|
PLATE TI LCP 1/3 TB CL 12H 141
|
Facility
|
OP
|
$1,990.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.81 |
| Max. Negotiated Rate |
$1,911.22 |
| Rate for Payer: Aetna Commercial |
$1,532.95
|
| Rate for Payer: Anthem Medicaid |
$684.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,552.86
|
| Rate for Payer: Cash Price |
$995.42
|
| Rate for Payer: Cigna Commercial |
$1,652.41
|
| Rate for Payer: First Health Commercial |
$1,891.31
|
| Rate for Payer: Humana Commercial |
$1,692.22
|
| Rate for Payer: Humana KY Medicaid |
$684.65
|
| Rate for Payer: Kentucky WC Medicaid |
$691.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,632.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$698.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,751.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.16
|
| Rate for Payer: PHCS Commercial |
$1,911.22
|
| Rate for Payer: United Healthcare All Payer |
$1,751.95
|
|
|
PLATE TI LCP 1/3 TB W/CL 5H 57
|
Facility
|
IP
|
$3,719.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.47 |
| Max. Negotiated Rate |
$3,570.24 |
| Rate for Payer: Aetna Commercial |
$2,863.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.82
|
| Rate for Payer: Cash Price |
$1,859.50
|
| Rate for Payer: Cigna Commercial |
$3,086.77
|
| Rate for Payer: First Health Commercial |
$3,533.05
|
| Rate for Payer: Humana Commercial |
$3,161.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,049.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,272.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,789.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.89
|
| Rate for Payer: PHCS Commercial |
$3,570.24
|
| Rate for Payer: United Healthcare All Payer |
$3,272.72
|
|
|
PLATE TI LCP 1/3 TB W/CL 5H 57
|
Facility
|
OP
|
$3,719.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.47 |
| Max. Negotiated Rate |
$3,570.24 |
| Rate for Payer: Anthem Medicaid |
$1,278.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,900.82
|
| Rate for Payer: Cash Price |
$1,859.50
|
| Rate for Payer: Cigna Commercial |
$3,086.77
|
| Rate for Payer: First Health Commercial |
$3,533.05
|
| Rate for Payer: Humana Commercial |
$3,161.15
|
| Rate for Payer: Humana KY Medicaid |
$1,278.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,049.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,744.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,272.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,789.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$743.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,152.89
|
| Rate for Payer: PHCS Commercial |
$3,570.24
|
| Rate for Payer: United Healthcare All Payer |
$3,272.72
|
| Rate for Payer: Aetna Commercial |
$2,863.63
|
|
|
PLATE TI LCP 1/3 TB W/CL 6H 69
|
Facility
|
IP
|
$2,010.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.39 |
| Max. Negotiated Rate |
$1,930.23 |
| Rate for Payer: Aetna Commercial |
$1,548.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,568.31
|
| Rate for Payer: Cash Price |
$1,005.33
|
| Rate for Payer: Cigna Commercial |
$1,668.85
|
| Rate for Payer: First Health Commercial |
$1,910.13
|
| Rate for Payer: Humana Commercial |
$1,709.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,648.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,483.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$603.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,769.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,508.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$623.30
|
| Rate for Payer: PHCS Commercial |
$1,930.23
|
| Rate for Payer: United Healthcare All Payer |
$1,769.38
|
|
|
PLATE TI LCP 1/3 TB W/CL 6H 69
|
Facility
|
OP
|
$2,010.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$261.39 |
| Max. Negotiated Rate |
$1,930.23 |
| Rate for Payer: Aetna Commercial |
$1,548.21
|
| Rate for Payer: Anthem Medicaid |
$691.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,568.31
|
| Rate for Payer: Cash Price |
$1,005.33
|
| Rate for Payer: Cigna Commercial |
$1,668.85
|
| Rate for Payer: First Health Commercial |
$1,910.13
|
| Rate for Payer: Humana Commercial |
$1,709.06
|
| Rate for Payer: Humana KY Medicaid |
$691.47
|
| Rate for Payer: Kentucky WC Medicaid |
