|
PLATE LCK TUB 4H 3.5*57
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE LCK TUB 6H 3.5*82
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE LCK TUB 6H 3.5*82
|
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
|
|
|
PLATE LCK TUB 8H 3.5*107
|
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 8H 3.5*107
|
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 L CONN 12H 235MM
|
Facility
|
OP
|
$2,967.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.25 |
| Max. Negotiated Rate |
$2,848.80 |
| Rate for Payer: Aetna Commercial |
$2,284.97
|
| Rate for Payer: Anthem Medicaid |
$1,020.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,314.65
|
| Rate for Payer: Cash Price |
$1,483.75
|
| Rate for Payer: Cigna Commercial |
$2,463.03
|
| Rate for Payer: First Health Commercial |
$2,819.12
|
| Rate for Payer: Humana Commercial |
$2,522.38
|
| Rate for Payer: Humana KY Medicaid |
$1,020.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,433.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,611.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,225.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,581.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,047.58
|
| Rate for Payer: PHCS Commercial |
$2,848.80
|
| Rate for Payer: United Healthcare All Payer |
$2,611.40
|
|
|
PLATE L CONN 12H 235MM
|
Facility
|
IP
|
$2,967.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.25 |
| Max. Negotiated Rate |
$2,848.80 |
| Rate for Payer: Aetna Commercial |
$2,284.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,314.65
|
| Rate for Payer: Cash Price |
$1,483.75
|
| Rate for Payer: Cigna Commercial |
$2,463.03
|
| Rate for Payer: First Health Commercial |
$2,819.12
|
| Rate for Payer: Humana Commercial |
$2,522.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,433.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,611.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,225.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,581.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,047.58
|
| Rate for Payer: PHCS Commercial |
$2,848.80
|
| Rate for Payer: United Healthcare All Payer |
$2,611.40
|
|
|
PLATE L CONN 17H 335MM LG
|
Facility
|
OP
|
$3,177.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.25 |
| Max. Negotiated Rate |
$3,050.40 |
| Rate for Payer: Aetna Commercial |
$2,446.68
|
| Rate for Payer: Anthem Medicaid |
$1,092.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,478.45
|
| Rate for Payer: Cash Price |
$1,588.75
|
| Rate for Payer: Cigna Commercial |
$2,637.32
|
| Rate for Payer: First Health Commercial |
$3,018.62
|
| Rate for Payer: Humana Commercial |
$2,700.88
|
| Rate for Payer: Humana KY Medicaid |
$1,092.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,103.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,605.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,344.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,114.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,796.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,383.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,542.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,764.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,192.47
|
| Rate for Payer: PHCS Commercial |
$3,050.40
|
| Rate for Payer: United Healthcare All Payer |
$2,796.20
|
|
|
PLATE L CONN 17H 335MM LG
|
Facility
|
IP
|
$3,177.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.25 |
| Max. Negotiated Rate |
$3,050.40 |
| Rate for Payer: Aetna Commercial |
$2,446.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,478.45
|
| Rate for Payer: Cash Price |
$1,588.75
|
| Rate for Payer: Cigna Commercial |
$2,637.32
|
| Rate for Payer: First Health Commercial |
$3,018.62
|
| Rate for Payer: Humana Commercial |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,605.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,344.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,796.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,383.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,542.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,764.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,192.47
|
| Rate for Payer: PHCS Commercial |
$3,050.40
|
| Rate for Payer: United Healthcare All Payer |
$2,796.20
|
|
|
PLATE L CONN 8H 155MM LG
|
Facility
|
IP
|
$2,967.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.25 |
| Max. Negotiated Rate |
$2,848.80 |
| Rate for Payer: Aetna Commercial |
$2,284.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,314.65
|
| Rate for Payer: Cash Price |
$1,483.75
|
| Rate for Payer: Cigna Commercial |
$2,463.03
|
| Rate for Payer: First Health Commercial |
$2,819.12
|
| Rate for Payer: Humana Commercial |
$2,522.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,433.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,611.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,225.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,581.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,047.58
|
| Rate for Payer: PHCS Commercial |
$2,848.80
|
| Rate for Payer: United Healthcare All Payer |
$2,611.40
|
|
|
PLATE L CONN 8H 155MM LG
|
Facility
|
OP
|
$2,967.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.25 |
| Max. Negotiated Rate |
$2,848.80 |
| Rate for Payer: Aetna Commercial |
$2,284.97
|
| Rate for Payer: Anthem Medicaid |
$1,020.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,314.65
|
| Rate for Payer: Cash Price |
$1,483.75
|
| Rate for Payer: Cigna Commercial |
$2,463.03
|
| Rate for Payer: First Health Commercial |
$2,819.12
|
| Rate for Payer: Humana Commercial |
