|
PLATE PRX FM LCK 9H 4.5*234M L
|
Facility
|
IP
|
$7,834.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.53 |
| Max. Negotiated Rate |
$7,521.42 |
| Rate for Payer: Humana Commercial |
$6,659.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,424.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,782.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,894.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,876.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,428.79
|
| Rate for Payer: PHCS Commercial |
$7,521.42
|
| Rate for Payer: United Healthcare All Payer |
$6,894.63
|
| Rate for Payer: Aetna Commercial |
$6,032.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,111.15
|
| Rate for Payer: Cash Price |
$3,917.41
|
| Rate for Payer: Cigna Commercial |
$6,502.89
|
| Rate for Payer: First Health Commercial |
$7,443.07
|
|
|
PLATE PRX FM LCK 9H 4.5*234M L
|
Facility
|
OP
|
$7,834.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.53 |
| Max. Negotiated Rate |
$7,521.42 |
| Rate for Payer: Aetna Commercial |
$6,032.80
|
| Rate for Payer: Anthem Medicaid |
$2,694.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,111.15
|
| Rate for Payer: Cash Price |
$3,917.41
|
| Rate for Payer: Cigna Commercial |
$6,502.89
|
| Rate for Payer: First Health Commercial |
$7,443.07
|
| Rate for Payer: Humana Commercial |
$6,659.59
|
| Rate for Payer: Humana KY Medicaid |
$2,694.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,721.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,424.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,782.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,748.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,894.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,876.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,428.79
|
| Rate for Payer: PHCS Commercial |
$7,521.42
|
| Rate for Payer: United Healthcare All Payer |
$6,894.63
|
|
|
PLATE PRX FM LCK 9H 4.5*234M R
|
Facility
|
IP
|
$7,834.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.53 |
| Max. Negotiated Rate |
$7,521.42 |
| Rate for Payer: Aetna Commercial |
$6,032.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,111.15
|
| Rate for Payer: Cash Price |
$3,917.41
|
| Rate for Payer: Cigna Commercial |
$6,502.89
|
| Rate for Payer: First Health Commercial |
$7,443.07
|
| Rate for Payer: Humana Commercial |
$6,659.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,424.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,782.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,894.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,876.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,428.79
|
| Rate for Payer: PHCS Commercial |
$7,521.42
|
| Rate for Payer: United Healthcare All Payer |
$6,894.63
|
|
|
PLATE PRX FM LCK 9H 4.5*234M R
|
Facility
|
OP
|
$7,834.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,018.53 |
| Max. Negotiated Rate |
$7,521.42 |
| Rate for Payer: Aetna Commercial |
$6,032.80
|
| Rate for Payer: Anthem Medicaid |
$2,694.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,111.15
|
| Rate for Payer: Cash Price |
$3,917.41
|
| Rate for Payer: Cigna Commercial |
$6,502.89
|
| Rate for Payer: First Health Commercial |
$7,443.07
|
| Rate for Payer: Humana Commercial |
$6,659.59
|
| Rate for Payer: Humana KY Medicaid |
$2,694.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,721.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,424.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,782.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,748.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,894.63
|
| Rate for Payer: Ohio Health Group HMO |
$5,876.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,566.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,018.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,428.79
|
| Rate for Payer: PHCS Commercial |
$7,521.42
|
| Rate for Payer: United Healthcare All Payer |
$6,894.63
|
|
|
PLATE PRX FM LK 4.5M 12 288M L
|
Facility
|
IP
|
$8,646.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.01 |
| Max. Negotiated Rate |
$8,300.35 |
| Rate for Payer: Aetna Commercial |
$6,657.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.04
|
| Rate for Payer: Cash Price |
$4,323.10
|
| Rate for Payer: Cigna Commercial |
$7,176.35
|
| Rate for Payer: First Health Commercial |
$8,213.89
|
| Rate for Payer: Humana Commercial |
$7,349.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,089.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,380.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,593.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,608.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,484.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.32
|
| Rate for Payer: PHCS Commercial |
$8,300.35
|
| Rate for Payer: United Healthcare All Payer |
$7,608.66
|
|
|
PLATE PRX FM LK 4.5M 12 288M L
|
Facility
|
OP
|
$8,646.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.01 |
| Max. Negotiated Rate |
$8,300.35 |
| Rate for Payer: Aetna Commercial |
$6,657.57
|
| Rate for Payer: Anthem Medicaid |
$2,973.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.04
|
| Rate for Payer: Cash Price |
$4,323.10
|
| Rate for Payer: Cigna Commercial |
$7,176.35
|
| Rate for Payer: First Health Commercial |
$8,213.89
|
| Rate for Payer: Humana Commercial |
$7,349.27
|
| Rate for Payer: Humana KY Medicaid |
