|
PLATE NARROW LCK COMP 4.5 9H
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE NARROW LOCK COMP 4.5 4H
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem Medicaid |
$695.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Humana KY Medicaid |
$695.37
|
| Rate for Payer: Kentucky WC Medicaid |
$702.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.82
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
PLATE NARROW LOCK COMP 4.5 4H
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.86 |
| Max. Negotiated Rate |
$1,941.12 |
| Rate for Payer: Aetna Commercial |
$1,556.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.16
|
| Rate for Payer: Cash Price |
$1,011.00
|
| Rate for Payer: Cigna Commercial |
$1,678.26
|
| Rate for Payer: First Health Commercial |
$1,920.90
|
| Rate for Payer: Humana Commercial |
$1,718.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,779.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.82
|
| Rate for Payer: PHCS Commercial |
$1,941.12
|
| Rate for Payer: United Healthcare All Payer |
$1,779.36
|
|
|
PLATE NARROW LOCK COMP 4.5 5H
|
Facility
|
IP
|
$3,404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.52 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$2,621.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.12
|
| Rate for Payer: Cash Price |
$1,702.00
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: First Health Commercial |
$3,233.80
|
| Rate for Payer: Humana Commercial |
$2,893.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.24
|
| Rate for Payer: PHCS Commercial |
$3,267.84
|
| Rate for Payer: United Healthcare All Payer |
$2,995.52
|
|
|
PLATE NARROW LOCK COMP 4.5 5H
|
Facility
|
OP
|
$3,404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.52 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$2,621.08
|
| Rate for Payer: Anthem Medicaid |
$1,170.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.12
|
| Rate for Payer: Cash Price |
$1,702.00
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: First Health Commercial |
$3,233.80
|
| Rate for Payer: Humana Commercial |
$2,893.40
|
| Rate for Payer: Humana KY Medicaid |
$1,170.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.24
|
| Rate for Payer: PHCS Commercial |
$3,267.84
|
| Rate for Payer: United Healthcare All Payer |
$2,995.52
|
|
|
PLATE NCB FEM SHFT CVD 10H*210
|
Facility
|
OP
|
$5,168.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.84 |
| Max. Negotiated Rate |
$4,961.28 |
| Rate for Payer: Aetna Commercial |
$3,979.36
|
| Rate for Payer: Anthem Medicaid |
$1,777.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.04
|
| Rate for Payer: Cash Price |
$2,584.00
|
| Rate for Payer: Cigna Commercial |
$4,289.44
|
| Rate for Payer: First Health Commercial |
$4,909.60
|
| Rate for Payer: Humana Commercial |
$4,392.80
|
| Rate for Payer: Humana KY Medicaid |
$1,777.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,795.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,237.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,813.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,812.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,547.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,602.08
|
| Rate for Payer: PHCS Commercial |
$4,961.28
|
| Rate for Payer: United Healthcare All Payer |
$4,547.84
|
|
|
PLATE NCB FEM SHFT CVD 10H*210
|
Facility
|
IP
|
$5,168.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.84 |
| Max. Negotiated Rate |
$4,961.28 |
| Rate for Payer: Aetna Commercial |
$3,979.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.04
|
| Rate for Payer: Cash Price |
$2,584.00
|
| Rate for Payer: Cigna Commercial |
$4,289.44
|
| Rate for Payer: First Health Commercial |
$4,909.60
|
| Rate for Payer: Humana Commercial |
$4,392.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,237.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,813.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,547.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,602.08
|
| Rate for Payer: PHCS Commercial |
$4,961.28
|
| Rate for Payer: United Healthcare All Payer |
$4,547.84
|
|
|
PLATE NCB FEM SHFT CVD 12H*249
|
Facility
|
IP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
|
|
PLATE NCB FEM SHFT CVD 12H*249
|
Facility
|
OP
|
$5,336.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.68 |
| Max. Negotiated Rate |
$5,122.56 |
| Rate for Payer: Aetna Commercial |
$4,108.72
|
| Rate for Payer: Anthem Medicaid |
$1,835.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,162.08
|
| Rate for Payer: Cash Price |
$2,668.00
|
| Rate for Payer: Cigna Commercial |
$4,428.88
|
| Rate for Payer: First Health Commercial |
$5,069.20
|
| Rate for Payer: Humana Commercial |
$4,535.60
|
| Rate for Payer: Humana KY Medicaid |
$1,835.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,853.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,375.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,937.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,600.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,871.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,695.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,002.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,067.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,654.16
|
| Rate for Payer: PHCS Commercial |
$5,122.56
|
| Rate for Payer: United Healthcare All Payer |
$4,695.68
|
|
|
PLATE NCB FEM SHFT CVD 14H*289
