|
PLATE T 2.0MM 3X9 HOLE
|
Facility
|
IP
|
$2,110.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$2,026.13 |
| Rate for Payer: Aetna Commercial |
$1,625.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.23
|
| Rate for Payer: Cash Price |
$1,055.28
|
| Rate for Payer: Cigna Commercial |
$1,751.76
|
| Rate for Payer: First Health Commercial |
$2,005.02
|
| Rate for Payer: Humana Commercial |
$1,793.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.27
|
| Rate for Payer: PHCS Commercial |
$2,026.13
|
| Rate for Payer: United Healthcare All Payer |
$1,857.28
|
|
|
PLATE T 2.0MM 3X9 HOLE
|
Facility
|
OP
|
$2,110.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.37 |
| Max. Negotiated Rate |
$2,026.13 |
| Rate for Payer: Aetna Commercial |
$1,625.12
|
| Rate for Payer: Anthem Medicaid |
$725.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,646.23
|
| Rate for Payer: Cash Price |
$1,055.28
|
| Rate for Payer: Cigna Commercial |
$1,751.76
|
| Rate for Payer: First Health Commercial |
$2,005.02
|
| Rate for Payer: Humana Commercial |
$1,793.97
|
| Rate for Payer: Humana KY Medicaid |
$725.82
|
| Rate for Payer: Kentucky WC Medicaid |
$733.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,857.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.27
|
| Rate for Payer: PHCS Commercial |
$2,026.13
|
| Rate for Payer: United Healthcare All Payer |
$1,857.28
|
|
|
PLATE T 2.0MM 4X9 HOLE
|
Facility
|
OP
|
$2,153.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.97 |
| Max. Negotiated Rate |
$2,067.46 |
| Rate for Payer: Aetna Commercial |
$1,658.27
|
| Rate for Payer: Anthem Medicaid |
$740.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,679.81
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cigna Commercial |
$1,787.49
|
| Rate for Payer: First Health Commercial |
$2,045.92
|
| Rate for Payer: Humana Commercial |
$1,830.56
|
| Rate for Payer: Humana KY Medicaid |
$740.62
|
| Rate for Payer: Kentucky WC Medicaid |
$748.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,765.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,589.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,895.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,615.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.62
|
| Rate for Payer: PHCS Commercial |
$2,067.46
|
| Rate for Payer: United Healthcare All Payer |
$1,895.17
|
|
|
PLATE T 2.0MM 4X9 HOLE
|
Facility
|
IP
|
$2,153.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$279.97 |
| Max. Negotiated Rate |
$2,067.46 |
| Rate for Payer: Aetna Commercial |
$1,658.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,679.81
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cigna Commercial |
$1,787.49
|
| Rate for Payer: First Health Commercial |
$2,045.92
|
| Rate for Payer: Humana Commercial |
$1,830.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,765.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,589.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,895.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,615.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$279.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.62
|
| Rate for Payer: PHCS Commercial |
$2,067.46
|
| Rate for Payer: United Healthcare All Payer |
$1,895.17
|
|
|
PLATE T 2.70MM
|
Facility
|
OP
|
$4,268.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.88 |
| Max. Negotiated Rate |
$4,097.59 |
| Rate for Payer: Aetna Commercial |
$3,286.61
|
| Rate for Payer: Anthem Medicaid |
$1,467.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,329.29
|
| Rate for Payer: Cash Price |
$2,134.16
|
| Rate for Payer: Cigna Commercial |
$3,542.71
|
| Rate for Payer: First Health Commercial |
$4,054.90
|
| Rate for Payer: Humana Commercial |
$3,628.07
|
| Rate for Payer: Humana KY Medicaid |
$1,467.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,482.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,500.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,150.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,497.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,756.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,201.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$853.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.18
|
| Rate for Payer: PHCS Commercial |
$4,097.59
|
| Rate for Payer: United Healthcare All Payer |
$3,756.12
|
|
|
PLATE T 2.70MM
|
Facility
|
IP
|
$4,268.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.88 |
| Max. Negotiated Rate |
$4,097.59 |
| Rate for Payer: Aetna Commercial |
$3,286.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,329.29
|
| Rate for Payer: Cash Price |
$2,134.16
|
| Rate for Payer: Cigna Commercial |
$3,542.71
|
| Rate for Payer: First Health Commercial |
$4,054.90
|
| Rate for Payer: Humana Commercial |
$3,628.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,500.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,150.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,756.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,201.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$853.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$554.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.18
|
| Rate for Payer: PHCS Commercial |
$4,097.59
|
| Rate for Payer: United Healthcare All Payer |
$3,756.12
|
|
|
PLATE T 2.7MM
|
Facility
|
