|
PLATE PRIMARY RECON 11H
|
Facility
|
IP
|
$4,057.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.21 |
| Max. Negotiated Rate |
$3,895.07 |
| Rate for Payer: Aetna Commercial |
$3,124.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,164.74
|
| Rate for Payer: Cash Price |
$2,028.68
|
| Rate for Payer: Cigna Commercial |
$3,367.61
|
| Rate for Payer: First Health Commercial |
$3,854.49
|
| Rate for Payer: Humana Commercial |
$3,448.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,327.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,994.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,217.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,570.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,043.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,245.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,529.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,799.58
|
| Rate for Payer: PHCS Commercial |
$3,895.07
|
| Rate for Payer: United Healthcare All Payer |
$3,570.48
|
|
|
PLATE PRIMARY RECON 17H
|
Facility
|
OP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem Medicaid |
$1,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Humana KY Medicaid |
$1,523.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,538.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE PRIMARY RECON 17H
|
Facility
|
IP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE PRIM MTP 2.7MM LT
|
Facility
|
IP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE PRIM MTP 2.7MM LT
|
Facility
|
OP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem Medicaid |
$1,757.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Humana KY Medicaid |
$1,757.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,775.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,792.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE PRIM MTP 2.7MM RT
|
Facility
|
IP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE PRIM MTP 2.7MM RT
|
Facility
|
OP
|
$5,110.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.13 |
| Max. Negotiated Rate |
$4,906.02 |
| Rate for Payer: Aetna Commercial |
$3,935.04
|
| Rate for Payer: Anthem Medicaid |
$1,757.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,986.14
|
| Rate for Payer: Cash Price |
$2,555.22
|
| Rate for Payer: Cigna Commercial |
$4,241.67
|
| Rate for Payer: First Health Commercial |
$4,854.92
|
| Rate for Payer: Humana Commercial |
$4,343.87
|
| Rate for Payer: Humana KY Medicaid |
$1,757.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,775.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,190.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,771.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,792.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,497.19
|
| Rate for Payer: Ohio Health Group HMO |
$3,832.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,088.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,446.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,526.20
|
| Rate for Payer: PHCS Commercial |
$4,906.02
|
| Rate for Payer: United Healthcare All Payer |
$4,497.19
|
|
|
PLATE PROFL LCK 2.3 3D 2X2+2H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LCK 2.3 3D 2X2+2H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LCK 2.3 STR BAR 4H
|
Facility
|
IP
|
$3,353.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,006.12 |
| Max. Negotiated Rate |
$3,219.60 |
| Rate for Payer: Aetna Commercial |
$2,582.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.93
|
| Rate for Payer: Cash Price |
$1,676.88
|
| Rate for Payer: Cigna Commercial |
$2,783.61
|
| Rate for Payer: First Health Commercial |
$3,186.06
|
| Rate for Payer: Humana Commercial |
$2,850.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,750.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,475.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,951.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,515.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,917.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,314.09
|
| Rate for Payer: PHCS Commercial |
$3,219.60
|
| Rate for Payer: United Healthcare All Payer |
$2,951.30
|
|
|
PLATE PROFL LCK 2.3 STR BAR 4H
|
Facility
|
OP
|
$3,353.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,006.12 |
| Max. Negotiated Rate |
$3,219.60 |
| Rate for Payer: Aetna Commercial |
$2,582.39
|
| Rate for Payer: Anthem Medicaid |
$1,153.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.93
|
| Rate for Payer: Cash Price |
$1,676.88
|
| Rate for Payer: Cigna Commercial |
$2,783.61
|
| Rate for Payer: First Health Commercial |
$3,186.06
|
| Rate for Payer: Humana Commercial |
$2,850.69
|
| Rate for Payer: Humana KY Medicaid |