$698.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,648.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,483.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$603.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$705.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,769.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,508.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$402.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$261.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$623.30
|
| Rate for Payer: PHCS Commercial |
$1,930.23
|
| Rate for Payer: United Healthcare All Payer |
$1,769.38
|
|
|
PLATE TI LCP 1/3 TB W/CL 7H 81
|
Facility
|
OP
|
$2,051.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.69 |
| Max. Negotiated Rate |
$1,969.41 |
| Rate for Payer: Aetna Commercial |
$1,579.63
|
| Rate for Payer: Anthem Medicaid |
$705.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.15
|
| Rate for Payer: Cash Price |
$1,025.73
|
| Rate for Payer: Cigna Commercial |
$1,702.72
|
| Rate for Payer: First Health Commercial |
$1,948.90
|
| Rate for Payer: Humana Commercial |
$1,743.75
|
| Rate for Payer: Humana KY Medicaid |
$705.50
|
| Rate for Payer: Kentucky WC Medicaid |
$712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,538.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.96
|
| Rate for Payer: PHCS Commercial |
$1,969.41
|
| Rate for Payer: United Healthcare All Payer |
$1,805.29
|
|
|
PLATE TI LCP 1/3 TB W/CL 7H 81
|
Facility
|
IP
|
$2,051.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.69 |
| Max. Negotiated Rate |
$1,969.41 |
| Rate for Payer: Aetna Commercial |
$1,579.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.15
|
| Rate for Payer: Cash Price |
$1,025.73
|
| Rate for Payer: Cigna Commercial |
$1,702.72
|
| Rate for Payer: First Health Commercial |
$1,948.90
|
| Rate for Payer: Humana Commercial |
$1,743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,538.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.96
|
| Rate for Payer: PHCS Commercial |
$1,969.41
|
| Rate for Payer: United Healthcare All Payer |
$1,805.29
|
|
|
PLATE TI LCP 1/3 TB W/CL 8H 93
|
Facility
|
OP
|
$2,022.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.96 |
| Max. Negotiated Rate |
$1,941.86 |
| Rate for Payer: Aetna Commercial |
$1,557.53
|
| Rate for Payer: Anthem Medicaid |
$695.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.76
|
| Rate for Payer: Cash Price |
$1,011.38
|
| Rate for Payer: Cigna Commercial |
$1,678.90
|
| Rate for Payer: First Health Commercial |
$1,921.63
|
| Rate for Payer: Humana Commercial |
$1,719.35
|
| Rate for Payer: Humana KY Medicaid |
$695.63
|
| Rate for Payer: Kentucky WC Medicaid |
$702.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$709.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.06
|
| Rate for Payer: PHCS Commercial |
$1,941.86
|
| Rate for Payer: United Healthcare All Payer |
$1,780.04
|
|
|
PLATE TI LCP 1/3 TB W/CL 8H 93
|
Facility
|
IP
|
$2,022.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.96 |
| Max. Negotiated Rate |
$1,941.86 |
| Rate for Payer: Aetna Commercial |
$1,557.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,577.76
|
| Rate for Payer: Cash Price |
$1,011.38
|
| Rate for Payer: Cigna Commercial |
$1,678.90
|
| Rate for Payer: First Health Commercial |
$1,921.63
|
| Rate for Payer: Humana Commercial |
$1,719.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,658.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,492.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,780.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,517.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.06
|
| Rate for Payer: PHCS Commercial |
$1,941.86
|
| Rate for Payer: United Healthcare All Payer |
$1,780.04
|
|
|
PLATE TI LCP 3.5*111MM 8H
|
Facility
|
OP
|
$3,481.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.57 |
| Max. Negotiated Rate |
$3,342.07 |
| Rate for Payer: Aetna Commercial |
$2,680.62
|
| Rate for Payer: Anthem Medicaid |
$1,197.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.43
|
| Rate for Payer: Cash Price |
$1,740.66
|
| Rate for Payer: Cigna Commercial |
$2,889.50
|
| Rate for Payer: First Health Commercial |
$3,307.25
|
| Rate for Payer: Humana Commercial |
$2,959.12
|
| Rate for Payer: Humana KY Medicaid |
$1,197.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.21
|
| Rate for Payer: PHCS Commercial |
$3,342.07
|
| Rate for Payer: United Healthcare All Payer |
$3,063.56
|
|
|
PLATE TI LCP 3.5*111MM 8H
|
Facility
|
IP
|