IP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE T 2.7MM
|
Facility
|
OP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Anthem Medicaid |
$383.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Humana KY Medicaid |
$383.26
|
| Rate for Payer: Kentucky WC Medicaid |
$387.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$390.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
| Rate for Payer: Aetna Commercial |
$858.13
|
|
|
PLATE T 3H HD 3H SHFT 3.5*50 R
|
Facility
|
OP
|
$2,199.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.94 |
| Max. Negotiated Rate |
$2,111.57 |
| Rate for Payer: Aetna Commercial |
$1,693.65
|
| Rate for Payer: Anthem Medicaid |
$756.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.65
|
| Rate for Payer: Cash Price |
$1,099.78
|
| Rate for Payer: Cigna Commercial |
$1,825.63
|
| Rate for Payer: First Health Commercial |
$2,089.57
|
| Rate for Payer: Humana Commercial |
$1,869.62
|
| Rate for Payer: Humana KY Medicaid |
$756.43
|
| Rate for Payer: Kentucky WC Medicaid |
$764.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$771.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.86
|
| Rate for Payer: PHCS Commercial |
$2,111.57
|
| Rate for Payer: United Healthcare All Payer |
$1,935.60
|
|
|
PLATE T 3H HD 3H SHFT 3.5*50 R
|
Facility
|
IP
|
$2,199.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.94 |
| Max. Negotiated Rate |
$2,111.57 |
| Rate for Payer: Aetna Commercial |
$1,693.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,715.65
|
| Rate for Payer: Cash Price |
$1,099.78
|
| Rate for Payer: Cigna Commercial |
$1,825.63
|
| Rate for Payer: First Health Commercial |
$2,089.57
|
| Rate for Payer: Humana Commercial |
$1,869.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,803.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,623.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,935.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,649.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$439.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$681.86
|
| Rate for Payer: PHCS Commercial |
$2,111.57
|
| Rate for Payer: United Healthcare All Payer |
$1,935.60
|
|
|
PLATE T 3H HD 3H SHT 3.5*52 OL
|
Facility
|
IP
|
$3,173.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.59 |
| Max. Negotiated Rate |
$3,046.79 |
| Rate for Payer: Aetna Commercial |
$2,443.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,475.52
|
| Rate for Payer: Cash Price |
$1,586.87
|
| Rate for Payer: Cigna Commercial |
$2,634.20
|
| Rate for Payer: First Health Commercial |
$3,015.05
|
| Rate for Payer: Humana Commercial |
$2,697.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,602.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,342.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,792.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,380.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.86
|
| Rate for Payer: PHCS Commercial |
$3,046.79
|
| Rate for Payer: United Healthcare All Payer |
$2,792.89
|
|
|
PLATE T 3H HD 3H SHT 3.5*52 OL
|
Facility
|
OP
|
$3,173.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.59 |
| Max. Negotiated Rate |
$3,046.79 |
| Rate for Payer: Aetna Commercial |
$2,443.78
|
| Rate for Payer: Anthem Medicaid |
$1,091.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,475.52
|
| Rate for Payer: Cash Price |
$1,586.87
|
| Rate for Payer: Cigna Commercial |
$2,634.20
|
| Rate for Payer: First Health Commercial |
$3,015.05
|
| Rate for Payer: Humana Commercial |
$2,697.68
|
| Rate for Payer: Humana KY Medicaid |
$1,091.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,102.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,602.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,342.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$952.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,113.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,792.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,380.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$634.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$412.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$983.86
|
| Rate for Payer: PHCS Commercial |
$3,046.79
|
| Rate for Payer: United Healthcare All Payer |
$2,792.89
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OL
|
Facility
|
OP
|
$3,215.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.02 |
| Max. Negotiated Rate |
$3,086.94 |
| Rate for Payer: Aetna Commercial |
$2,475.98
|
| Rate for Payer: Anthem Medicaid |
$1,105.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.14
|
| Rate for Payer: Cash Price |
$1,607.78
|
| Rate for Payer: Cigna Commercial |
$2,668.91
|
| Rate for Payer: First Health Commercial |
$3,054.78
|
| Rate for Payer: Humana Commercial |
$2,733.23
|
| Rate for Payer: Humana KY Medicaid |
$1,105.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,117.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,128.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.82
|
| Rate for Payer: PHCS Commercial |
$3,086.94
|
| Rate for Payer: United Healthcare All Payer |
$2,829.69
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OL
|
Facility
|
IP
|
$3,215.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.02 |
| Max. Negotiated Rate |
$3,086.94 |
| Rate for Payer: Aetna Commercial |
$2,475.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,508.14
