|
PLATE T SM 4H 56MM
|
Facility
|
OP
|
$1,777.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.06 |
| Max. Negotiated Rate |
$1,706.26 |
| Rate for Payer: Aetna Commercial |
$1,368.56
|
| Rate for Payer: Anthem Medicaid |
$611.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Cash Price |
$888.68
|
| Rate for Payer: Cigna Commercial |
$1,475.20
|
| Rate for Payer: First Health Commercial |
$1,688.48
|
| Rate for Payer: Humana Commercial |
$1,510.75
|
| Rate for Payer: Humana KY Medicaid |
$611.23
|
| Rate for Payer: Kentucky WC Medicaid |
$617.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,311.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$623.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,564.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,333.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.98
|
| Rate for Payer: PHCS Commercial |
$1,706.26
|
| Rate for Payer: United Healthcare All Payer |
$1,564.07
|
|
|
PLATE T SM 5H 67MM
|
Facility
|
IP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE T SM 5H 67MM
|
Facility
|
OP
|
$1,829.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.79 |
| Max. Negotiated Rate |
$1,755.98 |
| Rate for Payer: Aetna Commercial |
$1,408.45
|
| Rate for Payer: Anthem Medicaid |
$629.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,426.74
|
| Rate for Payer: Cash Price |
$914.58
|
| Rate for Payer: Cigna Commercial |
$1,518.19
|
| Rate for Payer: First Health Commercial |
$1,737.69
|
| Rate for Payer: Humana Commercial |
$1,554.78
|
| Rate for Payer: Humana KY Medicaid |
$629.04
|
| Rate for Payer: Kentucky WC Medicaid |
$635.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,349.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,371.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.04
|
| Rate for Payer: PHCS Commercial |
$1,755.98
|
| Rate for Payer: United Healthcare All Payer |
$1,609.65
|
|
|
PLATE T SMALL 4H 71829604
|
Facility
|
OP
|
$1,777.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.01 |
| Max. Negotiated Rate |
$1,705.92 |
| Rate for Payer: First Health Commercial |
$1,688.15
|
| Rate for Payer: Humana Commercial |
$1,510.45
|
| Rate for Payer: Humana KY Medicaid |
$611.11
|
| Rate for Payer: Kentucky WC Medicaid |
$617.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,311.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$623.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,563.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,332.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.87
|
| Rate for Payer: PHCS Commercial |
$1,705.92
|
| Rate for Payer: United Healthcare All Payer |
$1,563.76
|
| Rate for Payer: Aetna Commercial |
$1,368.29
|
| Rate for Payer: Anthem Medicaid |
$611.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.06
|
| Rate for Payer: Cash Price |
$888.50
|
| Rate for Payer: Cigna Commercial |
$1,474.91
|
|
|
PLATE T SMALL 4H 71829604
|
Facility
|
IP
|
$1,777.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.01 |
| Max. Negotiated Rate |
$1,705.92 |
| Rate for Payer: Aetna Commercial |
$1,368.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,386.06
|
| Rate for Payer: Cash Price |
$888.50
|
| Rate for Payer: Cigna Commercial |
$1,474.91
|
| Rate for Payer: First Health Commercial |
$1,688.15
|
| Rate for Payer: Humana Commercial |
$1,510.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,457.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,311.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,563.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,332.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$550.87
|
| Rate for Payer: PHCS Commercial |
$1,705.92
|
| Rate for Payer: United Healthcare All Payer |
$1,563.76
|
|
|
PLATE T SMALL 5H 71829605
|
Facility
|
IP
|
$1,829.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.84 |
| Max. Negotiated Rate |
$1,756.32 |
| Rate for Payer: Aetna Commercial |
$1,408.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.01
|
| Rate for Payer: Cash Price |
$914.75
|
| Rate for Payer: Cigna Commercial |
$1,518.48
|
| Rate for Payer: First Health Commercial |
$1,738.02
|
| Rate for Payer: Humana Commercial |
$1,555.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.14
|
| Rate for Payer: PHCS Commercial |
$1,756.32
|
| Rate for Payer: United Healthcare All Payer |
$1,609.96
|
|
|
PLATE T SMALL 5H 71829605
|
Facility
|
OP
|
$1,829.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.84 |
| Max. Negotiated Rate |
$1,756.32 |
| Rate for Payer: Aetna Commercial |
$1,408.72
|
| Rate for Payer: Anthem Medicaid |
$629.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.01
|
| Rate for Payer: Cash Price |
$914.75
|
| Rate for Payer: Cigna Commercial |
$1,518.48
|
| Rate for Payer: First Health Commercial |
$1,738.02
|
| Rate for Payer: Humana Commercial |
$1,555.08
|
| Rate for Payer: Humana KY Medicaid |
$629.17
|
| Rate for Payer: Kentucky WC Medicaid |
$635.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$548.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$641.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,609.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.14
|
| Rate for Payer: PHCS Commercial |
$1,756.32
|
| Rate for Payer: United Healthcare All Payer |
$1,609.96
|
|
|
PLATE T SMALL W PF 3H
|
Facility
|
IP
|
$1,880.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.52 |
| Max. Negotiated Rate |
$1,805.71 |
| Rate for Payer: Aetna Commercial |
$1,448.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.14
|
| Rate for Payer: Cash Price |
$940.48
|
| Rate for Payer: Cigna Commercial |
$1,561.19
|
| Rate for Payer: First Health Commercial |
$1,786.90
|
| Rate for Payer: Humana Commercial |
$1,598.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,410.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.09
|
| Rate for Payer: PHCS Commercial |
$1,805.71
|
| Rate for Payer: United Healthcare All Payer |
$1,655.24
|
|
|
PLATE T SMALL W PF 3H
|
Facility
|
OP
|
$1,880.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.52 |
