|
PLATE LOCK STERNAL 26H LADDER
|
Facility
|
OP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem Medicaid |
$2,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Humana KY Medicaid |
$2,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
PLATE LOCK STERNAL 26H LADDER
|
Facility
|
IP
|
$6,705.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,011.64 |
| Max. Negotiated Rate |
$6,437.26 |
| Rate for Payer: Aetna Commercial |
$5,163.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.27
|
| Rate for Payer: Cash Price |
$3,352.74
|
| Rate for Payer: Cigna Commercial |
$5,565.55
|
| Rate for Payer: First Health Commercial |
$6,370.21
|
| Rate for Payer: Humana Commercial |
$5,699.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.82
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,364.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,833.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,626.78
|
| Rate for Payer: PHCS Commercial |
$6,437.26
|
| Rate for Payer: United Healthcare All Payer |
$5,900.82
|
|
|
PLATE LOCK STERNAL 34H LADDER
|
Facility
|
OP
|
$7,931.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.34 |
| Max. Negotiated Rate |
$7,613.90 |
| Rate for Payer: Aetna Commercial |
$6,106.99
|
| Rate for Payer: Anthem Medicaid |
$2,727.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,186.30
|
| Rate for Payer: Cash Price |
$3,965.57
|
| Rate for Payer: Cigna Commercial |
$6,582.85
|
| Rate for Payer: First Health Commercial |
$7,534.59
|
| Rate for Payer: Humana Commercial |
$6,741.48
|
| Rate for Payer: Humana KY Medicaid |
$2,727.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,755.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,503.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,853.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,782.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,979.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,948.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,344.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,900.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,472.49
|
| Rate for Payer: PHCS Commercial |
$7,613.90
|
| Rate for Payer: United Healthcare All Payer |
$6,979.41
|
|
|
PLATE LOCK STERNAL 34H LADDER
|
Facility
|
IP
|
$7,931.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,379.34 |
| Max. Negotiated Rate |
$7,613.90 |
| Rate for Payer: Aetna Commercial |
$6,106.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,186.30
|
| Rate for Payer: Cash Price |
$3,965.57
|
| Rate for Payer: Cigna Commercial |
$6,582.85
|
| Rate for Payer: First Health Commercial |
$7,534.59
|
| Rate for Payer: Humana Commercial |
$6,741.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,503.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,853.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,379.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,979.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,948.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,344.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,900.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,472.49
|
| Rate for Payer: PHCS Commercial |
$7,613.90
|
| Rate for Payer: United Healthcare All Payer |
$6,979.41
|
|
|
PLATE LOCK STERNAL 4H ANGLE
|
Facility
|
OP
|
$4,043.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.12 |
| Max. Negotiated Rate |
$3,882.00 |
| Rate for Payer: Aetna Commercial |
$3,113.69
|
| Rate for Payer: Anthem Medicaid |
$1,390.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,154.12
|
| Rate for Payer: Cash Price |
$2,021.88
|
| Rate for Payer: Cigna Commercial |
$3,356.31
|
| Rate for Payer: First Health Commercial |
$3,841.56
|
| Rate for Payer: Humana Commercial |
$3,437.19
|
| Rate for Payer: Humana KY Medicaid |
$1,390.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,404.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,315.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,984.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,213.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,418.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,558.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,032.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,235.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,518.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,790.19
|
| Rate for Payer: PHCS Commercial |
$3,882.00
|
| Rate for Payer: United Healthcare All Payer |
$3,558.50
|
|
|
PLATE LOCK STERNAL 4H ANGLE
|
Facility
|
IP
|
$4,043.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,213.12 |
| Max. Negotiated Rate |
$3,882.00 |
| Rate for Payer: Aetna Commercial |
$3,113.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,154.12
|
| Rate for Payer: Cash Price |
$2,021.88
|
| Rate for Payer: Cigna Commercial |
$3,356.31
|
| Rate for Payer: First Health Commercial |
$3,841.56
|
| Rate for Payer: Humana Commercial |
$3,437.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,315.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,984.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,213.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,558.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,032.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,235.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,518.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,790.19