$2,973.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,003.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,089.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,380.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,593.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,608.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,484.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.32
|
| Rate for Payer: PHCS Commercial |
$8,300.35
|
| Rate for Payer: United Healthcare All Payer |
$7,608.66
|
|
|
PLATE PRX HM LK 13H 3.5X216M L
|
Facility
|
OP
|
$8,478.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.25 |
| Max. Negotiated Rate |
$8,139.70 |
| Rate for Payer: Aetna Commercial |
$6,528.71
|
| Rate for Payer: Anthem Medicaid |
$2,915.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,613.50
|
| Rate for Payer: Cash Price |
$4,239.43
|
| Rate for Payer: Cigna Commercial |
$7,037.45
|
| Rate for Payer: First Health Commercial |
$8,054.91
|
| Rate for Payer: Humana Commercial |
$7,207.02
|
| Rate for Payer: Humana KY Medicaid |
$2,915.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,945.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,952.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,257.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,543.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,974.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,461.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,359.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,695.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,628.44
|
| Rate for Payer: PHCS Commercial |
$8,139.70
|
| Rate for Payer: United Healthcare All Payer |
$7,461.39
|
|
|
PLATE PRX HM LK 13H 3.5X216M L
|
Facility
|
IP
|
$8,478.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.25 |
| Max. Negotiated Rate |
$8,139.70 |
| Rate for Payer: Aetna Commercial |
$6,528.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,613.50
|
| Rate for Payer: Cash Price |
$4,239.43
|
| Rate for Payer: Cigna Commercial |
$7,037.45
|
| Rate for Payer: First Health Commercial |
$8,054.91
|
| Rate for Payer: Humana Commercial |
$7,207.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,952.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,257.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,543.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,461.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,359.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,695.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,628.44
|
| Rate for Payer: PHCS Commercial |
$8,139.70
|
| Rate for Payer: United Healthcare All Payer |
$7,461.39
|
|
|
PLATE PRX HUM LCK 3H 3.5X115 R
|
Facility
|
IP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
|
|
PLATE PRX HUM LCK 3H 3.5X115 R
|
Facility
|
OP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Humana KY Medicaid |
$2,690.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,718.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,744.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem Medicaid |
$2,690.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
|
|
PLATE PRX HUM LCK 3H 3.5X89 R
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE PRX HUM LCK 3H 3.5X89 R
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE PRX HUMLK 11H 3.5X191M L
|
Facility
|
OP
|
$8,330.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.94 |
| Max. Negotiated Rate |
$7,997.09 |
| Rate for Payer: Aetna Commercial |
$6,414.33
|
| Rate for Payer: Anthem Medicaid |
$2,864.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.63
|
| Rate for Payer: Cash Price |
$4,165.15
|
| Rate for Payer: Cigna Commercial |
$6,914.15
|
| Rate for Payer: First Health Commercial |
$7,913.78
|
| Rate for Payer: Humana Commercial |
$7,080.76
|
| Rate for Payer: Humana KY Medicaid |
$2,864.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,082.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,582.39
|
| Rate for Payer: PHCS Commercial |
$7,997.09
|
| Rate for Payer: United Healthcare All Payer |
$7,330.66
|
|
|
PLATE PRX HUMLK 11H 3.5X191M L
|
Facility
|
IP
|
$8,330.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.94 |
| Max. Negotiated Rate |
$7,997.09 |
| Rate for Payer: Aetna Commercial |
$6,414.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.63
|
| Rate for Payer: Cash Price |
$4,165.15
|
| Rate for Payer: Cigna Commercial |
$6,914.15
|
| Rate for Payer: First Health Commercial |
$7,913.78
|
| Rate for Payer: Humana Commercial |
$7,080.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,082.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,582.39
|
| Rate for Payer: PHCS Commercial |
$7,997.09
|
| Rate for Payer: United Healthcare All Payer |
$7,330.66
|
|
|
PLATE PRX HUM LK 3H 3.5X89M L
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE PRX HUM LK 3H 3.5X89M L
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE PRX HUM LK 5H 3.5X115M L
|
Facility
|
IP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
|
|
PLATE PRX HUM LK 5H 3.5X115M L
|
Facility
|
OP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem Medicaid |
$2,690.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Humana KY Medicaid |
$2,690.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,718.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,744.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
|
|
PLATE PRX HUM LK 7H 3.5X140M L
|
Facility
|
IP
|
$7,979.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.29 |
| Max. Negotiated Rate |
$7,660.00 |
| Rate for Payer: Aetna Commercial |
$6,143.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.75
|
| Rate for Payer: Cash Price |
$3,989.58
|
| Rate for Payer: Cigna Commercial |
$6,622.71
|
| Rate for Payer: First Health Commercial |
