|
PLATE NARROW LCK CMP 4.5 12H
|
Facility
|
OP
|
$3,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.00 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$2,810.50
|
| Rate for Payer: Anthem Medicaid |
$1,255.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna Commercial |
$3,029.50
|
| Rate for Payer: First Health Commercial |
$3,467.50
|
| Rate for Payer: Humana Commercial |
$3,102.50
|
| Rate for Payer: Humana KY Medicaid |
$1,255.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,693.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,920.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,175.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,518.50
|
| Rate for Payer: PHCS Commercial |
$3,504.00
|
| Rate for Payer: United Healthcare All Payer |
$3,212.00
|
|
|
PLATE NARROW LCK CMP 4.5 14H
|
Facility
|
OP
|
$3,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem Medicaid |
$1,286.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
| Rate for Payer: Humana KY Medicaid |
$1,286.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,299.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,311.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,253.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,580.60
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
|
|
PLATE NARROW LCK CMP 4.5 14H
|
Facility
|
IP
|
$3,740.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,122.00 |
| Max. Negotiated Rate |
$3,590.40 |
| Rate for Payer: Aetna Commercial |
$2,879.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,917.20
|
| Rate for Payer: Cash Price |
$1,870.00
|
| Rate for Payer: Cigna Commercial |
$3,104.20
|
| Rate for Payer: First Health Commercial |
$3,553.00
|
| Rate for Payer: Humana Commercial |
$3,179.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,066.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,760.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,291.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,805.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,992.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,253.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,580.60
|
| Rate for Payer: PHCS Commercial |
$3,590.40
|
| Rate for Payer: United Healthcare All Payer |
$3,291.20
|
|
|
PLATE NARROW LCK COMP 4.5 6H
|
Facility
|
OP
|
$3,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$3,244.80 |
| Rate for Payer: Aetna Commercial |
$2,602.60
|
| Rate for Payer: Anthem Medicaid |
$1,162.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,636.40
|
| Rate for Payer: Cash Price |
$1,690.00
|
| Rate for Payer: Cigna Commercial |
$2,805.40
|
| Rate for Payer: First Health Commercial |
$3,211.00
|
| Rate for Payer: Humana Commercial |
$2,873.00
|
| Rate for Payer: Humana KY Medicaid |
$1,162.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,174.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,771.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,494.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,185.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,974.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,940.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,332.20
|
| Rate for Payer: PHCS Commercial |
$3,244.80
|
| Rate for Payer: United Healthcare All Payer |
$2,974.40
|
|
|
PLATE NARROW LCK COMP 4.5 6H
|
Facility
|
IP
|
$3,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.00 |
| Max. Negotiated Rate |
$3,244.80 |
| Rate for Payer: Aetna Commercial |
$2,602.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,636.40
|
| Rate for Payer: Cash Price |
$1,690.00
|
| Rate for Payer: Cigna Commercial |
$2,805.40
|
| Rate for Payer: First Health Commercial |
$3,211.00
|
| Rate for Payer: Humana Commercial |
$2,873.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,771.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,494.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,014.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,974.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,704.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,940.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,332.20
|
| Rate for Payer: PHCS Commercial |
$3,244.80
|
| Rate for Payer: United Healthcare All Payer |
$2,974.40
|
|
|
PLATE NARROW LCK COMP 4.5 7H
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem Medicaid |
$1,172.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Humana KY Medicaid |
$1,172.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LCK COMP 4.5 7H
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LCK COMP 4.5 8H
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LCK COMP 4.5 8H
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem Medicaid |
$1,172.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Humana KY Medicaid |
$1,172.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LCK COMP 4.5 9H
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem Medicaid |
$1,172.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Humana KY Medicaid |
$1,172.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LCK COMP 4.5 9H
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE NARROW LOCK COMP 4.5 4H
|
Facility
|
OP
|
$2,029.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.88 |
| Max. Negotiated Rate |
$1,948.42 |
| Rate for Payer: Aetna Commercial |
$1,562.79
|
| Rate for Payer: Anthem Medicaid |
$697.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.09
|
| Rate for Payer: Cash Price |
$1,014.80
|
| Rate for Payer: Cigna Commercial |
$1,684.57
|
| Rate for Payer: First Health Commercial |
$1,928.12
|
| Rate for Payer: Humana Commercial |
$1,725.16
|
| Rate for Payer: Humana KY Medicaid |
$697.98
|
| Rate for Payer: Kentucky WC Medicaid |
$705.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$711.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,400.42
|
| Rate for Payer: PHCS Commercial |
$1,948.42
|
| Rate for Payer: United Healthcare All Payer |
$1,786.05
|
|
|
PLATE NARROW LOCK COMP 4.5 4H
|
Facility
|
IP
|
$2,029.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.88 |
| Max. Negotiated Rate |
$1,948.42 |
| Rate for Payer: Aetna Commercial |
$1,562.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,583.09
|
| Rate for Payer: Cash Price |
$1,014.80
|
| Rate for Payer: Cigna Commercial |
$1,684.57
|
| Rate for Payer: First Health Commercial |
$1,928.12
|
| Rate for Payer: Humana Commercial |
$1,725.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,664.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,786.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,522.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,400.42
|
| Rate for Payer: PHCS Commercial |
$1,948.42
|
| Rate for Payer: United Healthcare All Payer |
$1,786.05
|
|
|
PLATE NARROW LOCK COMP 4.5 5H
|
Facility
|
IP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
PLATE NARROW LOCK COMP 4.5 5H
|
Facility
|
OP
|
$3,290.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.00 |
| Max. Negotiated Rate |
$3,158.40 |
| Rate for Payer: Aetna Commercial |
$2,533.30
|
| Rate for Payer: Anthem Medicaid |