$2,522.38
|
| Rate for Payer: Humana KY Medicaid |
$1,020.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,433.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,190.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$890.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,041.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,611.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,225.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,374.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,581.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,047.58
|
| Rate for Payer: PHCS Commercial |
$2,848.80
|
| Rate for Payer: United Healthcare All Payer |
$2,611.40
|
|
|
PLATE LCP 1/3 TUB 9H 105MM
|
Facility
|
IP
|
$1,998.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.69 |
| Max. Negotiated Rate |
$1,919.01 |
| Rate for Payer: Aetna Commercial |
$1,539.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,559.20
|
| Rate for Payer: Cash Price |
$999.49
|
| Rate for Payer: Cigna Commercial |
$1,659.15
|
| Rate for Payer: First Health Commercial |
$1,899.02
|
| Rate for Payer: Humana Commercial |
$1,699.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,639.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,475.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,759.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,499.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,599.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,739.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,379.29
|
| Rate for Payer: PHCS Commercial |
$1,919.01
|
| Rate for Payer: United Healthcare All Payer |
$1,759.09
|
|
|
PLATE LCP 1/3 TUB 9H 105MM
|
Facility
|
OP
|
$1,998.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.69 |
| Max. Negotiated Rate |
$1,919.01 |
| Rate for Payer: Aetna Commercial |
$1,539.21
|
| Rate for Payer: Anthem Medicaid |
$687.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,559.20
|
| Rate for Payer: Cash Price |
$999.49
|
| Rate for Payer: Cigna Commercial |
$1,659.15
|
| Rate for Payer: First Health Commercial |
$1,899.02
|
| Rate for Payer: Humana Commercial |
$1,699.12
|
| Rate for Payer: Humana KY Medicaid |
$687.45
|
| Rate for Payer: Kentucky WC Medicaid |
$694.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,639.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,475.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$701.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,759.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,499.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,599.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,739.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,379.29
|
| Rate for Payer: PHCS Commercial |
$1,919.01
|
| Rate for Payer: United Healthcare All Payer |
$1,759.09
|
|
|
PLATE LCP DIS HUM 3.5MM 6H R
|
Facility
|
IP
|
$8,648.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.45 |
| Max. Negotiated Rate |
$8,302.23 |
| Rate for Payer: Aetna Commercial |
$6,659.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.56
|
| Rate for Payer: Cash Price |
$4,324.08
|
| Rate for Payer: Cigna Commercial |
$7,177.97
|
| Rate for Payer: First Health Commercial |
$8,215.75
|
| Rate for Payer: Humana Commercial |
$7,350.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,610.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,486.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,918.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,523.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,967.23
|
| Rate for Payer: PHCS Commercial |
$8,302.23
|
| Rate for Payer: United Healthcare All Payer |
$7,610.38
|
|
|
PLATE LCP DIS HUM 3.5MM 6H R
|
Facility
|
OP
|
$8,648.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.45 |
| Max. Negotiated Rate |
$8,302.23 |
| Rate for Payer: Aetna Commercial |
$6,659.08
|
| Rate for Payer: Anthem Medicaid |
$2,974.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.56
|
| Rate for Payer: Cash Price |
$4,324.08
|
| Rate for Payer: Cigna Commercial |
$7,177.97
|
| Rate for Payer: First Health Commercial |
$8,215.75
|
| Rate for Payer: Humana Commercial |
$7,350.94
|
| Rate for Payer: Humana KY Medicaid |
$2,974.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,004.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,382.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,610.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,486.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,918.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,523.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,967.23
|
| Rate for Payer: PHCS Commercial |
$8,302.23
|
| Rate for Payer: United Healthcare All Payer |
$7,610.38
|
|
|
PLATE LCP LAT DIS FIB 3.5 5H R
|
Facility
|
OP
|
$4,445.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.51 |
| Max. Negotiated Rate |
$4,267.24 |
| Rate for Payer: Aetna Commercial |
$3,422.68
|
| Rate for Payer: Anthem Medicaid |
$1,528.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,467.13
|
| Rate for Payer: Cash Price |
$2,222.52
|
| Rate for Payer: Cigna Commercial |
$3,689.38
|
| Rate for Payer: First Health Commercial |
$4,222.79
|
| Rate for Payer: Humana Commercial |
$3,778.28
|
| Rate for Payer: Humana KY Medicaid |
$1,528.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,544.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,559.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,556.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,867.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.08
|
| Rate for Payer: PHCS Commercial |
$4,267.24
|
