|
PLATE ONE-THIRD TUBULAR 4H
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
|
PLATE ONE-THIRD TUBULAR 5H
|
Facility
|
OP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem Medicaid |
$517.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Humana KY Medicaid |
$517.23
|
| Rate for Payer: Kentucky WC Medicaid |
$522.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$527.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
PLATE ONE-THIRD TUBULAR 5H
|
Facility
|
IP
|
$1,504.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.20 |
| Max. Negotiated Rate |
$1,443.84 |
| Rate for Payer: Aetna Commercial |
$1,158.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,173.12
|
| Rate for Payer: Cash Price |
$752.00
|
| Rate for Payer: Cigna Commercial |
$1,248.32
|
| Rate for Payer: First Health Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial |
$1,278.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,233.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,109.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$451.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,323.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,128.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,203.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,308.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,037.76
|
| Rate for Payer: PHCS Commercial |
$1,443.84
|
| Rate for Payer: United Healthcare All Payer |
$1,323.52
|
|
|
PLATE ONE-THIRD TUBULAR 6H
|
Facility
|
IP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
PLATE ONE-THIRD TUBULAR 6H
|
Facility
|
OP
|
$1,523.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.90 |
| Max. Negotiated Rate |
$1,462.08 |
| Rate for Payer: Aetna Commercial |
$1,172.71
|
| Rate for Payer: Anthem Medicaid |
$523.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,187.94
|
| Rate for Payer: Cash Price |
$761.50
|
| Rate for Payer: Cigna Commercial |
$1,264.09
|
| Rate for Payer: First Health Commercial |
$1,446.85
|
| Rate for Payer: Humana Commercial |
$1,294.55
|
| Rate for Payer: Humana KY Medicaid |
$523.76
|
| Rate for Payer: Kentucky WC Medicaid |
$529.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,248.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,123.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$534.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,340.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,142.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,218.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,325.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.87
|
| Rate for Payer: PHCS Commercial |
$1,462.08
|
| Rate for Payer: United Healthcare All Payer |
$1,340.24
|
|
|
PLATE ONE-THIRD TUBULAR 7H
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE ONE-THIRD TUBULAR 7H
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.60 |
| Max. Negotiated Rate |
$1,480.32 |
| Rate for Payer: Aetna Commercial |
$1,187.34
|
| Rate for Payer: Anthem Medicaid |
$530.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.76
|
| Rate for Payer: Cash Price |
$771.00
|
| Rate for Payer: Cigna Commercial |
$1,279.86
|
| Rate for Payer: First Health Commercial |
$1,464.90
|
| Rate for Payer: Humana Commercial |
$1,310.70
|
| Rate for Payer: Humana KY Medicaid |
$530.29
|
| Rate for Payer: Kentucky WC Medicaid |
$535.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,356.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,063.98
|
| Rate for Payer: PHCS Commercial |
$1,480.32
|
| Rate for Payer: United Healthcare All Payer |
$1,356.96
|
|
|
PLATE ONE-THIRD TUBULAR 8H
|
Facility
|
OP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem Medicaid |
$536.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Humana KY Medicaid |
$536.83
|
| Rate for Payer: Kentucky WC Medicaid |
$542.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$547.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
PLATE ONE-THIRD TUBULAR 8H
|
Facility
|
IP
|
$1,561.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.30 |
| Max. Negotiated Rate |
$1,498.56 |
| Rate for Payer: Aetna Commercial |
$1,201.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,217.58
|
| Rate for Payer: Cash Price |
$780.50
|
| Rate for Payer: Cigna Commercial |
$1,295.63
|
| Rate for Payer: First Health Commercial |
$1,482.95
|
| Rate for Payer: Humana Commercial |
$1,326.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,280.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,152.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,373.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,170.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,248.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,358.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.09
|
| Rate for Payer: PHCS Commercial |
$1,498.56
|
