commercial |
$8,003.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,720.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,948.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,824.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,285.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,061.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,883.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,918.91
|
| Rate for Payer: PHCS Commercial |
$9,039.21
|
| Rate for Payer: United Healthcare All Payer |
$8,285.94
|
|
|
PLATE MTP VI T8 6H L
|
Facility
|
OP
|
$9,415.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.06 |
| Max. Negotiated Rate |
$9,039.21 |
| Rate for Payer: Aetna Commercial |
$7,250.20
|
| Rate for Payer: Anthem Medicaid |
$3,238.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,344.36
|
| Rate for Payer: Cash Price |
$4,707.92
|
| Rate for Payer: Cigna Commercial |
$7,815.15
|
| Rate for Payer: First Health Commercial |
$8,945.05
|
| Rate for Payer: Humana Commercial |
$8,003.46
|
| Rate for Payer: Humana KY Medicaid |
$3,238.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,271.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,720.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,948.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,824.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,303.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,285.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,061.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,883.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,224.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,918.91
|
| Rate for Payer: PHCS Commercial |
$9,039.21
|
| Rate for Payer: United Healthcare All Payer |
$8,285.94
|
|
|
PLATE MULTIFRAG 10 H 3.5MM
|
Facility
|
IP
|
$6,978.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.21 |
| Max. Negotiated Rate |
$6,699.38 |
| Rate for Payer: Aetna Commercial |
$5,373.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,443.25
|
| Rate for Payer: Cash Price |
$3,489.26
|
| Rate for Payer: Cigna Commercial |
$5,792.17
|
| Rate for Payer: First Health Commercial |
$6,629.59
|
| Rate for Payer: Humana Commercial |
$5,931.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,722.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,150.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,093.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,141.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,233.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,163.34
|
| Rate for Payer: PHCS Commercial |
$6,699.38
|
| Rate for Payer: United Healthcare All Payer |
$6,141.10
|
|
|
PLATE MULTIFRAG 10 H 3.5MM
|
Facility
|
OP
|
$6,978.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$907.21 |
| Max. Negotiated Rate |
$6,699.38 |
| Rate for Payer: Aetna Commercial |
$5,373.46
|
| Rate for Payer: Anthem Medicaid |
$2,399.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,443.25
|
| Rate for Payer: Cash Price |
$3,489.26
|
| Rate for Payer: Cigna Commercial |
$5,792.17
|
| Rate for Payer: First Health Commercial |
$6,629.59
|
| Rate for Payer: Humana Commercial |
$5,931.74
|
| Rate for Payer: Humana KY Medicaid |
$2,399.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,424.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,722.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,150.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,093.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,448.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,141.10
|
| Rate for Payer: Ohio Health Group HMO |
$5,233.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,395.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$907.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,163.34
|
| Rate for Payer: PHCS Commercial |
$6,699.38
|
| Rate for Payer: United Healthcare All Payer |
$6,141.10
|
|
|
PLATE MULTIFRAG 14 H 3.5MM
|
Facility
|
OP
|
$7,791.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.83 |
| Max. Negotiated Rate |
$7,479.37 |
| Rate for Payer: Aetna Commercial |
$5,999.08
|
| Rate for Payer: Anthem Medicaid |
$2,679.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.99
|
| Rate for Payer: Cash Price |
$3,895.50
|
| Rate for Payer: Cigna Commercial |
$6,466.54
|
| Rate for Payer: First Health Commercial |
$7,401.46
|
| Rate for Payer: Humana Commercial |
$6,622.36
|
| Rate for Payer: Humana KY Medicaid |
$2,679.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,388.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,733.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,856.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,843.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.21
|
| Rate for Payer: PHCS Commercial |
$7,479.37
|
| Rate for Payer: United Healthcare All Payer |
$6,856.09
|
|
|
PLATE MULTIFRAG 14 H 3.5MM
|
Facility
|
IP
|
$7,791.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.83 |
| Max. Negotiated Rate |
$7,479.37 |
| Rate for Payer: Aetna Commercial |
$5,999.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.99
|
| Rate for Payer: Cash Price |
$3,895.50
|
| Rate for Payer: Cigna Commercial |
$6,466.54
|
| Rate for Payer: First Health Commercial |
$7,401.46
|
| Rate for Payer: Humana Commercial |
$6,622.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,388.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,856.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,843.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,415.21
|
| Rate for Payer: PHCS Commercial |
$7,479.37
|
| Rate for Payer: United Healthcare All Payer |
$6,856.09
|
|
|
PLATE MULTIFRAG 6 H 3.5MM
|
Facility
|
IP
|
$5,103.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$4,898.96 |
| Rate for Payer: Aetna Commercial |
$3,929.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,980.40
|
| Rate for Payer: Cash Price |
$2,551.54
|
| Rate for Payer: Cigna Commercial |
$4,235.56
|
| Rate for Payer: First Health Commercial |
$4,847.93
|
| Rate for Payer: Humana Commercial |
$4,337.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,184.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,490.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,827.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.95