$1,153.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,165.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,750.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,475.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,006.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,176.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,951.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,515.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,683.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,917.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,314.09
|
| Rate for Payer: PHCS Commercial |
$3,219.60
|
| Rate for Payer: United Healthcare All Payer |
$2,951.30
|
|
|
PLATE PROFL LK 2.3 3D RPL 4X2H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 2.3 3D RPL 4X2H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D 1.7 2X2H+2H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D 1.7 2X2H+2H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D NAR 1.7 2X2H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D NAR 1.7 2X2H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D NAR 1.7 3X2H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D NAR 1.7 3X2H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D NAR 1.7 4X2H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFL LK 3D NAR 1.7 4X2H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PROFY L CMP 2.3 6H L 90^
|
Facility
|
OP
|
$2,178.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.57 |
| Max. Negotiated Rate |
$2,091.42 |
| Rate for Payer: Aetna Commercial |
$1,677.49
|
| Rate for Payer: Anthem Medicaid |
$749.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,699.28
|
| Rate for Payer: Cash Price |
$1,089.28
|
| Rate for Payer: Cigna Commercial |
$1,808.20
|
| Rate for Payer: First Health Commercial |
$2,069.63
|
| Rate for Payer: Humana Commercial |
$1,851.78
|
| Rate for Payer: Humana KY Medicaid |
$749.21
|
| Rate for Payer: Kentucky WC Medicaid |
$756.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,786.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$764.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,917.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,895.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.21
|
| Rate for Payer: PHCS Commercial |
$2,091.42
|
| Rate for Payer: United Healthcare All Payer |
$1,917.13
|
|
|
PLATE PROFY L CMP 2.3 6H L 90^
|
Facility
|
IP
|
$2,178.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.57 |
| Max. Negotiated Rate |
$2,091.42 |
| Rate for Payer: Aetna Commercial |
$1,677.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,699.28
|
| Rate for Payer: Cash Price |
$1,089.28
|
| Rate for Payer: Cigna Commercial |
$1,808.20
|
| Rate for Payer: First Health Commercial |
$2,069.63
|
| Rate for Payer: Humana Commercial |
$1,851.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,786.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,917.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,895.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.21
|
| Rate for Payer: PHCS Commercial |
$2,091.42
|
| Rate for Payer: United Healthcare All Payer |
$1,917.13
|
|
|
PLATE PROFY L CMP 2.3 6H R 90^
|
Facility
|
IP
|
$2,178.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.57 |
| Max. Negotiated Rate |
$2,091.42 |
| Rate for Payer: Aetna Commercial |
$1,677.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,699.28
|
| Rate for Payer: Cash Price |
$1,089.28
|
| Rate for Payer: Cigna Commercial |
$1,808.20
|
| Rate for Payer: First Health Commercial |
$2,069.63
|
| Rate for Payer: Humana Commercial |
$1,851.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,786.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,917.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,895.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.21
|
| Rate for Payer: PHCS Commercial |
$2,091.42
|
| Rate for Payer: United Healthcare All Payer |
$1,917.13
|
|
|
PLATE PROFY L CMP 2.3 6H R 90^
|
Facility
|
OP
|
$2,178.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.57 |
| Max. Negotiated Rate |
$2,091.42 |
| Rate for Payer: Aetna Commercial |
$1,677.49
|
| Rate for Payer: Anthem Medicaid |
$749.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,699.28
|
| Rate for Payer: Cash Price |
$1,089.28
|
| Rate for Payer: Cigna Commercial |
$1,808.20
|
| Rate for Payer: First Health Commercial |
$2,069.63
|
| Rate for Payer: Humana Commercial |
$1,851.78
|
| Rate for Payer: Humana KY Medicaid |
$749.21
|
| Rate for Payer: Kentucky WC Medicaid |
$756.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,786.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,607.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$653.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$764.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,917.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,633.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,895.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,503.21
|
| Rate for Payer: PHCS Commercial |
$2,091.42
|
| Rate for Payer: United Healthcare All Payer |
$1,917.13
|
|