|
| Rate for Payer: PHCS Commercial |
$3,882.00
|
| Rate for Payer: United Healthcare All Payer |
$3,558.50
|
|
|
PLATE LOCK STERNAL 6H FOOTBALL
|
Facility
|
OP
|
$4,028.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.51 |
| Max. Negotiated Rate |
$3,867.24 |
| Rate for Payer: Aetna Commercial |
$3,101.85
|
| Rate for Payer: Anthem Medicaid |
$1,385.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,142.14
|
| Rate for Payer: Cash Price |
$2,014.19
|
| Rate for Payer: Cigna Commercial |
$3,343.56
|
| Rate for Payer: First Health Commercial |
$3,826.96
|
| Rate for Payer: Humana Commercial |
$3,424.12
|
| Rate for Payer: Humana KY Medicaid |
$1,385.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,399.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,303.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,972.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,208.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,413.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,544.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,021.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,222.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,504.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,779.58
|
| Rate for Payer: PHCS Commercial |
$3,867.24
|
| Rate for Payer: United Healthcare All Payer |
$3,544.97
|
|
|
PLATE LOCK STERNAL 6H FOOTBALL
|
Facility
|
IP
|
$4,028.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.51 |
| Max. Negotiated Rate |
$3,867.24 |
| Rate for Payer: Aetna Commercial |
$3,101.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,142.14
|
| Rate for Payer: Cash Price |
$2,014.19
|
| Rate for Payer: Cigna Commercial |
$3,343.56
|
| Rate for Payer: First Health Commercial |
$3,826.96
|
| Rate for Payer: Humana Commercial |
$3,424.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,303.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,972.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,208.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,544.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,021.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,222.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,504.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,779.58
|
| Rate for Payer: PHCS Commercial |
$3,867.24
|
| Rate for Payer: United Healthcare All Payer |
$3,544.97
|
|
|
PLATE LOCK STERNAL 8H LADDER
|
Facility
|
OP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem Medicaid |
$1,638.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Humana KY Medicaid |
$1,638.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LOCK STERNAL 8H LADDER
|
Facility
|
IP
|
$4,764.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,429.24 |
| Max. Negotiated Rate |
$4,573.56 |
| Rate for Payer: Aetna Commercial |
$3,668.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,716.01
|
| Rate for Payer: Cash Price |
$2,382.06
|
| Rate for Payer: Cigna Commercial |
$3,954.22
|
| Rate for Payer: First Health Commercial |
$4,525.91
|
| Rate for Payer: Humana Commercial |
$4,049.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,906.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,515.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,192.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,573.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,811.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,144.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,287.24
|
| Rate for Payer: PHCS Commercial |
$4,573.56
|
| Rate for Payer: United Healthcare All Payer |
$4,192.43
|
|
|
PLATE LOCK STERNAL 8H X
|
Facility
|
OP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem Medicaid |
$1,744.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Humana KY Medicaid |
$1,744.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,761.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,778.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE LOCK STERNAL 8H X
|
Facility
|
IP
|
$5,071.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,521.38 |
| Max. Negotiated Rate |
$4,868.40 |
| Rate for Payer: Aetna Commercial |
$3,904.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,955.57
|
| Rate for Payer: Cash Price |
$2,535.62
|
| Rate for Payer: Cigna Commercial |
$4,209.14
|
| Rate for Payer: First Health Commercial |
$4,817.69
|
| Rate for Payer: Humana Commercial |
$4,310.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,158.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,742.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,521.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,462.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,803.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,057.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,411.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,499.16
|
| Rate for Payer: PHCS Commercial |
$4,868.40
|
| Rate for Payer: United Healthcare All Payer |
$4,462.70
|
|
|
PLATE LOCK STERNAL 9H Y SHP
|
Facility
|
IP
|
$4,457.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.10 |
| Max. Negotiated Rate |
$4,278.72 |
| Rate for Payer: Aetna Commercial |
$3,431.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.46
|
| Rate for Payer: Cash Price |
$2,228.50
|
| Rate for Payer: Cigna Commercial |
$3,699.31
|
| Rate for Payer: First Health Commercial |
$4,234.15
|
| Rate for Payer: Humana Commercial |
