|
PLATE LCK STERNAL 4H STR T=2.0
|
Facility
|
IP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LCK STERNAL 4H STR T=2.0
|
Facility
|
OP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem Medicaid |
$1,638.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Humana KY Medicaid |
$1,638.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LCK STERNAL 6H STR T=1.8
|
Facility
|
OP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem Medicaid |
$1,463.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Humana KY Medicaid |
$1,463.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,478.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,492.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE LCK STERNAL 6H STR T=1.8
|
Facility
|
IP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE LCK STERNAL 7H JLT T=1.8
|
Facility
|
IP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LCK STERNAL 7H JLT T=1.8
|
Facility
|
OP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem Medicaid |
$1,638.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Humana KY Medicaid |
$1,638.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LCK STERNAL 8H STR T=1.8
|
Facility
|
OP
|
$4,457.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.10 |
| Max. Negotiated Rate |
$4,278.72 |
| Rate for Payer: Aetna Commercial |
$3,431.89
|
| Rate for Payer: Anthem Medicaid |
$1,532.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.46
|
| Rate for Payer: Cash Price |
$2,228.50
|
| Rate for Payer: Cigna Commercial |
$3,699.31
|
| Rate for Payer: First Health Commercial |
$4,234.15
|
| Rate for Payer: Humana Commercial |
$3,788.45
|
| Rate for Payer: Humana KY Medicaid |
$1,532.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,877.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,075.33
|
| Rate for Payer: PHCS Commercial |
$4,278.72
|
| Rate for Payer: United Healthcare All Payer |
$3,922.16
|
|
|
PLATE LCK STERNAL 8H STR T=1.8
|
Facility
|
IP
|
$4,457.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.10 |
| Max. Negotiated Rate |
$4,278.72 |
| Rate for Payer: Aetna Commercial |
$3,431.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.46
|
| Rate for Payer: Cash Price |
$2,228.50
|
| Rate for Payer: Cigna Commercial |
$3,699.31
|
| Rate for Payer: First Health Commercial |
$4,234.15
|
| Rate for Payer: Humana Commercial |
$3,788.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,877.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,075.33
|
| Rate for Payer: PHCS Commercial |
$4,278.72
|
| Rate for Payer: United Healthcare All Payer |
$3,922.16
|
|
|
PLATE LCK STRNAL 10H BDY T=1.5
|
Facility
|
IP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LCK STRNAL 10H BDY T=1.5
|
Facility
|
OP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem Medicaid |
$1,638.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Humana KY Medicaid |
$1,638.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LCK STRNAL 10H BDY T=1.8
|
Facility
|
OP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem Medicaid |
$1,638.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Humana KY Medicaid |
$1,638.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
|
|
PLATE LCK STRNAL 10H BDY T=1.8
|
Facility
|
IP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LCK STRNAL 10H STR T=1.8
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE LCK STRNAL 10H STR T=1.8
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE LCK STRNAL 20H STR T=1.0
|
Facility
|
OP
|
$5,611.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.38 |
| Max. Negotiated Rate |
$5,386.80 |
| Rate for Payer: Aetna Commercial |
$4,320.66
|
| Rate for Payer: Anthem Medicaid |
$1,929.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,376.77
|
| Rate for Payer: Cash Price |
$2,805.62
|
| Rate for Payer: Cigna Commercial |
$4,657.34
|
| Rate for Payer: First Health Commercial |
$5,330.69
|
| Rate for Payer: Humana Commercial |
$4,769.56
|
| Rate for Payer: Humana KY Medicaid |
$1,929.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,949.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,601.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,141.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,968.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,937.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,208.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,489.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,881.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,871.76
|
| Rate for Payer: PHCS Commercial |
$5,386.80
|
| Rate for Payer: United Healthcare All Payer |
$4,937.90
|
|
|
PLATE LCK STRNAL 20H STR T=1.0
|
Facility
|
IP
|
$5,611.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.38 |
| Max. Negotiated Rate |
$5,386.80 |
| Rate for Payer: Aetna Commercial |
$4,320.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,376.77
|
| Rate for Payer: Cash Price |
$2,805.62
|
| Rate for Payer: Cigna Commercial |
$4,657.34
|
| Rate for Payer: First Health Commercial |
$5,330.69
|
| Rate for Payer: Humana Commercial |
$4,769.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,601.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,141.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,683.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,937.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,208.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,489.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,881.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,871.76