|
| Rate for Payer: Cash Price |
$1,607.78
|
| Rate for Payer: Cigna Commercial |
$2,668.91
|
| Rate for Payer: First Health Commercial |
$3,054.78
|
| Rate for Payer: Humana Commercial |
$2,733.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,636.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,373.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,829.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,411.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$996.82
|
| Rate for Payer: PHCS Commercial |
$3,086.94
|
| Rate for Payer: United Healthcare All Payer |
$2,829.69
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OR
|
Facility
|
IP
|
$3,166.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.68 |
| Max. Negotiated Rate |
$3,040.07 |
| Rate for Payer: Aetna Commercial |
$2,438.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.06
|
| Rate for Payer: Cash Price |
$1,583.37
|
| Rate for Payer: Cigna Commercial |
$2,628.39
|
| Rate for Payer: First Health Commercial |
$3,008.40
|
| Rate for Payer: Humana Commercial |
$2,691.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.69
|
| Rate for Payer: PHCS Commercial |
$3,040.07
|
| Rate for Payer: United Healthcare All Payer |
$2,786.73
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OR
|
Facility
|
OP
|
$3,166.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.68 |
| Max. Negotiated Rate |
$3,040.07 |
| Rate for Payer: Aetna Commercial |
$2,438.39
|
| Rate for Payer: Anthem Medicaid |
$1,089.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,470.06
|
| Rate for Payer: Cash Price |
$1,583.37
|
| Rate for Payer: Cigna Commercial |
$2,628.39
|
| Rate for Payer: First Health Commercial |
$3,008.40
|
| Rate for Payer: Humana Commercial |
$2,691.73
|
| Rate for Payer: Humana KY Medicaid |
$1,089.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,100.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,596.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,337.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$950.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,786.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,375.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$633.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.69
|
| Rate for Payer: PHCS Commercial |
$3,040.07
|
| Rate for Payer: United Healthcare All Payer |
$2,786.73
|
|
|
PLATE T 3H HD 5H SHFT 3.5*67 R
|
Facility
|
IP
|
$3,650.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.62 |
| Max. Negotiated Rate |
$3,504.85 |
| Rate for Payer: Aetna Commercial |
$2,811.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.69
|
| Rate for Payer: Cash Price |
$1,825.44
|
| Rate for Payer: Cigna Commercial |
$3,030.24
|
| Rate for Payer: First Health Commercial |
$3,468.35
|
| Rate for Payer: Humana Commercial |
$3,103.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,694.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,738.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.78
|
| Rate for Payer: PHCS Commercial |
$3,504.85
|
| Rate for Payer: United Healthcare All Payer |
$3,212.78
|
|
|
PLATE T 3H HD 5H SHFT 3.5*67 R
|
Facility
|
OP
|
$3,650.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.62 |
| Max. Negotiated Rate |
$3,504.85 |
| Rate for Payer: Aetna Commercial |
$2,811.19
|
| Rate for Payer: Anthem Medicaid |
$1,255.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.69
|
| Rate for Payer: Cash Price |
$1,825.44
|
| Rate for Payer: Cigna Commercial |
$3,030.24
|
| Rate for Payer: First Health Commercial |
$3,468.35
|
| Rate for Payer: Humana Commercial |
$3,103.26
|
| Rate for Payer: Humana KY Medicaid |
$1,255.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,694.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,738.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.78
|
| Rate for Payer: PHCS Commercial |
$3,504.85
|
| Rate for Payer: United Healthcare All Payer |
$3,212.78
|
|
|
PLATE T 3H HD 5H SHFT 3.5*74OL
|
Facility
|
OP
|
$3,254.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.10 |
| Max. Negotiated Rate |
$3,124.44 |
| Rate for Payer: Aetna Commercial |
$2,506.06
|
| Rate for Payer: Anthem Medicaid |
$1,119.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.60
|
| Rate for Payer: Cash Price |
$1,627.31
|
| Rate for Payer: Cigna Commercial |
$2,701.33
|
| Rate for Payer: First Health Commercial |
$3,091.89
|
| Rate for Payer: Humana Commercial |
$2,766.43
|
| Rate for Payer: Humana KY Medicaid |
$1,119.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,130.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,668.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,401.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,141.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,440.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.93
|
| Rate for Payer: PHCS Commercial |
$3,124.44
|
| Rate for Payer: United Healthcare All Payer |
$2,864.07
|
|
|
PLATE T 3H HD 5H SHFT 3.5*74OL
|
Facility
|
IP
|
$3,254.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.10 |
| Max. Negotiated Rate |
$3,124.44 |
| Rate for Payer: Aetna Commercial |
$2,506.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.60
|
| Rate for Payer: Cash Price |
$1,627.31
|
| Rate for Payer: Cigna Commercial |
$2,701.33
|
| Rate for Payer: First Health Commercial |
$3,091.89
|
| Rate for Payer: Humana Commercial |
