|
PLATE STD V-D-R HD LK 3 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 V-D-R HD LK 3 62MM 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 V-D-R HD LK 3 62MM 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 V-D-R HD LK 5 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 V-D-R HD LK 5 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 V-D-R HD LK 5 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 V-D-R HD LK 5 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 ST NARROW 54 4H
|
Facility
|
OP
|
$3,582.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.68 |
| Max. Negotiated Rate |
$3,438.89 |
| Rate for Payer: Aetna Commercial |
$2,758.28
|
| Rate for Payer: Anthem Medicaid |
$1,231.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.10
|
| Rate for Payer: Cash Price |
$1,791.09
|
| Rate for Payer: Cigna Commercial |
$2,973.21
|
| Rate for Payer: First Health Commercial |
$3,403.07
|
| Rate for Payer: Humana Commercial |
$3,044.85
|
| Rate for Payer: Humana KY Medicaid |
$1,231.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.48
|
| Rate for Payer: PHCS Commercial |
$3,438.89
|
| Rate for Payer: United Healthcare All Payer |
$3,152.32
|
|
|
PLATE ST NARROW 54 4H
|
Facility
|
IP
|
$3,582.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.68 |
| Max. Negotiated Rate |
$3,438.89 |
| Rate for Payer: Aetna Commercial |
$2,758.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.10
|
| Rate for Payer: Cash Price |
$1,791.09
|
| Rate for Payer: Cigna Commercial |
$2,973.21
|
| Rate for Payer: First Health Commercial |
$3,403.07
|
| Rate for Payer: Humana Commercial |
$3,044.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.48
|
| Rate for Payer: PHCS Commercial |
$3,438.89
|
| Rate for Payer: United Healthcare All Payer |
$3,152.32
|
|
|
PLATE STRAIGHT 1.5MM
|
Facility
|
OP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem Medicaid |
$760.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Humana KY Medicaid |
$760.36
|
| Rate for Payer: Kentucky WC Medicaid |
$768.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
PLATE STRAIGHT 1.5MM
|
Facility
|
IP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
PLATE STRAIGHT 2.0MM 20H
|
Facility
|
OP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem Medicaid |
$757.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Humana KY Medicaid |
$757.89
|
| Rate for Payer: Kentucky WC Medicaid |
$765.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$773.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
|
|
PLATE STRAIGHT 2.0MM 20H
|
Facility
|
IP
|
$2,203.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$286.50 |
| Max. Negotiated Rate |
$2,115.67 |
| Rate for Payer: Aetna Commercial |
$1,696.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,718.98
|
| Rate for Payer: Cash Price |
$1,101.91
|
| Rate for Payer: Cigna Commercial |
$1,829.17
|
| Rate for Payer: First Health Commercial |
$2,093.63
|
| Rate for Payer: Humana Commercial |
$1,873.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,652.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$440.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$286.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$683.18
|
| Rate for Payer: PHCS Commercial |
$2,115.67
|
| Rate for Payer: United Healthcare All Payer |
$1,939.36
|
|
|
PLATE STRAIGHT 2.0MM 3H
|
Facility
|
OP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem Medicaid |
$377.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Humana KY Medicaid |
$377.20
|
| Rate for Payer: Kentucky WC Medicaid |
$381.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
|
|
PLATE STRAIGHT 2.0MM 3H
|
Facility
|
IP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
|
|
PLATE STRAIGHT 2.0MM 4H
|
Facility
|
IP
|
$1,123.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.03 |
| Max. Negotiated Rate |
$1,078.34 |
| Rate for Payer: Aetna Commercial |
$864.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.15
|
| Rate for Payer: Cash Price |
$561.63
|
| Rate for Payer: Cigna Commercial |
$932.31
|
| Rate for Payer: First Health Commercial |
$1,067.11
|
| Rate for Payer: Humana Commercial |
$954.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$828.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$988.48
|
| Rate for Payer: Ohio Health Group HMO |
$842.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.21
|
| Rate for Payer: PHCS Commercial |
$1,078.34
|
| Rate for Payer: United Healthcare All Payer |
$988.48
|
|
|
PLATE STRAIGHT 2.0MM 4H
|
Facility
|
OP
|
$1,123.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.03 |
| Max. Negotiated Rate |
$1,078.34 |
| Rate for Payer: Aetna Commercial |
$864.92
|
| Rate for Payer: Anthem Medicaid |
$386.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$876.15
|
| Rate for Payer: Cash Price |
$561.63
|
| Rate for Payer: Cigna Commercial |