|
| Rate for Payer: PHCS Commercial |
$5,386.80
|
| Rate for Payer: United Healthcare All Payer |
$4,937.90
|
|
|
PLATE LCK STRNAL 20H STR T=2.0
|
Facility
|
OP
|
$7,384.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.31 |
| Max. Negotiated Rate |
$7,089.00 |
| Rate for Payer: Aetna Commercial |
$5,685.97
|
| Rate for Payer: Anthem Medicaid |
$2,539.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.82
|
| Rate for Payer: Cash Price |
$3,692.19
|
| Rate for Payer: Cigna Commercial |
$6,129.04
|
| Rate for Payer: First Health Commercial |
$7,015.16
|
| Rate for Payer: Humana Commercial |
$6,276.72
|
| Rate for Payer: Humana KY Medicaid |
$2,539.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,565.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,055.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,590.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,498.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,538.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,907.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,424.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,095.22
|
| Rate for Payer: PHCS Commercial |
$7,089.00
|
| Rate for Payer: United Healthcare All Payer |
$6,498.25
|
|
|
PLATE LCK STRNAL 20H STR T=2.0
|
Facility
|
IP
|
$7,384.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.31 |
| Max. Negotiated Rate |
$7,089.00 |
| Rate for Payer: Aetna Commercial |
$5,685.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.82
|
| Rate for Payer: Cash Price |
$3,692.19
|
| Rate for Payer: Cigna Commercial |
$6,129.04
|
| Rate for Payer: First Health Commercial |
$7,015.16
|
| Rate for Payer: Humana Commercial |
$6,276.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,055.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,498.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,538.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,907.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,424.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,095.22
|
| Rate for Payer: PHCS Commercial |
$7,089.00
|
| Rate for Payer: United Healthcare All Payer |
$6,498.25
|
|
|
PLATE LCK STRNL 14H LDDR 53*19
|
Facility
|
OP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem Medicaid |
$2,386.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Humana KY Medicaid |
$2,386.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,410.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE LCK STRNL 14H LDDR 53*19
|
Facility
|
IP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE LCK STRNL 18H LDDR 53*19
|
Facility
|
IP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE LCK STRNL 18H LDDR 53*19
|
Facility
|
OP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem Medicaid |
$2,386.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Humana KY Medicaid |
$2,386.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,410.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE LCK TUB 10H 3.5*133
|
Facility
|
IP
|
$1,968.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.64 |
| Max. Negotiated Rate |
$1,890.05 |
| Rate for Payer: Aetna Commercial |
$1,515.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,535.66
|
| Rate for Payer: Cash Price |
$984.40
|
| Rate for Payer: Cigna Commercial |
$1,634.10
|
| Rate for Payer: First Health Commercial |
$1,870.36
|
| Rate for Payer: Humana Commercial |
$1,673.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,614.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,732.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,476.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.47
|
| Rate for Payer: PHCS Commercial |
$1,890.05
|
| Rate for Payer: United Healthcare All Payer |
$1,732.54
|
|
|
PLATE LCK TUB 10H 3.5*133
|
Facility
|
OP
|
$1,968.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.64 |
| Max. Negotiated Rate |
$1,890.05 |
| Rate for Payer: Aetna Commercial |
$1,515.98
|
| Rate for Payer: Anthem Medicaid |
$677.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,535.66
|
| Rate for Payer: Cash Price |
$984.40
|
| Rate for Payer: Cigna Commercial |
$1,634.10
|
| Rate for Payer: First Health Commercial |
$1,870.36
|
| Rate for Payer: Humana Commercial |
$1,673.48
|
| Rate for Payer: Humana KY Medicaid |
$677.07
|
| Rate for Payer: Kentucky WC Medicaid |
$683.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,614.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,732.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,476.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.47
|
| Rate for Payer: PHCS Commercial |
$1,890.05
|
| Rate for Payer: United Healthcare All Payer |
$1,732.54
|
|
|
PLATE LCK TUB 4H 3.5*57
|
Facility
|
OP
|
$1,919.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.82 |
| Max. Negotiated Rate |
$1,842.62 |
| Rate for Payer: Aetna Commercial |
$1,477.94
|
| Rate for Payer: Anthem Medicaid |
$660.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.13
|
| Rate for Payer: Cash Price |
$959.70
|
| Rate for Payer: Cigna Commercial |
$1,593.10
|
| Rate for Payer: First Health Commercial |
$1,823.43
|
| Rate for Payer: Humana Commercial |
$1,631.49
|
| Rate for Payer: Humana KY Medicaid |
$660.08
|
| Rate for Payer: Kentucky WC Medicaid |
$666.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,535.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.39
|
| Rate for Payer: PHCS Commercial |
$1,842.62
|
| Rate for Payer: United Healthcare All Payer |
$1,689.07
|
|
