|
PLATE PROX WDG 3MM TI LCK 6.5M
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
PLATE PROX WDG 3MM TI LCK 7.0M
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
PLATE PROX WDG 3MM TI LCK 7.0M
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
PLATE PRX FMLCK 12H 4.5*288M L
|
Facility
|
IP
|
$8,680.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.51 |
| Max. Negotiated Rate |
$8,333.64 |
| Rate for Payer: Aetna Commercial |
$6,684.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.09
|
| Rate for Payer: Cash Price |
$4,340.44
|
| Rate for Payer: Cigna Commercial |
$7,205.13
|
| Rate for Payer: First Health Commercial |
$8,246.84
|
| Rate for Payer: Humana Commercial |
$7,378.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,128.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.07
|
| Rate for Payer: PHCS Commercial |
$8,333.64
|
| Rate for Payer: United Healthcare All Payer |
$7,639.17
|
|
|
PLATE PRX FMLCK 12H 4.5*288M L
|
Facility
|
OP
|
$8,680.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.51 |
| Max. Negotiated Rate |
$8,333.64 |
| Rate for Payer: Aetna Commercial |
$6,684.28
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.09
|
| Rate for Payer: Cash Price |
$4,340.44
|
| Rate for Payer: Cigna Commercial |
$7,205.13
|
| Rate for Payer: First Health Commercial |
$8,246.84
|
| Rate for Payer: Humana Commercial |
$7,378.75
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,128.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.07
|
| Rate for Payer: PHCS Commercial |
$8,333.64
|
| Rate for Payer: United Healthcare All Payer |
$7,639.17
|
|
|
PLATE PRX FMLCK 12H 4.5*288M R
|
Facility
|
OP
|
$8,680.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.51 |
| Max. Negotiated Rate |
$8,333.64 |
| Rate for Payer: Aetna Commercial |
$6,684.28
|
| Rate for Payer: Anthem Medicaid |
$2,985.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.09
|
| Rate for Payer: Cash Price |
$4,340.44
|
| Rate for Payer: Cigna Commercial |
$7,205.13
|
| Rate for Payer: First Health Commercial |
$8,246.84
|
| Rate for Payer: Humana Commercial |
$7,378.75
|
| Rate for Payer: Humana KY Medicaid |
$2,985.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,045.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,128.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.07
|
| Rate for Payer: PHCS Commercial |
$8,333.64
|
| Rate for Payer: United Healthcare All Payer |
$7,639.17
|
|
|
PLATE PRX FMLCK 12H 4.5*288M R
|
Facility
|
IP
|
$8,680.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,128.51 |
| Max. Negotiated Rate |
$8,333.64 |
| Rate for Payer: Aetna Commercial |
$6,684.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,771.09
|
| Rate for Payer: Cash Price |
$4,340.44
|
| Rate for Payer: Cigna Commercial |
$7,205.13
|
| Rate for Payer: First Health Commercial |
$8,246.84
|
| Rate for Payer: Humana Commercial |
$7,378.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,118.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,406.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,604.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,639.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,510.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,736.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,128.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.07
|
| Rate for Payer: PHCS Commercial |
$8,333.64
|
| Rate for Payer: United Healthcare All Payer |
$7,639.17
|
|
|
PLATE PRX FMLCK 15H 4.5*342M L
|
Facility
|
OP
|
$9,152.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.82 |
| Max. Negotiated Rate |
$8,786.36 |
| Rate for Payer: Aetna Commercial |
$7,047.39
|
| Rate for Payer: Anthem Medicaid |
$3,147.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,138.92
|
| Rate for Payer: Cash Price |
$4,576.23
|
| Rate for Payer: Cigna Commercial |
$7,596.54
|
| Rate for Payer: First Health Commercial |
$8,694.84
|
| Rate for Payer: Humana Commercial |
$7,779.59
|
| Rate for Payer: Humana KY Medicaid |
$3,147.53
|
| Rate for Payer: Kentucky WC Medicaid |
$3,179.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,505.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,754.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,210.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,054.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,864.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.26
|
| Rate for Payer: PHCS Commercial |
$8,786.36
|
| Rate for Payer: United Healthcare All Payer |
$8,054.16
|
|
|
PLATE PRX FMLCK 15H 4.5*342M L
|
Facility
|
IP
|
$9,152.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,189.82 |
| Max. Negotiated Rate |
$8,786.36 |
| Rate for Payer: Aetna Commercial |
$7,047.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,138.92
|
| Rate for Payer: Cash Price |
$4,576.23
|
