|
PLATE SM UTILITY 2.7MM
|
Facility
|
OP
|
$5,492.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.04 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$4,229.32
|
| Rate for Payer: Anthem Medicaid |
$1,888.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,284.24
|
| Rate for Payer: Cash Price |
$2,746.31
|
| Rate for Payer: Cigna Commercial |
$4,558.87
|
| Rate for Payer: First Health Commercial |
$5,217.99
|
| Rate for Payer: Humana Commercial |
$4,668.73
|
| Rate for Payer: Humana KY Medicaid |
$1,888.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,926.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.71
|
| Rate for Payer: PHCS Commercial |
$5,272.92
|
| Rate for Payer: United Healthcare All Payer |
$4,833.51
|
|
|
PLATE SPIDER 16MM
|
Facility
|
OP
|
$1,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.73 |
| Max. Negotiated Rate |
$1,652.16 |
| Rate for Payer: Aetna Commercial |
$1,325.17
|
| Rate for Payer: Anthem Medicaid |
$591.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.38
|
| Rate for Payer: Cash Price |
$860.50
|
| Rate for Payer: Cigna Commercial |
$1,428.43
|
| Rate for Payer: First Health Commercial |
$1,634.95
|
| Rate for Payer: Humana Commercial |
$1,462.85
|
| Rate for Payer: Humana KY Medicaid |
$591.85
|
| Rate for Payer: Kentucky WC Medicaid |
$597.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,514.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.51
|
| Rate for Payer: PHCS Commercial |
$1,652.16
|
| Rate for Payer: United Healthcare All Payer |
$1,514.48
|
|
|
PLATE SPIDER 16MM
|
Facility
|
IP
|
$1,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.73 |
| Max. Negotiated Rate |
$1,652.16 |
| Rate for Payer: Aetna Commercial |
$1,325.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.38
|
| Rate for Payer: Cash Price |
$860.50
|
| Rate for Payer: Cigna Commercial |
$1,428.43
|
| Rate for Payer: First Health Commercial |
$1,634.95
|
| Rate for Payer: Humana Commercial |
$1,462.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,514.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.51
|
| Rate for Payer: PHCS Commercial |
$1,652.16
|
| Rate for Payer: United Healthcare All Payer |
$1,514.48
|
|
|
PLATE SPIDER 20MM
|
Facility
|
OP
|
$1,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.73 |
| Max. Negotiated Rate |
$1,652.16 |
| Rate for Payer: Aetna Commercial |
$1,325.17
|
| Rate for Payer: Anthem Medicaid |
$591.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.38
|
| Rate for Payer: Cash Price |
$860.50
|
| Rate for Payer: Cigna Commercial |
$1,428.43
|
| Rate for Payer: First Health Commercial |
$1,634.95
|
| Rate for Payer: Humana Commercial |
$1,462.85
|
| Rate for Payer: Humana KY Medicaid |
$591.85
|
| Rate for Payer: Kentucky WC Medicaid |
$597.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$603.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,514.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.51
|
| Rate for Payer: PHCS Commercial |
$1,652.16
|
| Rate for Payer: United Healthcare All Payer |
$1,514.48
|
|
|
PLATE SPIDER 20MM
|
Facility
|
IP
|
$1,721.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.73 |
| Max. Negotiated Rate |
$1,652.16 |
| Rate for Payer: Aetna Commercial |
$1,325.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,342.38
|
| Rate for Payer: Cash Price |
$860.50
|
| Rate for Payer: Cigna Commercial |
$1,428.43
|
| Rate for Payer: First Health Commercial |
$1,634.95
|
| Rate for Payer: Humana Commercial |
$1,462.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,411.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,270.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,514.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,290.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$223.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$533.51
|
| Rate for Payer: PHCS Commercial |
$1,652.16
|
| Rate for Payer: United Healthcare All Payer |
$1,514.48
|
|
|
PLATE SPIDER LRG FRAG 20MM
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem Medicaid |
$656.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Humana KY Medicaid |
$656.85
|
| Rate for Payer: Kentucky WC Medicaid |
$663.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
PLATE SPIDER LRG FRAG 20MM
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.30 |
| Max. Negotiated Rate |
$1,833.60 |
| Rate for Payer: Aetna Commercial |
$1,470.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.80
|
| Rate for Payer: Cash Price |
$955.00
|
| Rate for Payer: Cigna Commercial |
$1,585.30
|
| Rate for Payer: First Health Commercial |
$1,814.50
|
| Rate for Payer: Humana Commercial |
$1,623.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.10
|
| Rate for Payer: PHCS Commercial |
$1,833.60
|
| Rate for Payer: United Healthcare All Payer |
$1,680.80
|
|
|
PLATE SPIDER OFFSET
|
Facility
|
IP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.48
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE SPIDER OFFSET
|
Facility
|
OP
|
$1,159.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$150.75 |
| Max. Negotiated Rate |
$1,113.22 |
| Rate for Payer: Aetna Commercial |
$892.89
|
| Rate for Payer: Anthem Medicaid |
$398.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$904.49
|
| Rate for Payer: Cash Price |
$579.80
|
| Rate for Payer: Cigna Commercial |
$962.47
|
| Rate for Payer: First Health Commercial |
$1,101.62
|
| Rate for Payer: Humana Commercial |
$985.66
|
| Rate for Payer: Humana KY Medicaid |
$398.79
|
| Rate for Payer: Kentucky WC Medicaid |
