|
PLATE STANDARD 95 8 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: 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
|
| 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
|
|
|
PLATE STANDARD 95 8 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
|
|
|
PLATE STD BARL KEYLESS 130^ 3H
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.76 |
| Max. Negotiated Rate |
$5,041.92 |
| Rate for Payer: Aetna Commercial |
$4,044.04
|
| Rate for Payer: Anthem Medicaid |
$1,806.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.56
|
| Rate for Payer: Cash Price |
$2,626.00
|
| Rate for Payer: Cigna Commercial |
$4,359.16
|
| Rate for Payer: First Health Commercial |
$4,989.40
|
| Rate for Payer: Humana Commercial |
$4,464.20
|
| Rate for Payer: Humana KY Medicaid |
$1,806.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,824.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,842.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,621.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,939.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.12
|
| Rate for Payer: PHCS Commercial |
$5,041.92
|
| Rate for Payer: United Healthcare All Payer |
$4,621.76
|
|
|
PLATE STD BARL KEYLESS 130^ 3H
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.76 |
| Max. Negotiated Rate |
$5,041.92 |
| Rate for Payer: Aetna Commercial |
$4,044.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.56
|
| Rate for Payer: Cash Price |
$2,626.00
|
| Rate for Payer: Cigna Commercial |
$4,359.16
|
| Rate for Payer: First Health Commercial |
$4,989.40
|
| Rate for Payer: Humana Commercial |
$4,464.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,621.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,939.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.12
|
| Rate for Payer: PHCS Commercial |
$5,041.92
|
| Rate for Payer: United Healthcare All Payer |
$4,621.76
|
|
|
PLATE STD BARL KEYLESS 135^ 2H
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.76 |
| Max. Negotiated Rate |
$5,041.92 |
| Rate for Payer: Aetna Commercial |
$4,044.04
|
| Rate for Payer: Anthem Medicaid |
$1,806.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.56
|
| Rate for Payer: Cash Price |
$2,626.00
|
| Rate for Payer: Cigna Commercial |
$4,359.16
|
| Rate for Payer: First Health Commercial |
$4,989.40
|
| Rate for Payer: Humana Commercial |
$4,464.20
|
| Rate for Payer: Humana KY Medicaid |
$1,806.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,824.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,842.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,621.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,939.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.12
|
| Rate for Payer: PHCS Commercial |
$5,041.92
|
| Rate for Payer: United Healthcare All Payer |
$4,621.76
|
|
|
PLATE STD BARL KEYLESS 135^ 2H
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.76 |
| Max. Negotiated Rate |
$5,041.92 |
| Rate for Payer: Aetna Commercial |
$4,044.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.56
|
| Rate for Payer: Cash Price |
$2,626.00
|
| Rate for Payer: Cigna Commercial |
$4,359.16
|
| Rate for Payer: First Health Commercial |
$4,989.40
|
| Rate for Payer: Humana Commercial |
$4,464.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,621.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,939.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.12
|
| Rate for Payer: PHCS Commercial |
$5,041.92
|
| Rate for Payer: United Healthcare All Payer |
$4,621.76
|
|
|
PLATE STD BARL KEYLESS 135^ 3H
|
Facility
|
OP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.76 |
| Max. Negotiated Rate |
$5,041.92 |
| Rate for Payer: Humana Commercial |
$4,464.20
|
| Rate for Payer: Humana KY Medicaid |
$1,806.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,824.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,842.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,621.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,939.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.12
|
| Rate for Payer: PHCS Commercial |
$5,041.92
|
| Rate for Payer: United Healthcare All Payer |
$4,621.76
|
| Rate for Payer: Aetna Commercial |
$4,044.04
|
| Rate for Payer: Anthem Medicaid |
$1,806.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.56
|
| Rate for Payer: Cash Price |
$2,626.00
|
| Rate for Payer: Cigna Commercial |
$4,359.16
|
| Rate for Payer: First Health Commercial |
$4,989.40
|
|
|
PLATE STD BARL KEYLESS 135^ 3H
|
Facility
|
IP
|
$5,252.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.76 |
| Max. Negotiated Rate |
$5,041.92 |
| Rate for Payer: Aetna Commercial |
$4,044.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,096.56
|
| Rate for Payer: Cash Price |
$2,626.00
|
| Rate for Payer: Cigna Commercial |
$4,359.16
|
| Rate for Payer: First Health Commercial |
$4,989.40
|
| Rate for Payer: Humana Commercial |
$4,464.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,306.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,875.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,575.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,621.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,939.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,050.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,628.12
|
| Rate for Payer: PHCS Commercial |
$5,041.92
|
| Rate for Payer: United Healthcare All Payer |
$4,621.76
|
|
|
PLATE STD GOLD 1.7MM 8H
|
Facility
|
IP
|