| Rate for Payer: Cigna Commercial |
$7,596.54
|
| Rate for Payer: First Health Commercial |
$8,694.84
|
| Rate for Payer: Humana Commercial |
$7,779.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,505.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,754.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,745.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,054.16
|
| Rate for Payer: Ohio Health Group HMO |
$6,864.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,189.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.26
|
| Rate for Payer: PHCS Commercial |
$8,786.36
|
| Rate for Payer: United Healthcare All Payer |
$8,054.16
|
|
|
PLATE PRX FMLCK 15H 4.5*342M R
|
Facility
|
OP
|
$9,103.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.51 |
| Max. Negotiated Rate |
$8,739.76 |
| Rate for Payer: Aetna Commercial |
$7,010.02
|
| Rate for Payer: Anthem Medicaid |
$3,130.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,101.06
|
| Rate for Payer: Cash Price |
$4,551.96
|
| Rate for Payer: Cigna Commercial |
$7,556.25
|
| Rate for Payer: First Health Commercial |
$8,648.72
|
| Rate for Payer: Humana Commercial |
$7,738.33
|
| Rate for Payer: Humana KY Medicaid |
$3,130.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,162.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,465.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,718.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,731.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,193.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,011.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,820.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,822.22
|
| Rate for Payer: PHCS Commercial |
$8,739.76
|
| Rate for Payer: United Healthcare All Payer |
$8,011.45
|
|
|
PLATE PRX FMLCK 15H 4.5*342M R
|
Facility
|
IP
|
$9,103.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,183.51 |
| Max. Negotiated Rate |
$8,739.76 |
| Rate for Payer: Aetna Commercial |
$7,010.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,101.06
|
| Rate for Payer: Cash Price |
$4,551.96
|
| Rate for Payer: Cigna Commercial |
$7,556.25
|
| Rate for Payer: First Health Commercial |
$8,648.72
|
| Rate for Payer: Humana Commercial |
$7,738.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,465.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,718.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,731.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,011.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,827.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,820.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,183.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,822.22
|
| Rate for Payer: PHCS Commercial |
$8,739.76
|
| Rate for Payer: United Healthcare All Payer |
$8,011.45
|
|
|
PLATE PRX FMLCK 18H 4.5*396M L
|
Facility
|
OP
|
$9,624.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.13 |
| Max. Negotiated Rate |
$9,239.08 |
| Rate for Payer: Anthem Medicaid |
$3,309.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,506.75
|
| Rate for Payer: Cash Price |
$4,812.02
|
| Rate for Payer: Cigna Commercial |
$7,987.95
|
| Rate for Payer: First Health Commercial |
$9,142.84
|
| Rate for Payer: Humana Commercial |
$8,180.43
|
| Rate for Payer: Humana KY Medicaid |
$3,309.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,343.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,891.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,102.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,376.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,469.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,983.45
|
| Rate for Payer: PHCS Commercial |
$9,239.08
|
| Rate for Payer: United Healthcare All Payer |
$8,469.16
|
| Rate for Payer: Aetna Commercial |
$7,410.51
|
|
|
PLATE PRX FMLCK 18H 4.5*396M L
|
Facility
|
IP
|
$9,624.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.13 |
| Max. Negotiated Rate |
$9,239.08 |
| Rate for Payer: Aetna Commercial |
$7,410.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,506.75
|
| Rate for Payer: Cash Price |
$4,812.02
|
| Rate for Payer: Cigna Commercial |
$7,987.95
|
| Rate for Payer: First Health Commercial |
$9,142.84
|
| Rate for Payer: Humana Commercial |
$8,180.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,891.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,102.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,469.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,983.45
|
| Rate for Payer: PHCS Commercial |
$9,239.08
|
| Rate for Payer: United Healthcare All Payer |
$8,469.16
|
|
|
PLATE PRX FMLCK 18H 4.5*396M R
|
Facility
|
OP
|
$9,561.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.01 |
| Max. Negotiated Rate |
$9,179.16 |
| Rate for Payer: Aetna Commercial |
$7,362.45
|
| Rate for Payer: Anthem Medicaid |