| Rate for Payer: United Healthcare All Payer |
$1,373.68
|
|
|
PLATE PERC CALC MD 2.7M 58M L
|
Facility
|
OP
|
$7,091.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.44 |
| Max. Negotiated Rate |
$6,807.81 |
| Rate for Payer: Aetna Commercial |
$5,460.43
|
| Rate for Payer: Anthem Medicaid |
$2,438.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,531.35
|
| Rate for Payer: Cash Price |
$3,545.73
|
| Rate for Payer: Cigna Commercial |
$5,885.92
|
| Rate for Payer: First Health Commercial |
$6,736.90
|
| Rate for Payer: Humana Commercial |
$6,027.75
|
| Rate for Payer: Humana KY Medicaid |
$2,438.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,673.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.11
|
| Rate for Payer: PHCS Commercial |
$6,807.81
|
| Rate for Payer: United Healthcare All Payer |
$6,240.49
|
|
|
PLATE PERC CALC MD 2.7M 58M L
|
Facility
|
IP
|
$7,091.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.44 |
| Max. Negotiated Rate |
$6,807.81 |
| Rate for Payer: Aetna Commercial |
$5,460.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,531.35
|
| Rate for Payer: Cash Price |
$3,545.73
|
| Rate for Payer: Cigna Commercial |
$5,885.92
|
| Rate for Payer: First Health Commercial |
$6,736.90
|
| Rate for Payer: Humana Commercial |
$6,027.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,673.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.11
|
| Rate for Payer: PHCS Commercial |
$6,807.81
|
| Rate for Payer: United Healthcare All Payer |
$6,240.49
|
|
|
PLATE PERC CALC MD 2.7M 58M R
|
Facility
|
IP
|
$7,091.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.44 |
| Max. Negotiated Rate |
$6,807.81 |
| Rate for Payer: Aetna Commercial |
$5,460.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,531.35
|
| Rate for Payer: Cash Price |
$3,545.73
|
| Rate for Payer: Cigna Commercial |
$5,885.92
|
| Rate for Payer: First Health Commercial |
$6,736.90
|
| Rate for Payer: Humana Commercial |
$6,027.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,673.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.11
|
| Rate for Payer: PHCS Commercial |
$6,807.81
|
| Rate for Payer: United Healthcare All Payer |
$6,240.49
|
|
|
PLATE PERC CALC MD 2.7M 58M R
|
Facility
|
OP
|
$7,091.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.44 |
| Max. Negotiated Rate |
$6,807.81 |
| Rate for Payer: Aetna Commercial |
$5,460.43
|
| Rate for Payer: Anthem Medicaid |
$2,438.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,531.35
|
| Rate for Payer: Cash Price |
$3,545.73
|
| Rate for Payer: Cigna Commercial |
$5,885.92
|
| Rate for Payer: First Health Commercial |
$6,736.90
|
| Rate for Payer: Humana Commercial |
$6,027.75
|
| Rate for Payer: Humana KY Medicaid |
$2,438.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,673.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.11
|
| Rate for Payer: PHCS Commercial |
$6,807.81
|
| Rate for Payer: United Healthcare All Payer |
$6,240.49
|
|
|
PLATE PINCH 4H STR
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PLATE PINCH 4H STR
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PLATE PINCH 6H STR
|
Facility
|
IP
|
$9,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.75 |
| Max. Negotiated Rate |
$9,362.40 |
| Rate for Payer: Aetna Commercial |
$7,509.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,606.95
|
| Rate for Payer: Cash Price |
$4,876.25
|
| Rate for Payer: Cigna Commercial |
$8,094.57
|
| Rate for Payer: First Health Commercial |
$9,264.88
|
| Rate for Payer: Humana Commercial |
$8,289.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,802.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,484.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,729.23
|
| Rate for Payer: PHCS Commercial |
$9,362.40
|
| Rate for Payer: United Healthcare All Payer |
$8,582.20
|
|
|
PLATE PINCH 6H STR
|
Facility
|
OP
|
$9,752.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,925.75 |
| Max. Negotiated Rate |
$9,362.40 |
| Rate for Payer: Aetna Commercial |
$7,509.43
|
| Rate for Payer: Anthem Medicaid |
$3,353.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,606.95
|
| Rate for Payer: Cash Price |
$4,876.25
|
| Rate for Payer: Cigna Commercial |
$8,094.57
|
| Rate for Payer: First Health Commercial |
$9,264.88
|
| Rate for Payer: Humana Commercial |
$8,289.62
|
| Rate for Payer: Humana KY Medicaid |
$3,353.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,388.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,997.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,197.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,925.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,421.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,582.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,314.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,802.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,484.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,729.23