$2,766.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,668.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,401.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,440.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.93
|
| Rate for Payer: PHCS Commercial |
$3,124.44
|
| Rate for Payer: United Healthcare All Payer |
$2,864.07
|
|
|
PLATE T 3H HD 5H SHT 3.5*74 OR
|
Facility
|
OP
|
$3,254.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.10 |
| Max. Negotiated Rate |
$3,124.44 |
| Rate for Payer: Aetna Commercial |
$2,506.06
|
| Rate for Payer: Anthem Medicaid |
$1,119.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.60
|
| Rate for Payer: Cash Price |
$1,627.31
|
| Rate for Payer: Cigna Commercial |
$2,701.33
|
| Rate for Payer: First Health Commercial |
$3,091.89
|
| Rate for Payer: Humana Commercial |
$2,766.43
|
| Rate for Payer: Humana KY Medicaid |
$1,119.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,130.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,668.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,401.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,141.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,440.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.93
|
| Rate for Payer: PHCS Commercial |
$3,124.44
|
| Rate for Payer: United Healthcare All Payer |
$2,864.07
|
|
|
PLATE T 3H HD 5H SHT 3.5*74 OR
|
Facility
|
IP
|
$3,254.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.10 |
| Max. Negotiated Rate |
$3,124.44 |
| Rate for Payer: Humana Commercial |
$2,766.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,668.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,401.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,440.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.93
|
| Rate for Payer: PHCS Commercial |
$3,124.44
|
| Rate for Payer: United Healthcare All Payer |
$2,864.07
|
| Rate for Payer: Aetna Commercial |
$2,506.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.60
|
| Rate for Payer: Cash Price |
$1,627.31
|
| Rate for Payer: Cigna Commercial |
$2,701.33
|
| Rate for Payer: First Health Commercial |
$3,091.89
|
|
|
PLATE T 3H HD 7H SHFT 3.5*87 R
|
Facility
|
OP
|
$4,143.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.72 |
| Max. Negotiated Rate |
$3,978.21 |
| Rate for Payer: Aetna Commercial |
$3,190.86
|
| Rate for Payer: Anthem Medicaid |
$1,425.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,232.30
|
| Rate for Payer: Cash Price |
$2,071.99
|
| Rate for Payer: Cigna Commercial |
$3,439.50
|
| Rate for Payer: First Health Commercial |
$3,936.77
|
| Rate for Payer: Humana Commercial |
$3,522.37
|
| Rate for Payer: Humana KY Medicaid |
$1,425.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,439.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,058.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,453.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,646.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,107.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$828.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.63
|
| Rate for Payer: PHCS Commercial |
$3,978.21
|
| Rate for Payer: United Healthcare All Payer |
$3,646.69
|
|
|
PLATE T 3H HD 7H SHFT 3.5*87 R
|
Facility
|
IP
|
$4,143.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$538.72 |
| Max. Negotiated Rate |
$3,978.21 |
| Rate for Payer: Aetna Commercial |
$3,190.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,232.30
|
| Rate for Payer: Cash Price |
$2,071.99
|
| Rate for Payer: Cigna Commercial |
$3,439.50
|
| Rate for Payer: First Health Commercial |
$3,936.77
|
| Rate for Payer: Humana Commercial |
$3,522.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,058.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,646.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,107.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$828.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$538.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.63
|
| Rate for Payer: PHCS Commercial |
$3,978.21
|
| Rate for Payer: United Healthcare All Payer |
$3,646.69
|
|
|
PLATE T 3H HD 7H SHFT 3.5*96OL
|
Facility
|
OP
|
$3,349.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.37 |
| Max. Negotiated Rate |
$3,215.05 |
| Rate for Payer: Aetna Commercial |
$2,578.74
|
| Rate for Payer: Anthem Medicaid |
$1,151.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,612.23
|
| Rate for Payer: Cash Price |
$1,674.51
|
| Rate for Payer: Cigna Commercial |
$2,779.68
|
| Rate for Payer: First Health Commercial |
$3,181.56
|
| Rate for Payer: Humana Commercial |
$2,846.66
|
| Rate for Payer: Humana KY Medicaid |
$1,151.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,163.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,746.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,471.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,004.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,174.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,947.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,511.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$669.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$435.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,038.19
|
| Rate for Payer: PHCS Commercial |
$3,215.05
|
| Rate for Payer: United Healthcare All Payer |
$2,947.13
|
|