$3,788.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,877.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,075.33
|
| Rate for Payer: PHCS Commercial |
$4,278.72
|
| Rate for Payer: United Healthcare All Payer |
$3,922.16
|
|
|
PLATE LOCK STERNAL 9H Y SHP
|
Facility
|
OP
|
$4,457.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,337.10 |
| Max. Negotiated Rate |
$4,278.72 |
| Rate for Payer: Aetna Commercial |
$3,431.89
|
| Rate for Payer: Anthem Medicaid |
$1,532.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,476.46
|
| Rate for Payer: Cash Price |
$2,228.50
|
| Rate for Payer: Cigna Commercial |
$3,699.31
|
| Rate for Payer: First Health Commercial |
$4,234.15
|
| Rate for Payer: Humana Commercial |
$3,788.45
|
| Rate for Payer: Humana KY Medicaid |
$1,532.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,548.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,654.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,289.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,337.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,563.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,922.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,342.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,565.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,877.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,075.33
|
| Rate for Payer: PHCS Commercial |
$4,278.72
|
| Rate for Payer: United Healthcare All Payer |
$3,922.16
|
|
|
PLATE LOCK THIRD TUB SS 12H
|
Facility
|
IP
|
$3,181.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.38 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.38
|
| Rate for Payer: Cash Price |
$1,590.62
|
| Rate for Payer: Cigna Commercial |
$2,640.44
|
| Rate for Payer: First Health Commercial |
$3,022.19
|
| Rate for Payer: Humana Commercial |
$2,704.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.06
|
| Rate for Payer: PHCS Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Payer |
$2,799.50
|
|
|
PLATE LOCK THIRD TUB SS 12H
|
Facility
|
OP
|
$3,181.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.38 |
| Max. Negotiated Rate |
$3,054.00 |
| Rate for Payer: Aetna Commercial |
$2,449.56
|
| Rate for Payer: Anthem Medicaid |
$1,094.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.38
|
| Rate for Payer: Cash Price |
$1,590.62
|
| Rate for Payer: Cigna Commercial |
$2,640.44
|
| Rate for Payer: First Health Commercial |
$3,022.19
|
| Rate for Payer: Humana Commercial |
$2,704.06
|
| Rate for Payer: Humana KY Medicaid |
$1,094.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,105.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,545.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,195.06
|
| Rate for Payer: PHCS Commercial |
$3,054.00
|
| Rate for Payer: United Healthcare All Payer |
$2,799.50
|
|
|
PLATE LOCK THIRD TUB SS 4H
|
Facility
|
OP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem Medicaid |
$755.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Humana KY Medicaid |
$755.81
|
| Rate for Payer: Kentucky WC Medicaid |
$763.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
PLATE LOCK THIRD TUB SS 4H
|
Facility
|
IP
|
$2,197.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.33 |
| Max. Negotiated Rate |
$2,109.84 |
| Rate for Payer: Aetna Commercial |
$1,692.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,714.24
|
| Rate for Payer: Cash Price |
$1,098.88
|
| Rate for Payer: Cigna Commercial |
$1,824.13
|
| Rate for Payer: First Health Commercial |
$2,087.86
|
| Rate for Payer: Humana Commercial |
$1,868.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,802.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,934.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,648.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,758.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,912.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,516.45
|
| Rate for Payer: PHCS Commercial |
$2,109.84
|
| Rate for Payer: United Healthcare All Payer |
$1,934.02
|
|
|
PLATE LOCK THIRD TUB SS 5H
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem Medicaid |
$754.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Humana KY Medicaid |
$754.17
|
| Rate for Payer: Kentucky WC Medicaid |
$761.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
PLATE LOCK THIRD TUB SS 5H
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$657.90 |
| Max. Negotiated Rate |
$2,105.28 |
| Rate for Payer: Aetna Commercial |
$1,688.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,710.54
|
| Rate for Payer: Cash Price |
$1,096.50
|
| Rate for Payer: Cigna Commercial |
$1,820.19
|
| Rate for Payer: First Health Commercial |
$2,083.35
|
| Rate for Payer: Humana Commercial |
$1,864.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,798.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,618.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$657.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,929.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,644.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,754.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,907.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,513.17
|
| Rate for Payer: PHCS Commercial |
$2,105.28
|
| Rate for Payer: United Healthcare All Payer |
$1,929.84
|
|
|
PLATE LOCK THIRD TUB SS 6H
|
Facility
|
OP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$883.50 |