|
| Rate for Payer: PHCS Commercial |
$9,362.40
|
| Rate for Payer: United Healthcare All Payer |
$8,582.20
|
|
|
PLATE P-L-D HUM LK 11 157MM L
|
Facility
|
IP
|
$8,003.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.08 |
| Max. Negotiated Rate |
$7,683.46 |
| Rate for Payer: Aetna Commercial |
$6,162.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,242.81
|
| Rate for Payer: Cash Price |
$4,001.80
|
| Rate for Payer: Cigna Commercial |
$6,642.99
|
| Rate for Payer: First Health Commercial |
$7,603.42
|
| Rate for Payer: Humana Commercial |
$6,803.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,562.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,906.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,043.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,402.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,963.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,522.48
|
| Rate for Payer: PHCS Commercial |
$7,683.46
|
| Rate for Payer: United Healthcare All Payer |
$7,043.17
|
|
|
PLATE P-L-D HUM LK 11 157MM L
|
Facility
|
OP
|
$8,003.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,401.08 |
| Max. Negotiated Rate |
$7,683.46 |
| Rate for Payer: Aetna Commercial |
$6,162.77
|
| Rate for Payer: Anthem Medicaid |
$2,752.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,242.81
|
| Rate for Payer: Cash Price |
$4,001.80
|
| Rate for Payer: Cigna Commercial |
$6,642.99
|
| Rate for Payer: First Health Commercial |
$7,603.42
|
| Rate for Payer: Humana Commercial |
$6,803.06
|
| Rate for Payer: Humana KY Medicaid |
$2,752.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,780.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,562.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,906.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,401.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,807.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,043.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,002.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,402.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,963.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,522.48
|
| Rate for Payer: PHCS Commercial |
$7,683.46
|
| Rate for Payer: United Healthcare All Payer |
$7,043.17
|
|
|
PLATE P-L-D HUM LK 11 157MM R
|
Facility
|
OP
|
$7,821.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,346.33 |
| Max. Negotiated Rate |
$7,508.26 |
| Rate for Payer: Aetna Commercial |
$6,022.25
|
| Rate for Payer: Anthem Medicaid |
$2,689.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,100.46
|
| Rate for Payer: Cash Price |
$3,910.55
|
| Rate for Payer: Cigna Commercial |
$6,491.51
|
| Rate for Payer: First Health Commercial |
$7,430.05
|
| Rate for Payer: Humana Commercial |
$6,647.94
|
| Rate for Payer: Humana KY Medicaid |
$2,689.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,717.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,413.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,771.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,743.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,882.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,865.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,256.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,804.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.56
|
| Rate for Payer: PHCS Commercial |
$7,508.26
|
| Rate for Payer: United Healthcare All Payer |
$6,882.57
|
|
|
PLATE P-L-D HUM LK 11 157MM R
|
Facility
|
IP
|
$7,821.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,346.33 |
| Max. Negotiated Rate |
$7,508.26 |
| Rate for Payer: Aetna Commercial |
$6,022.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,100.46
|
| Rate for Payer: Cash Price |
$3,910.55
|
| Rate for Payer: Cigna Commercial |
$6,491.51
|
| Rate for Payer: First Health Commercial |
$7,430.05
|
| Rate for Payer: Humana Commercial |
$6,647.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,413.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,771.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,882.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,865.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,256.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,804.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.56
|
| Rate for Payer: PHCS Commercial |
$7,508.26
|
| Rate for Payer: United Healthcare All Payer |
$6,882.57
|
|
|
PLATE P-L-D HUM LK 15 207MM L
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE P-L-D HUM LK 15 207MM L
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE P-L-D HUM LK 15 207MM R
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE P-L-D HUM LK 15 207MM R
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