$402.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$950.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$855.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,020.45
|
| Rate for Payer: Ohio Health Group HMO |
$869.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$231.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$150.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$359.48
|
| Rate for Payer: PHCS Commercial |
$1,113.22
|
| Rate for Payer: United Healthcare All Payer |
$1,020.45
|
|
|
PLATE SPIDER OFFST LG FRAG 25M
|
Facility
|
OP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.66 |
| Max. Negotiated Rate |
$1,806.72 |
| Rate for Payer: Anthem Medicaid |
$647.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.96
|
| Rate for Payer: Cash Price |
$941.00
|
| Rate for Payer: Cigna Commercial |
$1,562.06
|
| Rate for Payer: First Health Commercial |
$1,787.90
|
| Rate for Payer: Humana Commercial |
$1,599.70
|
| Rate for Payer: Humana KY Medicaid |
$647.22
|
| Rate for Payer: Kentucky WC Medicaid |
$653.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,543.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,656.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.42
|
| Rate for Payer: PHCS Commercial |
$1,806.72
|
| Rate for Payer: United Healthcare All Payer |
$1,656.16
|
| Rate for Payer: Aetna Commercial |
$1,449.14
|
|
|
PLATE SPIDER OFFST LG FRAG 25M
|
Facility
|
IP
|
$1,882.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.66 |
| Max. Negotiated Rate |
$1,806.72 |
| Rate for Payer: Aetna Commercial |
$1,449.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.96
|
| Rate for Payer: Cash Price |
$941.00
|
| Rate for Payer: Cigna Commercial |
$1,562.06
|
| Rate for Payer: First Health Commercial |
$1,787.90
|
| Rate for Payer: Humana Commercial |
$1,599.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,543.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,656.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,411.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.42
|
| Rate for Payer: PHCS Commercial |
$1,806.72
|
| Rate for Payer: United Healthcare All Payer |
$1,656.16
|
|
|
PLATE SPOON 5 HOLE 100MM
|
Facility
|
IP
|
$3,505.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$3,365.62 |
| Rate for Payer: Aetna Commercial |
$2,699.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.56
|
| Rate for Payer: Cash Price |
$1,752.92
|
| Rate for Payer: Cigna Commercial |
$2,909.86
|
| Rate for Payer: First Health Commercial |
$3,330.56
|
| Rate for Payer: Humana Commercial |
$2,979.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,085.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.81
|
| Rate for Payer: PHCS Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Payer |
$3,085.15
|
|
|
PLATE SPOON 5 HOLE 100MM
|
Facility
|
OP
|
$3,505.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.76 |
| Max. Negotiated Rate |
$3,365.62 |
| Rate for Payer: Aetna Commercial |
$2,699.50
|
| Rate for Payer: Anthem Medicaid |
$1,205.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.56
|
| Rate for Payer: Cash Price |
$1,752.92
|
| Rate for Payer: Cigna Commercial |
$2,909.86
|
| Rate for Payer: First Health Commercial |
$3,330.56
|
| Rate for Payer: Humana Commercial |
$2,979.97
|
| Rate for Payer: Humana KY Medicaid |
$1,205.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,085.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.81
|
| Rate for Payer: PHCS Commercial |
$3,365.62
|
| Rate for Payer: United Healthcare All Payer |
$3,085.15
|
|
|
PLATE SPOON 6 HOLE 120MM
|
Facility
|
IP
|
$3,333.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.37 |
| Max. Negotiated Rate |
$3,200.30 |
| Rate for Payer: Aetna Commercial |
$2,566.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.25
|
| Rate for Payer: Cash Price |
$1,666.83
|
| Rate for Payer: Cigna Commercial |
$2,766.93
|
| Rate for Payer: First Health Commercial |
$3,166.97
|
| Rate for Payer: Humana Commercial |
$2,833.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,733.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,460.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,933.61
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.43
|
| Rate for Payer: PHCS Commercial |
$3,200.30
|
| Rate for Payer: United Healthcare All Payer |
$2,933.61
|
|
|
PLATE SPOON 6 HOLE 120MM
|
Facility
|
OP
|
$3,333.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$433.37 |
| Max. Negotiated Rate |
$3,200.30 |
| Rate for Payer: Aetna Commercial |
$2,566.91
|
| Rate for Payer: Anthem Medicaid |
$1,146.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,600.25
|
| Rate for Payer: Cash Price |
$1,666.83
|
| Rate for Payer: Cigna Commercial |
$2,766.93
|
| Rate for Payer: First Health Commercial |
$3,166.97
|
| Rate for Payer: Humana Commercial |
$2,833.60
|
| Rate for Payer: Humana KY Medicaid |
$1,146.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,158.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,733.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,460.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,000.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,169.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,933.61
|
| Rate for Payer: Ohio Health Group HMO |
$2,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$666.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$433.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,033.43
|
| Rate for Payer: PHCS Commercial |
$3,200.30
|
| Rate for Payer: United Healthcare All Payer |
$2,933.61
|
|
|
PLATE SS 2 HOLE
|
Facility
|
IP
|