|
Facility
|
OP
|
$5,476.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.88 |
| Max. Negotiated Rate |
$5,256.96 |
| Rate for Payer: Aetna Commercial |
$4,216.52
|
| Rate for Payer: Anthem Medicaid |
$1,883.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,271.28
|
| Rate for Payer: Cash Price |
$2,738.00
|
| Rate for Payer: Cigna Commercial |
$4,545.08
|
| Rate for Payer: First Health Commercial |
$5,202.20
|
| Rate for Payer: Humana Commercial |
$4,654.60
|
| Rate for Payer: Humana KY Medicaid |
$1,883.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,902.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,490.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,041.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,920.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,818.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,107.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,697.56
|
| Rate for Payer: PHCS Commercial |
$5,256.96
|
| Rate for Payer: United Healthcare All Payer |
$4,818.88
|
|
|
PLATE NCB FEM SHFT CVD 14H*289
|
Facility
|
IP
|
$5,476.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$711.88 |
| Max. Negotiated Rate |
$5,256.96 |
| Rate for Payer: Aetna Commercial |
$4,216.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,271.28
|
| Rate for Payer: Cash Price |
$2,738.00
|
| Rate for Payer: Cigna Commercial |
$4,545.08
|
| Rate for Payer: First Health Commercial |
$5,202.20
|
| Rate for Payer: Humana Commercial |
$4,654.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,490.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,041.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,642.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,818.88
|
| Rate for Payer: Ohio Health Group HMO |
$4,107.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,095.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$711.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,697.56
|
| Rate for Payer: PHCS Commercial |
$5,256.96
|
| Rate for Payer: United Healthcare All Payer |
$4,818.88
|
|
|
PLATE NCB PP DIST FEM L 278MM
|
Facility
|
OP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem Medicaid |
$3,403.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Humana KY Medicaid |
$3,403.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,437.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE NCB PP DIST FEM L 278MM
|
Facility
|
IP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE NCB PP PROX FEM L 285MM
|
Facility
|
OP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem Medicaid |
$3,403.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Humana KY Medicaid |
$3,403.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,437.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE NCB PP PROX FEM L 285MM
|
Facility
|
IP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE NCB PP PROX FEM L 324MM
|
Facility
|
IP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE NCB PP PROX FEM L 324MM
|
Facility
|
OP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Humana KY Medicaid |
$3,715.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,753.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Anthem Medicaid |
$3,715.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,790.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE NCB PP PROX FEM L 363MM
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE NCB PP PROX FEM L 363MM
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE NCB PP PROX FEM R L 285M
|
Facility
|
IP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE NCB PP PROX FEM R L 285M
|
Facility
|
OP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem Medicaid |
$3,403.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Humana KY Medicaid |
$3,403.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,437.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE NCB PP PROX FEM R L 324
|
Facility
|
OP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Anthem Medicaid |
$3,715.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Humana KY Medicaid |
$3,715.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,753.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,790.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE NCB PP PROX FEM R L 324
|
Facility
|
IP
|
$10,804.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,404.57 |
| Max. Negotiated Rate |
$10,372.22 |
| Rate for Payer: Aetna Commercial |
$8,319.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,427.43
|
| Rate for Payer: Cash Price |
$5,402.20
|
| Rate for Payer: Cigna Commercial |
$8,967.65
|
| Rate for Payer: First Health Commercial |
$10,264.18
|
| Rate for Payer: Humana Commercial |
$9,183.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,859.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,973.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,241.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,507.87
|
| Rate for Payer: Ohio Health Group HMO |
$8,103.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,160.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,404.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.36
|
| Rate for Payer: PHCS Commercial |
$10,372.22
|
| Rate for Payer: United Healthcare All Payer |
$9,507.87
|
|
|
PLATE NCB PP PROX FEM R L 363M
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE NCB PP PROX FEM R L 363M
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