$3,126.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.40 |
| Max. Negotiated Rate |
$3,001.12 |
| Rate for Payer: Aetna Commercial |
$2,407.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,438.41
|
| Rate for Payer: Cash Price |
$1,563.09
|
| Rate for Payer: Cigna Commercial |
$2,594.72
|
| Rate for Payer: First Health Commercial |
$2,969.86
|
| Rate for Payer: Humana Commercial |
$2,657.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,563.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,307.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,751.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,344.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.11
|
| Rate for Payer: PHCS Commercial |
$3,001.12
|
| Rate for Payer: United Healthcare All Payer |
$2,751.03
|
|
|
PLATE STD GOLD 1.7MM 8H
|
Facility
|
OP
|
$3,126.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.40 |
| Max. Negotiated Rate |
$3,001.12 |
| Rate for Payer: Aetna Commercial |
$2,407.15
|
| Rate for Payer: Anthem Medicaid |
$1,075.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,438.41
|
| Rate for Payer: Cash Price |
$1,563.09
|
| Rate for Payer: Cigna Commercial |
$2,594.72
|
| Rate for Payer: First Health Commercial |
$2,969.86
|
| Rate for Payer: Humana Commercial |
$2,657.24
|
| Rate for Payer: Humana KY Medicaid |
$1,075.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,563.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,307.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,751.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,344.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.11
|
| Rate for Payer: PHCS Commercial |
$3,001.12
|
| Rate for Payer: United Healthcare All Payer |
$2,751.03
|
|
|
PLATE STD LCK HD VDR 3H 62MM L
|
Facility
|
IP
|
$5,016.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$4,815.96 |
| Rate for Payer: Aetna Commercial |
$3,862.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,912.96
|
| Rate for Payer: Cash Price |
$2,508.31
|
| Rate for Payer: Cigna Commercial |
$4,163.79
|
| Rate for Payer: First Health Commercial |
$4,765.79
|
| Rate for Payer: Humana Commercial |
$4,264.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,113.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,702.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,414.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,762.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,555.15
|
| Rate for Payer: PHCS Commercial |
$4,815.96
|
| Rate for Payer: United Healthcare All Payer |
$4,414.63
|
|
|
PLATE STD LCK HD VDR 3H 62MM L
|
Facility
|
OP
|
$5,016.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$4,815.96 |
| Rate for Payer: Aetna Commercial |
$3,862.80
|
| Rate for Payer: Anthem Medicaid |
$1,725.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,912.96
|
| Rate for Payer: Cash Price |
$2,508.31
|
| Rate for Payer: Cigna Commercial |
$4,163.79
|
| Rate for Payer: First Health Commercial |
$4,765.79
|
| Rate for Payer: Humana Commercial |
$4,264.13
|
| Rate for Payer: Humana KY Medicaid |
$1,725.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,742.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,113.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,702.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,414.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,762.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,555.15
|
| Rate for Payer: PHCS Commercial |
$4,815.96
|
| Rate for Payer: United Healthcare All Payer |
$4,414.63
|
|
|
PLATE STD LCK HD VDR 3H 62MM R
|
Facility
|
OP
|
$5,016.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$4,815.96 |
| Rate for Payer: Aetna Commercial |
$3,862.80
|
| Rate for Payer: Anthem Medicaid |
$1,725.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,912.96
|
| Rate for Payer: Cash Price |
$2,508.31
|
| Rate for Payer: Cigna Commercial |
$4,163.79
|
| Rate for Payer: First Health Commercial |
$4,765.79
|
| Rate for Payer: Humana Commercial |
$4,264.13
|
| Rate for Payer: Humana KY Medicaid |
$1,725.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,742.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,113.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,702.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,414.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,762.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,555.15
|
| Rate for Payer: PHCS Commercial |
$4,815.96
|
| Rate for Payer: United Healthcare All Payer |
$4,414.63
|
|
|
PLATE STD LCK HD VDR 3H 62MM R
|
Facility
|
IP
|
$5,016.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$4,815.96 |
| Rate for Payer: Aetna Commercial |
$3,862.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,912.96
|
| Rate for Payer: Cash Price |
$2,508.31
|
| Rate for Payer: Cigna Commercial |
$4,163.79
|
| Rate for Payer: First Health Commercial |
$4,765.79
|
| Rate for Payer: Humana Commercial |
$4,264.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,113.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,702.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,414.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,762.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,555.15
|
| Rate for Payer: PHCS Commercial |
$4,815.96
|
| Rate for Payer: United Healthcare All Payer |
$4,414.63
|
|
|
PLATE STD LCK HD VDR 5H 86MM L
|
Facility
|
OP
|
$5,184.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.05 |
| Max. Negotiated Rate |
