|
PLATE LK CLAV SP DS 84M R SHT
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SP DS 84M R SHT
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP 109MM L
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP 109MM L
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP 109MM R
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP 109MM R
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP 10H 121M L
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP 10H 121M L
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP 8H 97M L
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK CLAV SUP 8H 97M L
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK CLAV SUP DIS 84 L SHT
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV SUP DIS 84 L SHT
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK DIS CLAV INF 81MM
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK DIS CLAV INF 81MM
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK HUM PLD 11H 157MM L
|
Facility
|
OP
|
$8,003.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.08 |
| Max. Negotiated Rate |
$7,683.46 |
| Rate for Payer: Aetna Commercial |
$6,162.77
|
| Rate for Payer: Anthem Medicaid |
$2,752.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,242.81
|
| Rate for Payer: Cash Price |
$4,001.80
|
| Rate for Payer: Cigna Commercial |
$6,642.99
|
| Rate for Payer: First Health Commercial |
$7,603.42
|
| Rate for Payer: Humana Commercial |
$6,803.06
|
| Rate for Payer: Humana KY Medicaid |
$2,752.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,780.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,562.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,906.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,807.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,043.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,402.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,963.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,522.48
|
| Rate for Payer: PHCS Commercial |
$7,683.46
|
| Rate for Payer: United Healthcare All Payer |
$7,043.17
|
|
|
PLATE LK HUM PLD 11H 157MM L
|
Facility
|
IP
|
$8,003.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.08 |
| Max. Negotiated Rate |
$7,683.46 |
| Rate for Payer: Aetna Commercial |
$6,162.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,242.81
|
| Rate for Payer: Cash Price |
$4,001.80
|
| Rate for Payer: Cigna Commercial |
$6,642.99
|
| Rate for Payer: First Health Commercial |
$7,603.42
|
| Rate for Payer: Humana Commercial |
$6,803.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,562.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,906.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,043.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,402.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,963.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,522.48
|
| Rate for Payer: PHCS Commercial |
$7,683.46
|
| Rate for Payer: United Healthcare All Payer |
$7,043.17
|
|
|
PLATE LK HUM PLD 11H 157MM R
|
Facility
|
IP
|
$8,003.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.08 |
| Max. Negotiated Rate |
$7,683.46 |
| Rate for Payer: Aetna Commercial |
$6,162.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,242.81
|
| Rate for Payer: Cash Price |
$4,001.80
|
| Rate for Payer: Cigna Commercial |
$6,642.99
|
| Rate for Payer: First Health Commercial |
$7,603.42
|
| Rate for Payer: Humana Commercial |
$6,803.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,562.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,906.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,043.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,402.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,963.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,522.48
|
| Rate for Payer: PHCS Commercial |
$7,683.46
|
| Rate for Payer: United Healthcare All Payer |
$7,043.17
|
|
|
PLATE LK HUM PLD 11H 157MM R
|
Facility
|
OP
|
$8,003.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.08 |
| Max. Negotiated Rate |
$7,683.46 |
| Rate for Payer: Aetna Commercial |
$6,162.77
|
| Rate for Payer: Anthem Medicaid |
$2,752.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,242.81
|
| Rate for Payer: Cash Price |
$4,001.80
|
| Rate for Payer: Cigna Commercial |
$6,642.99
|
| Rate for Payer: First Health Commercial |
$7,603.42
|
| Rate for Payer: Humana Commercial |
$6,803.06
|
| Rate for Payer: Humana KY Medicaid |
$2,752.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,780.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,562.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,906.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,807.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,043.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,402.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,963.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,522.48
|
| Rate for Payer: PHCS Commercial |
$7,683.46
|
| Rate for Payer: United Healthcare All Payer |
$7,043.17
|
|
|
PLATE LK HUM PLD 15H 207MM L
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE LK HUM PLD 15H 207MM L
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE LK HUM PLD 15H 207MM R
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE LK HUM PLD 15H 207MM R
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE LK HUM PLD 5H 80MM L
|
Facility
|
OP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem Medicaid |
$2,404.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Humana KY Medicaid |
$2,404.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,452.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE LK HUM PLD 5H 80MM L
|
Facility
|
IP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE LK HUM PLD 5H 80MM R
|
Facility
|
OP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem Medicaid |
$2,404.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Humana KY Medicaid |
$2,404.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,452.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