$3,481.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.57 |
| Max. Negotiated Rate |
$3,342.07 |
| Rate for Payer: Aetna Commercial |
$2,680.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.43
|
| Rate for Payer: Cash Price |
$1,740.66
|
| Rate for Payer: Cigna Commercial |
$2,889.50
|
| Rate for Payer: First Health Commercial |
$3,307.25
|
| Rate for Payer: Humana Commercial |
$2,959.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.21
|
| Rate for Payer: PHCS Commercial |
$3,342.07
|
| Rate for Payer: United Healthcare All Payer |
$3,063.56
|
|
|
PLATE TI LCP 3.5*124MM 9H
|
Facility
|
IP
|
$3,588.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.49 |
| Max. Negotiated Rate |
$3,444.88 |
| Rate for Payer: Aetna Commercial |
$2,763.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,798.97
|
| Rate for Payer: Cash Price |
$1,794.21
|
| Rate for Payer: Cigna Commercial |
$2,978.39
|
| Rate for Payer: First Health Commercial |
$3,409.00
|
| Rate for Payer: Humana Commercial |
$3,050.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,942.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,648.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,157.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,691.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.41
|
| Rate for Payer: PHCS Commercial |
$3,444.88
|
| Rate for Payer: United Healthcare All Payer |
$3,157.81
|
|
|
PLATE TI LCP 3.5*124MM 9H
|
Facility
|
OP
|
$3,588.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.49 |
| Max. Negotiated Rate |
$3,444.88 |
| Rate for Payer: Aetna Commercial |
$2,763.08
|
| Rate for Payer: Anthem Medicaid |
$1,234.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,798.97
|
| Rate for Payer: Cash Price |
$1,794.21
|
| Rate for Payer: Cigna Commercial |
$2,978.39
|
| Rate for Payer: First Health Commercial |
$3,409.00
|
| Rate for Payer: Humana Commercial |
$3,050.16
|
| Rate for Payer: Humana KY Medicaid |
$1,234.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,246.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,942.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,648.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,258.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,157.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,691.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$717.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,112.41
|
| Rate for Payer: PHCS Commercial |
$3,444.88
|
| Rate for Payer: United Healthcare All Payer |
$3,157.81
|
|
|
PLATE TI LCP 3.5*137MM 10H
|
Facility
|
IP
|
$3,453.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$3,315.69 |
| Rate for Payer: Aetna Commercial |
$2,659.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,694.00
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna Commercial |
$2,866.69
|
| Rate for Payer: First Health Commercial |
$3,281.15
|
| Rate for Payer: Humana Commercial |
$2,935.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,832.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,548.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,036.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,039.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.69
|
| Rate for Payer: PHCS Commercial |
$3,315.69
|
| Rate for Payer: United Healthcare All Payer |
$3,039.38
|
|
|
PLATE TI LCP 3.5*137MM 10H
|
Facility
|
OP
|
$3,453.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$3,315.69 |
| Rate for Payer: Aetna Commercial |
$2,659.46
|
| Rate for Payer: Anthem Medicaid |
$1,187.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,694.00
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna Commercial |
$2,866.69
|
| Rate for Payer: First Health Commercial |
$3,281.15
|
| Rate for Payer: Humana Commercial |
$2,935.76
|
| Rate for Payer: Humana KY Medicaid |
$1,187.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,832.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,548.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,036.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,039.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.69
|
| Rate for Payer: PHCS Commercial |
$3,315.69
|
| Rate for Payer: United Healthcare All Payer |
$3,039.38
|
|
|
PLATE TI LCP 3.5*163MM 12H
|
Facility
|
OP
|
$3,850.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.53 |
| Max. Negotiated Rate |
$3,696.24 |
| Rate for Payer: Aetna Commercial |
$2,964.69