$4,977.58 |
| Rate for Payer: Aetna Commercial |
$3,992.43
|
| Rate for Payer: Anthem Medicaid |
$1,783.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,044.28
|
| Rate for Payer: Cash Price |
$2,592.49
|
| Rate for Payer: Cigna Commercial |
$4,303.53
|
| Rate for Payer: First Health Commercial |
$4,925.73
|
| Rate for Payer: Humana Commercial |
$4,407.23
|
| Rate for Payer: Humana KY Medicaid |
$1,783.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,251.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,826.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,818.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,562.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,888.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,607.34
|
| Rate for Payer: PHCS Commercial |
$4,977.58
|
| Rate for Payer: United Healthcare All Payer |
$4,562.78
|
|
|
PLATE STD LCK HD VDR 5H 86MM L
|
Facility
|
IP
|
$5,184.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.05 |
| Max. Negotiated Rate |
$4,977.58 |
| Rate for Payer: Aetna Commercial |
$3,992.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,044.28
|
| Rate for Payer: Cash Price |
$2,592.49
|
| Rate for Payer: Cigna Commercial |
$4,303.53
|
| Rate for Payer: First Health Commercial |
$4,925.73
|
| Rate for Payer: Humana Commercial |
$4,407.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,251.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,826.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,562.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,888.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,607.34
|
| Rate for Payer: PHCS Commercial |
$4,977.58
|
| Rate for Payer: United Healthcare All Payer |
$4,562.78
|
|
|
PLATE STD LCK HD VDR 5H 86MM R
|
Facility
|
OP
|
$5,184.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.05 |
| Max. Negotiated Rate |
$4,977.58 |
| Rate for Payer: Aetna Commercial |
$3,992.43
|
| Rate for Payer: Anthem Medicaid |
$1,783.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,044.28
|
| Rate for Payer: Cash Price |
$2,592.49
|
| Rate for Payer: Cigna Commercial |
$4,303.53
|
| Rate for Payer: First Health Commercial |
$4,925.73
|
| Rate for Payer: Humana Commercial |
$4,407.23
|
| Rate for Payer: Humana KY Medicaid |
$1,783.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,801.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,251.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,826.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,818.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,562.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,888.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,607.34
|
| Rate for Payer: PHCS Commercial |
$4,977.58
|
| Rate for Payer: United Healthcare All Payer |
$4,562.78
|
|
|
PLATE STD LCK HD VDR 5H 86MM R
|
Facility
|
IP
|
$5,184.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.05 |
| Max. Negotiated Rate |
$4,977.58 |
| Rate for Payer: Aetna Commercial |
$3,992.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,044.28
|
| Rate for Payer: Cash Price |
$2,592.49
|
| Rate for Payer: Cigna Commercial |
$4,303.53
|
| Rate for Payer: First Health Commercial |
$4,925.73
|
| Rate for Payer: Humana Commercial |
$4,407.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,251.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,826.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,555.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,562.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,888.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,037.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,607.34
|
| Rate for Payer: PHCS Commercial |
$4,977.58
|
| Rate for Payer: United Healthcare All Payer |
$4,562.78
|
|
|
PLATE STD LCK HD VDR 9H 135M L
|
Facility
|
IP
|
$9,626.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.48 |
| Max. Negotiated Rate |
$9,241.71 |
| Rate for Payer: Aetna Commercial |
$7,412.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,508.89
|
| Rate for Payer: Cash Price |
$4,813.39
|
| Rate for Payer: Cigna Commercial |
$7,990.23
|
| Rate for Payer: First Health Commercial |
$9,145.44
|
| Rate for Payer: Humana Commercial |
$8,182.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,893.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,104.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,888.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,471.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,220.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.30
|
| Rate for Payer: PHCS Commercial |
$9,241.71
|
| Rate for Payer: United Healthcare All Payer |
$8,471.57
|
|
|
PLATE STD LCK HD VDR 9H 135M L
|
Facility
|
OP
|
$9,626.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.48 |
| Max. Negotiated Rate |
$9,241.71 |
| Rate for Payer: Aetna Commercial |
$7,412.62
|
| Rate for Payer: Anthem Medicaid |
$3,310.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,508.89
|
| Rate for Payer: Cash Price |
$4,813.39
|
| Rate for Payer: Cigna Commercial |
$7,990.23
|
| Rate for Payer: First Health Commercial |
$9,145.44
|
| Rate for Payer: Humana Commercial |
$8,182.76
|
| Rate for Payer: Humana KY Medicaid |
$3,310.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,344.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,893.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,104.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,888.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,377.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,471.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,220.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.30