| Max. Negotiated Rate |
$2,827.20 |
| Rate for Payer: Aetna Commercial |
$2,267.65
|
| Rate for Payer: Anthem Medicaid |
$1,012.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,297.10
|
| Rate for Payer: Cash Price |
$1,472.50
|
| Rate for Payer: Cigna Commercial |
$2,444.35
|
| Rate for Payer: First Health Commercial |
$2,797.75
|
| Rate for Payer: Humana Commercial |
$2,503.25
|
| Rate for Payer: Humana KY Medicaid |
$1,012.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,023.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,414.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,173.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,033.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,591.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,208.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,356.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,562.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,032.05
|
| Rate for Payer: PHCS Commercial |
$2,827.20
|
| Rate for Payer: United Healthcare All Payer |
$2,591.60
|
|
|
PLATE LOCK THIRD TUB SS 6H
|
Facility
|
IP
|
$2,945.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$883.50 |
| Max. Negotiated Rate |
$2,827.20 |
| Rate for Payer: Aetna Commercial |
$2,267.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,297.10
|
| Rate for Payer: Cash Price |
$1,472.50
|
| Rate for Payer: Cigna Commercial |
$2,444.35
|
| Rate for Payer: First Health Commercial |
$2,797.75
|
| Rate for Payer: Humana Commercial |
$2,503.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,414.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,173.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$883.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,591.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,208.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,356.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,562.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,032.05
|
| Rate for Payer: PHCS Commercial |
$2,827.20
|
| Rate for Payer: United Healthcare All Payer |
$2,591.60
|
|
|
PLATE LOCK THIRD TUB SS 7H
|
Facility
|
OP
|
$3,004.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.22 |
| Max. Negotiated Rate |
$2,883.90 |
| Rate for Payer: Aetna Commercial |
$2,313.13
|
| Rate for Payer: Anthem Medicaid |
$1,033.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,343.17
|
| Rate for Payer: Cash Price |
$1,502.03
|
| Rate for Payer: Cigna Commercial |
$2,493.37
|
| Rate for Payer: First Health Commercial |
$2,853.86
|
| Rate for Payer: Humana Commercial |
$2,553.45
|
| Rate for Payer: Humana KY Medicaid |
$1,033.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,043.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,463.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,217.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$901.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,053.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,643.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,253.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,403.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,613.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,072.80
|
| Rate for Payer: PHCS Commercial |
$2,883.90
|
| Rate for Payer: United Healthcare All Payer |
$2,643.57
|
|
|
PLATE LOCK THIRD TUB SS 7H
|
Facility
|
IP
|
$3,004.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.22 |
| Max. Negotiated Rate |
$2,883.90 |
| Rate for Payer: Aetna Commercial |
$2,313.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,343.17
|
| Rate for Payer: Cash Price |
$1,502.03
|
| Rate for Payer: Cigna Commercial |
$2,493.37
|
| Rate for Payer: First Health Commercial |
$2,853.86
|
| Rate for Payer: Humana Commercial |
$2,553.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,463.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,217.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$901.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,643.57
|
| Rate for Payer: Ohio Health Group HMO |
$2,253.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,403.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,613.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,072.80
|
| Rate for Payer: PHCS Commercial |
$2,883.90
|
| Rate for Payer: United Healthcare All Payer |
$2,643.57
|
|
|
PLATE LOCK THIRD TUB SS 8H
|
Facility
|
IP
|
$3,043.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$913.03 |
| Max. Negotiated Rate |
$2,921.70 |
| Rate for Payer: Aetna Commercial |
$2,343.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,373.88
|
| Rate for Payer: Cash Price |
$1,521.72
|
| Rate for Payer: Cigna Commercial |
$2,526.06
|
| Rate for Payer: First Health Commercial |
$2,891.27
|
| Rate for Payer: Humana Commercial |
$2,586.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,495.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,246.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$913.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,678.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,282.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,434.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,647.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,099.97
|
| Rate for Payer: PHCS Commercial |
$2,921.70
|
| Rate for Payer: United Healthcare All Payer |
$2,678.23
|
|