$5,323.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.09 |
| Max. Negotiated Rate |
$5,110.80 |
| Rate for Payer: Aetna Commercial |
$4,099.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,152.52
|
| Rate for Payer: Cash Price |
$2,661.88
|
| Rate for Payer: Cigna Commercial |
$4,418.71
|
| Rate for Payer: First Health Commercial |
$5,057.56
|
| Rate for Payer: Humana Commercial |
$4,525.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,365.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,928.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,597.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,684.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,992.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.36
|
| Rate for Payer: PHCS Commercial |
$5,110.80
|
| Rate for Payer: United Healthcare All Payer |
$4,684.90
|
|
|
PLATE SS 2 HOLE
|
Facility
|
OP
|
$5,323.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.09 |
| Max. Negotiated Rate |
$5,110.80 |
| Rate for Payer: Aetna Commercial |
$4,099.29
|
| Rate for Payer: Anthem Medicaid |
$1,830.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,152.52
|
| Rate for Payer: Cash Price |
$2,661.88
|
| Rate for Payer: Cigna Commercial |
$4,418.71
|
| Rate for Payer: First Health Commercial |
$5,057.56
|
| Rate for Payer: Humana Commercial |
$4,525.19
|
| Rate for Payer: Humana KY Medicaid |
$1,830.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,849.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,365.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,928.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,597.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,867.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,684.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,992.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.36
|
| Rate for Payer: PHCS Commercial |
$5,110.80
|
| Rate for Payer: United Healthcare All Payer |
$4,684.90
|
|
|
PLATE STANDARD 95 10 SLOT
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
PLATE STANDARD 95 10 SLOT
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
PLATE STANDARD 95 12 SLOT
|
Facility
|
IP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
PLATE STANDARD 95 12 SLOT
|
Facility
|
OP
|
$4,471.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$581.30 |
| Max. Negotiated Rate |
$4,292.64 |
| Rate for Payer: Aetna Commercial |
$3,443.06
|
| Rate for Payer: Anthem Medicaid |
$1,537.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,487.77
|
| Rate for Payer: Cash Price |
$2,235.75
|
| Rate for Payer: Cigna Commercial |
$3,711.34
|
| Rate for Payer: First Health Commercial |
$4,247.92
|
| Rate for Payer: Humana Commercial |
$3,800.78
|
| Rate for Payer: Humana KY Medicaid |
$1,537.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,553.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,666.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,299.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,341.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,568.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,934.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,353.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$894.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$581.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,386.16
|
| Rate for Payer: PHCS Commercial |
$4,292.64
|
| Rate for Payer: United Healthcare All Payer |
$3,934.92
|
|
|
PLATE STANDARD 95 14 SLOT
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
PLATE STANDARD 95 14 SLOT
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
PLATE STANDARD 95 6 SLOT
|
Facility
|
IP
|
$4,055.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.15 |
| Max. Negotiated Rate |
$3,892.80 |
| Rate for Payer: Humana Commercial |
$3,446.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,325.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,992.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,568.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,041.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,257.05
|
| Rate for Payer: PHCS Commercial |
$3,892.80
|
| Rate for Payer: United Healthcare All Payer |
$3,568.40
|
| Rate for Payer: Aetna Commercial |
$3,122.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.90
|
| Rate for Payer: Cash Price |
$2,027.50
|
| Rate for Payer: Cigna Commercial |
$3,365.65
|
| Rate for Payer: First Health Commercial |
$3,852.25
|
|
|
PLATE STANDARD 95 6 SLOT
|
Facility
|
OP
|
$4,055.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.15 |
| Max. Negotiated Rate |
$3,892.80 |
| Rate for Payer: Aetna Commercial |
$3,122.35
|
| Rate for Payer: Anthem Medicaid |
$1,394.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,162.90
|
| Rate for Payer: Cash Price |
$2,027.50
|
| Rate for Payer: Cigna Commercial |
$3,365.65
|
| Rate for Payer: First Health Commercial |
$3,852.25
|
| Rate for Payer: Humana Commercial |
$3,446.75
|
| Rate for Payer: Humana KY Medicaid |
$1,394.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,408.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,325.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,992.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,216.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,422.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,568.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,041.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,257.05
|
| Rate for Payer: PHCS Commercial |
$3,892.80
|
| Rate for Payer: United Healthcare All Payer |
$3,568.40
|
|