|
| Rate for Payer: PHCS Commercial |
$9,241.71
|
| Rate for Payer: United Healthcare All Payer |
$8,471.57
|
|
|
PLATE STD LCK HD VDR 9H 135M R
|
Facility
|
IP
|
$9,626.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.48 |
| Max. Negotiated Rate |
$9,241.71 |
| Rate for Payer: Aetna Commercial |
$7,412.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,508.89
|
| Rate for Payer: Cash Price |
$4,813.39
|
| Rate for Payer: Cigna Commercial |
$7,990.23
|
| Rate for Payer: First Health Commercial |
$9,145.44
|
| Rate for Payer: Humana Commercial |
$8,182.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,893.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,104.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,888.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,471.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,220.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.30
|
| Rate for Payer: PHCS Commercial |
$9,241.71
|
| Rate for Payer: United Healthcare All Payer |
$8,471.57
|
|
|
PLATE STD LCK HD VDR 9H 135M R
|
Facility
|
OP
|
$9,626.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.48 |
| Max. Negotiated Rate |
$9,241.71 |
| Rate for Payer: Aetna Commercial |
$7,412.62
|
| Rate for Payer: Anthem Medicaid |
$3,310.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,508.89
|
| Rate for Payer: Cash Price |
$4,813.39
|
| Rate for Payer: Cigna Commercial |
$7,990.23
|
| Rate for Payer: First Health Commercial |
$9,145.44
|
| Rate for Payer: Humana Commercial |
$8,182.76
|
| Rate for Payer: Humana KY Medicaid |
$3,310.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,344.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,893.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,104.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,888.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,377.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,471.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,220.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,925.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,251.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.30
|
| Rate for Payer: PHCS Commercial |
$9,241.71
|
| Rate for Payer: United Healthcare All Payer |
$8,471.57
|
|
|
PLATE STD ORBTL GOLD 1.2M 10H
|
Facility
|
IP
|
$2,161.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$2,075.05 |
| Rate for Payer: Aetna Commercial |
$1,664.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.98
|
| Rate for Payer: Cash Price |
$1,080.76
|
| Rate for Payer: Cigna Commercial |
$1,794.05
|
| Rate for Payer: First Health Commercial |
$2,053.43
|
| Rate for Payer: Humana Commercial |
$1,837.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,595.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,902.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,621.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.07
|
| Rate for Payer: PHCS Commercial |
$2,075.05
|
| Rate for Payer: United Healthcare All Payer |
$1,902.13
|
|
|
PLATE STD ORBTL GOLD 1.2M 10H
|
Facility
|
OP
|
$2,161.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$281.00 |
| Max. Negotiated Rate |
$2,075.05 |
| Rate for Payer: Aetna Commercial |
$1,664.36
|
| Rate for Payer: Anthem Medicaid |
$743.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,685.98
|
| Rate for Payer: Cash Price |
$1,080.76
|
| Rate for Payer: Cigna Commercial |
$1,794.05
|
| Rate for Payer: First Health Commercial |
$2,053.43
|
| Rate for Payer: Humana Commercial |
$1,837.28
|
| Rate for Payer: Humana KY Medicaid |
$743.34
|
| Rate for Payer: Kentucky WC Medicaid |
$750.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,772.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,595.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,902.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,621.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$432.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$281.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$670.07
|
| Rate for Payer: PHCS Commercial |
$2,075.05
|
| Rate for Payer: United Healthcare All Payer |
$1,902.13
|
|
|
PLATE STD V-D-R HD LK 3 62MM L
|
Facility
|
OP
|
$5,016.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.16 |
| Max. Negotiated Rate |
$4,815.96 |
| Rate for Payer: Anthem Medicaid |
$1,725.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,912.96
|
| Rate for Payer: Cash Price |
$2,508.31
|
| Rate for Payer: Cigna Commercial |
$4,163.79
|
| Rate for Payer: First Health Commercial |
$4,765.79
|
| Rate for Payer: Humana Commercial |
$4,264.13
|
| Rate for Payer: Humana KY Medicaid |
$1,725.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,742.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,113.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,702.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,504.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,759.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,414.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,762.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,555.15
|
| Rate for Payer: PHCS Commercial |
$4,815.96
|
| Rate for Payer: United Healthcare All Payer |
$4,414.63
|
| Rate for Payer: Aetna Commercial |
$3,862.80
|
|