$1,131.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.20
|
| Rate for Payer: Cash Price |
$1,645.00
|
| Rate for Payer: Cigna Commercial |
$2,730.70
|
| Rate for Payer: First Health Commercial |
$3,125.50
|
| Rate for Payer: Humana Commercial |
$2,796.50
|
| Rate for Payer: Humana KY Medicaid |
$1,131.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,142.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,428.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,632.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,270.10
|
| Rate for Payer: PHCS Commercial |
$3,158.40
|
| Rate for Payer: United Healthcare All Payer |
$2,895.20
|
|
|
PLATE NCB FEM SHFT CVD 10H*210
|
Facility
|
OP
|
$5,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.00 |
| Max. Negotiated Rate |
$4,972.80 |
| Rate for Payer: Aetna Commercial |
$3,988.60
|
| Rate for Payer: Anthem Medicaid |
$1,781.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,040.40
|
| Rate for Payer: Cash Price |
$2,590.00
|
| Rate for Payer: Cigna Commercial |
$4,299.40
|
| Rate for Payer: First Health Commercial |
$4,921.00
|
| Rate for Payer: Humana Commercial |
$4,403.00
|
| Rate for Payer: Humana KY Medicaid |
$1,781.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,247.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,817.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,558.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,506.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.20
|
| Rate for Payer: PHCS Commercial |
$4,972.80
|
| Rate for Payer: United Healthcare All Payer |
$4,558.40
|
|
|
PLATE NCB FEM SHFT CVD 10H*210
|
Facility
|
IP
|
$5,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.00 |
| Max. Negotiated Rate |
$4,972.80 |
| Rate for Payer: Aetna Commercial |
$3,988.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,040.40
|
| Rate for Payer: Cash Price |
$2,590.00
|
| Rate for Payer: Cigna Commercial |
$4,299.40
|
| Rate for Payer: First Health Commercial |
$4,921.00
|
| Rate for Payer: Humana Commercial |
$4,403.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,247.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,822.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,558.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,885.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,144.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,506.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.20
|
| Rate for Payer: PHCS Commercial |
$4,972.80
|
| Rate for Payer: United Healthcare All Payer |
$4,558.40
|
|
|
PLATE NCB FEM SHFT CVD 12H*249
|
Facility
|
OP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem Medicaid |
$1,843.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Humana KY Medicaid |
$1,843.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,862.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,880.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
PLATE NCB FEM SHFT CVD 12H*249
|
Facility
|
IP
|
$5,360.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,608.00 |
| Max. Negotiated Rate |
$5,145.60 |
| Rate for Payer: Aetna Commercial |
$4,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,180.80
|
| Rate for Payer: Cash Price |
$2,680.00
|
| Rate for Payer: Cigna Commercial |
$4,448.80
|
| Rate for Payer: First Health Commercial |
$5,092.00
|
| Rate for Payer: Humana Commercial |
$4,556.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,395.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,955.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,608.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,716.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,020.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,288.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,663.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,698.40
|
| Rate for Payer: PHCS Commercial |
$5,145.60
|
| Rate for Payer: United Healthcare All Payer |
$4,716.80
|
|
|
PLATE NCB FEM SHFT CVD 14H*289
|
Facility
|
OP
|
$5,510.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.00 |
| Max. Negotiated Rate |
$5,289.60 |
| Rate for Payer: Aetna Commercial |
$4,242.70
|
| Rate for Payer: Anthem Medicaid |
$1,894.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,297.80
|
| Rate for Payer: Cash Price |
$2,755.00
|
| Rate for Payer: Cigna Commercial |
$4,573.30
|
| Rate for Payer: First Health Commercial |
$5,234.50
|
| Rate for Payer: Humana Commercial |
$4,683.50
|
| Rate for Payer: Humana KY Medicaid |
$1,894.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,914.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,518.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,066.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,653.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,932.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,848.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,132.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,793.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.90
|
| Rate for Payer: PHCS Commercial |
$5,289.60
|
| Rate for Payer: United Healthcare All Payer |
$4,848.80
|
|
|
PLATE NCB FEM SHFT CVD 14H*289
|
Facility
|
IP
|
$5,510.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,653.00 |
| Max. Negotiated Rate |
$5,289.60 |
| Rate for Payer: Aetna Commercial |
$4,242.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,297.80
|
| Rate for Payer: Cash Price |
$2,755.00
|
| Rate for Payer: Cigna Commercial |
$4,573.30
|
| Rate for Payer: First Health Commercial |
$5,234.50
|
| Rate for Payer: Humana Commercial |
$4,683.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,518.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,066.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,653.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,848.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,132.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,408.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,793.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,801.90
|
| Rate for Payer: PHCS Commercial |
$5,289.60
|
| Rate for Payer: United Healthcare All Payer |
$4,848.80
|
|
|
PLATE NCB PP DIST FEM L 278MM
|
Facility
|
OP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem Medicaid |
$3,471.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Humana KY Medicaid |
$3,471.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,507.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,541.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE NCB PP DIST FEM L 278MM
|
Facility
|
IP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE NCB PP PROX FEM L 285MM
|
Facility
|
IP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE NCB PP PROX FEM L 285MM
|
Facility
|
OP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem Medicaid |
$3,471.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Humana KY Medicaid |
$3,471.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,507.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,541.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