$3,288.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,458.06
|
| Rate for Payer: Cash Price |
$4,780.81
|
| Rate for Payer: Cigna Commercial |
$7,936.14
|
| Rate for Payer: First Health Commercial |
$9,083.54
|
| Rate for Payer: Humana Commercial |
$8,127.38
|
| Rate for Payer: Humana KY Medicaid |
$3,288.24
|
| Rate for Payer: Kentucky WC Medicaid |
$3,321.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,840.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,056.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,868.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,414.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,171.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,243.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,964.10
|
| Rate for Payer: PHCS Commercial |
$9,179.16
|
| Rate for Payer: United Healthcare All Payer |
$8,414.23
|
|
|
PLATE PRX FMLCK 18H 4.5*396M R
|
Facility
|
IP
|
$9,561.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.01 |
| Max. Negotiated Rate |
$9,179.16 |
| Rate for Payer: Aetna Commercial |
$7,362.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,458.06
|
| Rate for Payer: Cash Price |
$4,780.81
|
| Rate for Payer: Cigna Commercial |
$7,936.14
|
| Rate for Payer: First Health Commercial |
$9,083.54
|
| Rate for Payer: Humana Commercial |
$8,127.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,840.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,056.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,868.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,414.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,171.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,912.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,243.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,964.10
|
| Rate for Payer: PHCS Commercial |
$9,179.16
|
| Rate for Payer: United Healthcare All Payer |
$8,414.23
|
|
|
PLATE PRX FM LCK 2H 4.5*99MM R
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
PLATE PRX FM LCK 2H 4.5*99MM R
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
PLATE PRX FM LCK 4H 4.5*144M L
|
Facility
|
OP
|
$7,557.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.46 |
| Max. Negotiated Rate |
$7,255.11 |
| Rate for Payer: Aetna Commercial |
$5,819.21
|
| Rate for Payer: Anthem Medicaid |
$2,598.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,894.78
|
| Rate for Payer: Cash Price |
$3,778.70
|
| Rate for Payer: Cigna Commercial |
$6,272.65
|
| Rate for Payer: First Health Commercial |
$7,179.54
|
| Rate for Payer: Humana Commercial |
$6,423.80
|
| Rate for Payer: Humana KY Medicaid |
$2,598.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,625.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,197.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,577.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,267.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,651.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,650.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,668.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.80
|
| Rate for Payer: PHCS Commercial |
$7,255.11
|
| Rate for Payer: United Healthcare All Payer |
$6,650.52
|
|
|
PLATE PRX FM LCK 4H 4.5*144M L
|
Facility
|
IP
|
$7,557.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.46 |
| Max. Negotiated Rate |
$7,255.11 |
| Rate for Payer: Aetna Commercial |
$5,819.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,894.78
|
| Rate for Payer: Cash Price |
$3,778.70
|
| Rate for Payer: Cigna Commercial |
$6,272.65
|
| Rate for Payer: First Health Commercial |
$7,179.54
|
| Rate for Payer: Humana Commercial |
$6,423.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,197.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,577.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,267.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,650.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,668.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.80
|
| Rate for Payer: PHCS Commercial |
$7,255.11
|
| Rate for Payer: United Healthcare All Payer |
$6,650.52
|
|
|
PLATE PRX FM LCK 4H 4.5*144M R
|
Facility
|
IP
|
$7,557.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.46 |
| Max. Negotiated Rate |
$7,255.11 |
| Rate for Payer: Aetna Commercial |
$5,819.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,894.78
|
| Rate for Payer: Cash Price |
$3,778.70
|
| Rate for Payer: Cigna Commercial |
$6,272.65
|
| Rate for Payer: First Health Commercial |
$7,179.54
|
| Rate for Payer: Humana Commercial |
$6,423.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,197.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,577.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,267.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,650.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,668.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.80