|
| Rate for Payer: Anthem Medicaid |
$1,324.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,003.20
|
| Rate for Payer: Cash Price |
$1,925.12
|
| Rate for Payer: Cigna Commercial |
$3,195.71
|
| Rate for Payer: First Health Commercial |
$3,657.74
|
| Rate for Payer: Humana Commercial |
$3,272.71
|
| Rate for Payer: Humana KY Medicaid |
$1,324.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,337.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,157.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,841.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,350.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,388.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,887.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$770.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.58
|
| Rate for Payer: PHCS Commercial |
$3,696.24
|
| Rate for Payer: United Healthcare All Payer |
$3,388.22
|
|
|
PLATE TI LCP 3.5*163MM 12H
|
Facility
|
IP
|
$3,850.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.53 |
| Max. Negotiated Rate |
$3,696.24 |
| Rate for Payer: Humana Commercial |
$3,272.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,157.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,841.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,388.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,887.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$770.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,193.58
|
| Rate for Payer: PHCS Commercial |
$3,696.24
|
| Rate for Payer: United Healthcare All Payer |
$3,388.22
|
| Rate for Payer: Aetna Commercial |
$2,964.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,003.20
|
| Rate for Payer: Cash Price |
$1,925.12
|
| Rate for Payer: Cigna Commercial |
$3,195.71
|
| Rate for Payer: First Health Commercial |
$3,657.74
|
|
|
PLATE TI LCP 3.5*189MM 14H
|
Facility
|
IP
|
$4,274.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.65 |
| Max. Negotiated Rate |
$4,103.27 |
| Rate for Payer: Aetna Commercial |
$3,291.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.91
|
| Rate for Payer: Cash Price |
$2,137.12
|
| Rate for Payer: Cigna Commercial |
$3,547.62
|
| Rate for Payer: First Health Commercial |
$4,060.53
|
| Rate for Payer: Humana Commercial |
$3,633.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.33
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.01
|
| Rate for Payer: PHCS Commercial |
$4,103.27
|
| Rate for Payer: United Healthcare All Payer |
$3,761.33
|
|
|
PLATE TI LCP 3.5*189MM 14H
|
Facility
|
OP
|
$4,274.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.65 |
| Max. Negotiated Rate |
$4,103.27 |
| Rate for Payer: Aetna Commercial |
$3,291.16
|
| Rate for Payer: Anthem Medicaid |
$1,469.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,333.91
|
| Rate for Payer: Cash Price |
$2,137.12
|
| Rate for Payer: Cigna Commercial |
$3,547.62
|
| Rate for Payer: First Health Commercial |
$4,060.53
|
| Rate for Payer: Humana Commercial |
$3,633.10
|
| Rate for Payer: Humana KY Medicaid |
$1,469.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,504.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,154.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,282.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,499.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,761.33
|
| Rate for Payer: Ohio Health Group HMO |
$3,205.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$854.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$555.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,325.01
|
| Rate for Payer: PHCS Commercial |
$4,103.27
|
| Rate for Payer: United Healthcare All Payer |
$3,761.33
|
|
|
PLATE TI LCP 3.5*72MM 5H
|
Facility
|
IP
|
$3,203.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$3,074.94 |
| Rate for Payer: Aetna Commercial |
$2,466.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,498.39
|
| Rate for Payer: Cash Price |
$1,601.53
|
| Rate for Payer: Cigna Commercial |
$2,658.54
|
| Rate for Payer: First Health Commercial |
$3,042.91
|
| Rate for Payer: Humana Commercial |
$2,722.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,626.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,363.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,818.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,402.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.95
|
| Rate for Payer: PHCS Commercial |