$7,580.21
|
| Rate for Payer: Humana Commercial |
$6,782.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.54
|
| Rate for Payer: PHCS Commercial |
$7,660.00
|
| Rate for Payer: United Healthcare All Payer |
$7,021.67
|
|
|
PLATE PRX HUM LK 7H 3.5X140M L
|
Facility
|
OP
|
$7,979.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.29 |
| Max. Negotiated Rate |
$7,660.00 |
| Rate for Payer: Aetna Commercial |
$6,143.96
|
| Rate for Payer: Anthem Medicaid |
$2,744.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.75
|
| Rate for Payer: Cash Price |
$3,989.58
|
| Rate for Payer: Cigna Commercial |
$6,622.71
|
| Rate for Payer: First Health Commercial |
$7,580.21
|
| Rate for Payer: Humana Commercial |
$6,782.29
|
| Rate for Payer: Humana KY Medicaid |
$2,744.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,799.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.54
|
| Rate for Payer: PHCS Commercial |
$7,660.00
|
| Rate for Payer: United Healthcare All Payer |
$7,021.67
|
|
|
PLATE PRX HUM LK 9H 3.5X165M L
|
Facility
|
IP
|
$7,979.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.29 |
| Max. Negotiated Rate |
$7,660.00 |
| Rate for Payer: Aetna Commercial |
$6,143.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.75
|
| Rate for Payer: Cash Price |
$3,989.58
|
| Rate for Payer: Cigna Commercial |
$6,622.71
|
| Rate for Payer: First Health Commercial |
$7,580.21
|
| Rate for Payer: Humana Commercial |
$6,782.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.54
|
| Rate for Payer: PHCS Commercial |
$7,660.00
|
| Rate for Payer: United Healthcare All Payer |
$7,021.67
|
|
|
PLATE PRX HUM LK 9H 3.5X165M L
|
Facility
|
OP
|
$7,979.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.29 |
| Max. Negotiated Rate |
$7,660.00 |
| Rate for Payer: Aetna Commercial |
$6,143.96
|
| Rate for Payer: Anthem Medicaid |
$2,744.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,223.75
|
| Rate for Payer: Cash Price |
$3,989.58
|
| Rate for Payer: Cigna Commercial |
$6,622.71
|
| Rate for Payer: First Health Commercial |
$7,580.21
|
| Rate for Payer: Humana Commercial |
$6,782.29
|
| Rate for Payer: Humana KY Medicaid |
$2,744.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,771.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,542.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,888.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,393.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,799.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,021.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,984.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,595.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,473.54
|
| Rate for Payer: PHCS Commercial |
$7,660.00
|
| Rate for Payer: United Healthcare All Payer |
$7,021.67
|
|
|
PLATE QUARTER-TUBULAR
|
Facility
|
OP
|
$1,149.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.46 |
| Max. Negotiated Rate |
$1,103.72 |
| Rate for Payer: Aetna Commercial |
$885.28
|
| Rate for Payer: Anthem Medicaid |
$395.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.77
|
| Rate for Payer: Cash Price |
$574.86
|
| Rate for Payer: Cigna Commercial |
$954.26
|
| Rate for Payer: First Health Commercial |
$1,092.22
|
| Rate for Payer: Humana Commercial |
$977.25
|
| Rate for Payer: Humana KY Medicaid |
$395.39
|
| Rate for Payer: Kentucky WC Medicaid |
$399.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.74
|
| Rate for Payer: Ohio Health Group HMO |
$862.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.41
|
| Rate for Payer: PHCS Commercial |
$1,103.72
|
| Rate for Payer: United Healthcare All Payer |
$1,011.74
|
|
|
PLATE QUARTER-TUBULAR
|
Facility
|
IP
|
$1,149.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.46 |
| Max. Negotiated Rate |
$1,103.72 |
| Rate for Payer: Aetna Commercial |
$885.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.77
|
| Rate for Payer: Cash Price |
$574.86
|
| Rate for Payer: Cigna Commercial |
$954.26
|
| Rate for Payer: First Health Commercial |
$1,092.22
|
| Rate for Payer: Humana Commercial |
$977.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.74
|
| Rate for Payer: Ohio Health Group HMO |
$862.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.41
|
| Rate for Payer: PHCS Commercial |
$1,103.72
|
| Rate for Payer: United Healthcare All Payer |
$1,011.74
|
|
|
PLATE QUARTER-TUBULAR 7H
|
Facility
|
OP
|
$1,572.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.47 |
| Max. Negotiated Rate |
$1,509.96 |
| Rate for Payer: Aetna Commercial |
$1,211.12
|
| Rate for Payer: Anthem Medicaid |
$540.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,226.85
|
| Rate for Payer: Cash Price |
$786.44
|
| Rate for Payer: Cigna Commercial |
$1,305.49
|
| Rate for Payer: First Health Commercial |
$1,494.24
|
| Rate for Payer: Humana Commercial |
$1,336.95
|
| Rate for Payer: Humana KY Medicaid |
$540.91
|
| Rate for Payer: Kentucky WC Medicaid |
$546.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,289.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,160.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$471.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$551.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,384.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,179.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$314.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$204.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$487.59
|
| Rate for Payer: PHCS Commercial |
$1,509.96
|
| Rate for Payer: United Healthcare All Payer |
$1,384.13
|
|