|
| Rate for Payer: PHCS Commercial |
$7,255.11
|
| Rate for Payer: United Healthcare All Payer |
$6,650.52
|
|
|
PLATE PRX FM LCK 4H 4.5*144M R
|
Facility
|
OP
|
$7,557.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.46 |
| Max. Negotiated Rate |
$7,255.11 |
| Rate for Payer: Aetna Commercial |
$5,819.21
|
| Rate for Payer: Anthem Medicaid |
$2,598.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,894.78
|
| Rate for Payer: Cash Price |
$3,778.70
|
| Rate for Payer: Cigna Commercial |
$6,272.65
|
| Rate for Payer: First Health Commercial |
$7,179.54
|
| Rate for Payer: Humana Commercial |
$6,423.80
|
| Rate for Payer: Humana KY Medicaid |
$2,598.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,625.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,197.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,577.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,267.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,651.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,650.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,668.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,511.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$982.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,342.80
|
| Rate for Payer: PHCS Commercial |
$7,255.11
|
| Rate for Payer: United Healthcare All Payer |
$6,650.52
|
|
|
PLATE PRX FM LCK 6H 4.5*180M L
|
Facility
|
IP
|
$7,647.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.18 |
| Max. Negotiated Rate |
$7,341.66 |
| Rate for Payer: Aetna Commercial |
$5,888.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.10
|
| Rate for Payer: Cash Price |
$3,823.78
|
| Rate for Payer: Cigna Commercial |
$6,347.47
|
| Rate for Payer: First Health Commercial |
$7,265.18
|
| Rate for Payer: Humana Commercial |
$6,500.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,735.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,529.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$994.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,370.74
|
| Rate for Payer: PHCS Commercial |
$7,341.66
|
| Rate for Payer: United Healthcare All Payer |
$6,729.85
|
|
|
PLATE PRX FM LCK 6H 4.5*180M L
|
Facility
|
OP
|
$7,647.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.18 |
| Max. Negotiated Rate |
$7,341.66 |
| Rate for Payer: Aetna Commercial |
$5,888.62
|
| Rate for Payer: Anthem Medicaid |
$2,630.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.10
|
| Rate for Payer: Cash Price |
$3,823.78
|
| Rate for Payer: Cigna Commercial |
$6,347.47
|
| Rate for Payer: First Health Commercial |
$7,265.18
|
| Rate for Payer: Humana Commercial |
$6,500.43
|
| Rate for Payer: Humana KY Medicaid |
$2,630.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,735.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,529.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$994.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,370.74
|
| Rate for Payer: PHCS Commercial |
$7,341.66
|
| Rate for Payer: United Healthcare All Payer |
$6,729.85
|
|
|
PLATE PRX FM LCK 6H 4.5*180M R
|
Facility
|
IP
|
$7,647.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.18 |
| Max. Negotiated Rate |
$7,341.66 |
| Rate for Payer: Aetna Commercial |
$5,888.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.10
|
| Rate for Payer: Cash Price |
$3,823.78
|
| Rate for Payer: Cigna Commercial |
$6,347.47
|
| Rate for Payer: First Health Commercial |
$7,265.18
|
| Rate for Payer: Humana Commercial |
$6,500.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,735.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,529.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$994.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,370.74
|
| Rate for Payer: PHCS Commercial |
$7,341.66
|
| Rate for Payer: United Healthcare All Payer |
$6,729.85
|
|
|
PLATE PRX FM LCK 6H 4.5*180M R
|
Facility
|
OP
|
$7,647.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.18 |
| Max. Negotiated Rate |
$7,341.66 |
| Rate for Payer: Aetna Commercial |
$5,888.62
|
| Rate for Payer: Anthem Medicaid |
$2,630.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,965.10
|
| Rate for Payer: Cash Price |
$3,823.78
|
| Rate for Payer: Cigna Commercial |
$6,347.47
|
| Rate for Payer: First Health Commercial |
$7,265.18
|
| Rate for Payer: Humana Commercial |
$6,500.43
|
| Rate for Payer: Humana KY Medicaid |
$2,630.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,271.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,735.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,529.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$994.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,370.74
|
| Rate for Payer: PHCS Commercial |
$7,341.66
|
| Rate for Payer: United Healthcare All Payer |
$6,729.85
|
|