|
| Rate for Payer: PHCS Commercial |
$4,898.96
|
| Rate for Payer: United Healthcare All Payer |
$4,490.71
|
|
|
PLATE MULTIFRAG 6 H 3.5MM
|
Facility
|
OP
|
$5,103.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$4,898.96 |
| Rate for Payer: Aetna Commercial |
$3,929.37
|
| Rate for Payer: Anthem Medicaid |
$1,754.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,980.40
|
| Rate for Payer: Cash Price |
$2,551.54
|
| Rate for Payer: Cigna Commercial |
$4,235.56
|
| Rate for Payer: First Health Commercial |
$4,847.93
|
| Rate for Payer: Humana Commercial |
$4,337.62
|
| Rate for Payer: Humana KY Medicaid |
$1,754.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,772.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,184.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,790.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,490.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,827.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.95
|
| Rate for Payer: PHCS Commercial |
$4,898.96
|
| Rate for Payer: United Healthcare All Payer |
$4,490.71
|
|
|
PLATE MULTIFRAG H 4 3.5MM
|
Facility
|
OP
|
$4,963.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.31 |
| Max. Negotiated Rate |
$4,765.39 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,871.88
|
| Rate for Payer: Cash Price |
$2,481.98
|
| Rate for Payer: Cigna Commercial |
$4,120.08
|
| Rate for Payer: First Health Commercial |
$4,715.75
|
| Rate for Payer: Humana Commercial |
$4,219.36
|
| Rate for Payer: Humana KY Medicaid |
$1,707.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,724.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,070.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,489.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,741.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,722.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.82
|
| Rate for Payer: PHCS Commercial |
$4,765.39
|
| Rate for Payer: United Healthcare All Payer |
$4,368.28
|
| Rate for Payer: Aetna Commercial |
$3,822.24
|
| Rate for Payer: Anthem Medicaid |
$1,707.10
|
|
|
PLATE MULTIFRAG H 4 3.5MM
|
Facility
|
IP
|
$4,963.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$645.31 |
| Max. Negotiated Rate |
$4,765.39 |
| Rate for Payer: Aetna Commercial |
$3,822.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,871.88
|
| Rate for Payer: Cash Price |
$2,481.98
|
| Rate for Payer: Cigna Commercial |
$4,120.08
|
| Rate for Payer: First Health Commercial |
$4,715.75
|
| Rate for Payer: Humana Commercial |
$4,219.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,070.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,663.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,489.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,722.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$992.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$645.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,538.82
|
| Rate for Payer: PHCS Commercial |
$4,765.39
|
| Rate for Payer: United Healthcare All Payer |
$4,368.28
|
|
|
PLATE MULTI FRAGMENT
|
Facility
|
IP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE MULTI FRAGMENT
|
Facility
|
OP
|
$1,158.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.61 |
| Max. Negotiated Rate |
$1,112.19 |
| Rate for Payer: Aetna Commercial |
$892.07
|
| Rate for Payer: Anthem Medicaid |
$398.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$903.65
|
| Rate for Payer: Cash Price |
$579.26
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: First Health Commercial |
$1,100.60
|
| Rate for Payer: Humana Commercial |
$984.75
|
| Rate for Payer: Humana KY Medicaid |
$398.42
|
| Rate for Payer: Kentucky WC Medicaid |
$402.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,019.51
|
| Rate for Payer: Ohio Health Group HMO |
$868.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.14
|
| Rate for Payer: PHCS Commercial |
$1,112.19
|
| Rate for Payer: United Healthcare All Payer |
$1,019.51
|
|
|
PLATE NARROW 4.5*106 5H
|
Facility
|
OP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Humana KY Medicaid |
$629.04
|
| Rate for Payer: Kentucky WC Medicaid |
$635.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5*106 5H
|
Facility
|
IP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE NARROW 4.5*124 6H
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*124 6H
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*142 7H
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*142 7H
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*160 8H
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*160 8H
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*178 9H
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*178 9H
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE NARROW 4.5*196 10H
|
Facility
|
OP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem Medicaid |
$706.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
| Rate for Payer: Humana KY Medicaid |
$706.98
|
| Rate for Payer: Kentucky WC Medicaid |
$714.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$721.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
|
|
PLATE NARROW 4.5*196 10H
|
Facility
|
IP
|
$2,055.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.25 |
| Max. Negotiated Rate |
$1,973.55 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,685.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,517.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$616.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,809.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$411.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$637.29
|
| Rate for Payer: PHCS Commercial |
$1,973.55
|
| Rate for Payer: United Healthcare All Payer |
$1,809.09
|
| Rate for Payer: Aetna Commercial |
$1,582.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,603.51
|
| Rate for Payer: Cash Price |
$1,027.89
|
| Rate for Payer: Cigna Commercial |
$1,706.30
|
| Rate for Payer: First Health Commercial |
$1,952.99
|
| Rate for Payer: Humana Commercial |
$1,747.41
|
|