$932.31
|
| Rate for Payer: First Health Commercial |
$1,067.11
|
| Rate for Payer: Humana Commercial |
$954.78
|
| Rate for Payer: Humana KY Medicaid |
$386.29
|
| Rate for Payer: Kentucky WC Medicaid |
$390.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$921.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$828.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$988.48
|
| Rate for Payer: Ohio Health Group HMO |
$842.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$224.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.21
|
| Rate for Payer: PHCS Commercial |
$1,078.34
|
| Rate for Payer: United Healthcare All Payer |
$988.48
|
|
|
PLATE STRAIGHT 2.0MM 5H
|
Facility
|
IP
|
$1,149.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.46 |
| Max. Negotiated Rate |
$1,103.72 |
| Rate for Payer: Aetna Commercial |
$885.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.77
|
| Rate for Payer: Cash Price |
$574.86
|
| Rate for Payer: Cigna Commercial |
$954.26
|
| Rate for Payer: First Health Commercial |
$1,092.22
|
| Rate for Payer: Humana Commercial |
$977.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.74
|
| Rate for Payer: Ohio Health Group HMO |
$862.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.41
|
| Rate for Payer: PHCS Commercial |
$1,103.72
|
| Rate for Payer: United Healthcare All Payer |
$1,011.74
|
|
|
PLATE STRAIGHT 2.0MM 5H
|
Facility
|
OP
|
$1,149.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.46 |
| Max. Negotiated Rate |
$1,103.72 |
| Rate for Payer: Aetna Commercial |
$885.28
|
| Rate for Payer: Anthem Medicaid |
$395.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$896.77
|
| Rate for Payer: Cash Price |
$574.86
|
| Rate for Payer: Cigna Commercial |
$954.26
|
| Rate for Payer: First Health Commercial |
$1,092.22
|
| Rate for Payer: Humana Commercial |
$977.25
|
| Rate for Payer: Humana KY Medicaid |
$395.39
|
| Rate for Payer: Kentucky WC Medicaid |
$399.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$942.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$848.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$403.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,011.74
|
| Rate for Payer: Ohio Health Group HMO |
$862.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$356.41
|
| Rate for Payer: PHCS Commercial |
$1,103.72
|
| Rate for Payer: United Healthcare All Payer |
$1,011.74
|
|
|
PLATE STRAIGHT 2.0MM 6H
|
Facility
|
OP
|
$3,541.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$3,400.05 |
| Rate for Payer: Aetna Commercial |
$2,727.12
|
| Rate for Payer: Anthem Medicaid |
$1,218.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,762.54
|
| Rate for Payer: Cash Price |
$1,770.86
|
| Rate for Payer: Cigna Commercial |
$2,939.63
|
| Rate for Payer: First Health Commercial |
$3,364.63
|
| Rate for Payer: Humana Commercial |
$3,010.46
|
| Rate for Payer: Humana KY Medicaid |
$1,218.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,230.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,904.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,242.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,116.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,656.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.93
|
| Rate for Payer: PHCS Commercial |
$3,400.05
|
| Rate for Payer: United Healthcare All Payer |
$3,116.71
|
|
|
PLATE STRAIGHT 2.0MM 6H
|
Facility
|
IP
|
$3,541.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.42 |
| Max. Negotiated Rate |
$3,400.05 |
| Rate for Payer: Aetna Commercial |
$2,727.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,762.54
|
| Rate for Payer: Cash Price |
$1,770.86
|
| Rate for Payer: Cigna Commercial |
$2,939.63
|
| Rate for Payer: First Health Commercial |
$3,364.63
|
| Rate for Payer: Humana Commercial |
$3,010.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,904.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,613.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,062.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,116.71
|
| Rate for Payer: Ohio Health Group HMO |
$2,656.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$708.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.93
|
| Rate for Payer: PHCS Commercial |
$3,400.05
|
| Rate for Payer: United Healthcare All Payer |
$3,116.71
|
|
|
PLATE STRAIGHT AR-9943C-04
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
PLATE STRAIGHT AR-9943C-04
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
|
|
PLATE STRAIGHT AR-9943C-06
|
Facility
|
IP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
PLATE STRAIGHT AR-9943C-06
|
Facility
|
OP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem Medicaid |
$1,328.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Humana KY Medicaid |
$1,328.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