$3,074.94
|
| Rate for Payer: United Healthcare All Payer |
$2,818.69
|
|
|
PLATE TI LCP 3.5*72MM 5H
|
Facility
|
OP
|
$3,203.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.40 |
| Max. Negotiated Rate |
$3,074.94 |
| Rate for Payer: Aetna Commercial |
$2,466.36
|
| Rate for Payer: Anthem Medicaid |
$1,101.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,498.39
|
| Rate for Payer: Cash Price |
$1,601.53
|
| Rate for Payer: Cigna Commercial |
$2,658.54
|
| Rate for Payer: First Health Commercial |
$3,042.91
|
| Rate for Payer: Humana Commercial |
$2,722.60
|
| Rate for Payer: Humana KY Medicaid |
$1,101.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,112.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,626.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,363.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,123.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,818.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,402.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$992.95
|
| Rate for Payer: PHCS Commercial |
$3,074.94
|
| Rate for Payer: United Healthcare All Payer |
$2,818.69
|
|
|
PLATE TI LCP 3.5*85MM 6H
|
Facility
|
OP
|
$3,477.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.06 |
| Max. Negotiated Rate |
$3,338.30 |
| Rate for Payer: Aetna Commercial |
$2,677.60
|
| Rate for Payer: Anthem Medicaid |
$1,195.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.37
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cigna Commercial |
$2,886.24
|
| Rate for Payer: First Health Commercial |
$3,303.53
|
| Rate for Payer: Humana Commercial |
$2,955.79
|
| Rate for Payer: Humana KY Medicaid |
$1,195.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,208.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,219.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.99
|
| Rate for Payer: PHCS Commercial |
$3,338.30
|
| Rate for Payer: United Healthcare All Payer |
$3,060.11
|
|
|
PLATE TI LCP 3.5*85MM 6H
|
Facility
|
IP
|
$3,477.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.06 |
| Max. Negotiated Rate |
$3,338.30 |
| Rate for Payer: Aetna Commercial |
$2,677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.37
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cigna Commercial |
$2,886.24
|
| Rate for Payer: First Health Commercial |
$3,303.53
|
| Rate for Payer: Humana Commercial |
$2,955.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.99
|
| Rate for Payer: PHCS Commercial |
$3,338.30
|
| Rate for Payer: United Healthcare All Payer |
$3,060.11
|
|
|
PLATE TI LCP PROX HM 3H 3.5*90
|
Facility
|
OP
|
$9,133.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.35 |
| Max. Negotiated Rate |
$8,768.10 |
| Rate for Payer: Humana Commercial |
$7,763.42
|
| Rate for Payer: Humana KY Medicaid |
$3,140.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,489.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,740.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,204.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,037.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,850.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.37
|
| Rate for Payer: PHCS Commercial |
$8,768.10
|
| Rate for Payer: United Healthcare All Payer |
$8,037.43
|
| Rate for Payer: Aetna Commercial |
$7,032.75
|
| Rate for Payer: Anthem Medicaid |
$3,140.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,124.08
|
| Rate for Payer: Cash Price |
$4,566.72
|
| Rate for Payer: Cigna Commercial |
$7,580.76
|
| Rate for Payer: First Health Commercial |
$8,676.77
|
|
|
PLATE TI LCP PROX HM 3H 3.5*90
|
Facility
|
IP
|
$9,133.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.35 |
| Max. Negotiated Rate |
$8,768.10 |
| Rate for Payer: Aetna Commercial |
$7,032.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,124.08
|
| Rate for Payer: Cash Price |
$4,566.72
|
| Rate for Payer: Cigna Commercial |
$7,580.76
|
| Rate for Payer: First Health Commercial |
$8,676.77
|
| Rate for Payer: Humana Commercial |
$7,763.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,489.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,740.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,037.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,850.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.37
|
| Rate for Payer: PHCS Commercial |
$8,768.10
|
| Rate for Payer: United Healthcare All Payer |
$8,037.43
|
|