| Rate for Payer: United Healthcare All Payer |
$3,911.64
|
|
|
PLATE LCP LAT DIS FIB 3.5 5H R
|
Facility
|
IP
|
$4,445.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.51 |
| Max. Negotiated Rate |
$4,267.24 |
| Rate for Payer: Aetna Commercial |
$3,422.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,467.13
|
| Rate for Payer: Cash Price |
$2,222.52
|
| Rate for Payer: Cigna Commercial |
$3,689.38
|
| Rate for Payer: First Health Commercial |
$4,222.79
|
| Rate for Payer: Humana Commercial |
$3,778.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,556.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,867.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.08
|
| Rate for Payer: PHCS Commercial |
$4,267.24
|
| Rate for Payer: United Healthcare All Payer |
$3,911.64
|
|
|
PLATE LCP LAT DIS FIB 3.5 7H L
|
Facility
|
OP
|
$4,630.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.22 |
| Max. Negotiated Rate |
$4,445.51 |
| Rate for Payer: Aetna Commercial |
$3,565.67
|
| Rate for Payer: Anthem Medicaid |
$1,592.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,611.98
|
| Rate for Payer: Cash Price |
$2,315.37
|
| Rate for Payer: Cigna Commercial |
$3,843.51
|
| Rate for Payer: First Health Commercial |
$4,399.20
|
| Rate for Payer: Humana Commercial |
$3,936.13
|
| Rate for Payer: Humana KY Medicaid |
$1,592.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,608.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,797.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,417.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,624.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,075.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,473.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,704.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,028.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,195.21
|
| Rate for Payer: PHCS Commercial |
$4,445.51
|
| Rate for Payer: United Healthcare All Payer |
$4,075.05
|
|
|
PLATE LCP LAT DIS FIB 3.5 7H L
|
Facility
|
IP
|
$4,630.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.22 |
| Max. Negotiated Rate |
$4,445.51 |
| Rate for Payer: Aetna Commercial |
$3,565.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,611.98
|
| Rate for Payer: Cash Price |
$2,315.37
|
| Rate for Payer: Cigna Commercial |
$3,843.51
|
| Rate for Payer: First Health Commercial |
$4,399.20
|
| Rate for Payer: Humana Commercial |
$3,936.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,797.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,417.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,075.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,473.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,704.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,028.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,195.21
|
| Rate for Payer: PHCS Commercial |
$4,445.51
|
| Rate for Payer: United Healthcare All Payer |
$4,075.05
|
|
|
PLATE LCP M DS TB 3.5*116 L 4H
|
Facility
|
OP
|
$8,585.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.64 |
| Max. Negotiated Rate |
$8,242.03 |
| Rate for Payer: Aetna Commercial |
$6,610.80
|
| Rate for Payer: Anthem Medicaid |
$2,952.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,696.65
|
| Rate for Payer: Cash Price |
$4,292.72
|
| Rate for Payer: Cigna Commercial |
$7,125.92
|
| Rate for Payer: First Health Commercial |
$8,156.18
|
| Rate for Payer: Humana Commercial |
$7,297.63
|
| Rate for Payer: Humana KY Medicaid |
$2,952.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,040.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,336.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,439.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,868.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,469.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.96
|
| Rate for Payer: PHCS Commercial |
$8,242.03
|
| Rate for Payer: United Healthcare All Payer |
$7,555.20
|
|
|
PLATE LCP M DS TB 3.5*116 L 4H
|
Facility
|
IP
|
$8,585.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.64 |
| Max. Negotiated Rate |
$8,242.03 |
| Rate for Payer: Aetna Commercial |
$6,610.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,696.65
|
| Rate for Payer: Cash Price |
$4,292.72
|
| Rate for Payer: Cigna Commercial |
$7,125.92
|
| Rate for Payer: First Health Commercial |
$8,156.18
|
| Rate for Payer: Humana Commercial |
$7,297.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,040.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,336.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,555.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,439.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,868.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,469.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.96
|
| Rate for Payer: PHCS Commercial |
$8,242.03
|
| Rate for Payer: United Healthcare All Payer |
$7,555.20
|
|
|
PLATE LCP M DS TB 3.5*116 R 4H
|
Facility
|
OP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem Medicaid |
$3,744.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Humana KY Medicaid |
$3,744.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
|
PLATE LCP M DS TB 3.5*116 R 4H
|
Facility
|
IP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
|
PLATE LCP M DS TB 3.5*142 L 6H
|
Facility
|
OP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem Medicaid |
$3,744.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Humana KY Medicaid |
$3,744.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
|
PLATE LCP M DS TB 3.5*142 L 6H
|
Facility
|
IP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