| Max. Negotiated Rate |
$1,805.71 |
| Rate for Payer: Aetna Commercial |
$1,448.33
|
| Rate for Payer: Anthem Medicaid |
$646.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,467.14
|
| Rate for Payer: Cash Price |
$940.48
|
| Rate for Payer: Cigna Commercial |
$1,561.19
|
| Rate for Payer: First Health Commercial |
$1,786.90
|
| Rate for Payer: Humana Commercial |
$1,598.81
|
| Rate for Payer: Humana KY Medicaid |
$646.86
|
| Rate for Payer: Kentucky WC Medicaid |
$653.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,542.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,388.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$564.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$659.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,655.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,410.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$376.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$583.09
|
| Rate for Payer: PHCS Commercial |
$1,805.71
|
| Rate for Payer: United Healthcare All Payer |
$1,655.24
|
|
|
PLATE T SMALL W PF 4H
|
Facility
|
IP
|
$1,895.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.39 |
| Max. Negotiated Rate |
$1,819.49 |
| Rate for Payer: Aetna Commercial |
$1,459.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.33
|
| Rate for Payer: Cash Price |
$947.65
|
| Rate for Payer: Cigna Commercial |
$1,573.10
|
| Rate for Payer: First Health Commercial |
$1,800.54
|
| Rate for Payer: Humana Commercial |
$1,611.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.54
|
| Rate for Payer: PHCS Commercial |
$1,819.49
|
| Rate for Payer: United Healthcare All Payer |
$1,667.86
|
|
|
PLATE T SMALL W PF 4H
|
Facility
|
OP
|
$1,895.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.39 |
| Max. Negotiated Rate |
$1,819.49 |
| Rate for Payer: Aetna Commercial |
$1,459.38
|
| Rate for Payer: Anthem Medicaid |
$651.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.33
|
| Rate for Payer: Cash Price |
$947.65
|
| Rate for Payer: Cigna Commercial |
$1,573.10
|
| Rate for Payer: First Health Commercial |
$1,800.54
|
| Rate for Payer: Humana Commercial |
$1,611.00
|
| Rate for Payer: Humana KY Medicaid |
$651.79
|
| Rate for Payer: Kentucky WC Medicaid |
$658.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$664.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.54
|
| Rate for Payer: PHCS Commercial |
$1,819.49
|
| Rate for Payer: United Healthcare All Payer |
$1,667.86
|
|
|
PLATE T SMALL W PF 5H
|
Facility
|
IP
|
$2,038.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.04 |
| Max. Negotiated Rate |
$1,957.25 |
| Rate for Payer: Aetna Commercial |
$1,569.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,590.26
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,692.20
|
| Rate for Payer: First Health Commercial |
$1,936.86
|
| Rate for Payer: Humana Commercial |
$1,732.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,671.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,504.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,794.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,529.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.03
|
| Rate for Payer: PHCS Commercial |
$1,957.25
|
| Rate for Payer: United Healthcare All Payer |
$1,794.14
|
|
|
PLATE T SMALL W PF 5H
|
Facility
|
OP
|
$2,038.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.04 |
| Max. Negotiated Rate |
$1,957.25 |
| Rate for Payer: Aetna Commercial |
$1,569.88
|
| Rate for Payer: Anthem Medicaid |
$701.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,590.26
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,692.20
|
| Rate for Payer: First Health Commercial |
$1,936.86
|
| Rate for Payer: Humana Commercial |
$1,732.98
|
| Rate for Payer: Humana KY Medicaid |
$701.14
|
| Rate for Payer: Kentucky WC Medicaid |
$708.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,671.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,504.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,794.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,529.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.03
|
| Rate for Payer: PHCS Commercial |
$1,957.25
|
| Rate for Payer: United Healthcare All Payer |
$1,794.14
|
|
|
PLATE T TI 4H 84MM
|
Facility
|
OP
|
$5,403.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$5,187.41 |
| Rate for Payer: Aetna Commercial |
$4,160.73
|
| Rate for Payer: Anthem Medicaid |
$1,858.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,214.77
|
| Rate for Payer: Cash Price |
$2,701.78
|
| Rate for Payer: Cigna Commercial |
$4,484.95
|
| Rate for Payer: First Health Commercial |
$5,133.37
|
| Rate for Payer: Humana Commercial |
$4,593.02
|
| Rate for Payer: Humana KY Medicaid |
$1,858.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,877.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,430.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,987.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,621.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,895.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,755.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,052.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,675.10
|
| Rate for Payer: PHCS Commercial |
$5,187.41
|
| Rate for Payer: United Healthcare All Payer |
$4,755.12
|
|
|
PLATE T TI 4H 84MM
|
Facility
|
IP
|
$5,403.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$702.46 |
| Max. Negotiated Rate |
$5,187.41 |
| Rate for Payer: Aetna Commercial |
$4,160.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,214.77
|
| Rate for Payer: Cash Price |
$2,701.78
|
| Rate for Payer: Cigna Commercial |
$4,484.95
|
| Rate for Payer: First Health Commercial |
$5,133.37
|
| Rate for Payer: Humana Commercial |
$4,593.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,430.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,987.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,621.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,755.12
|
| Rate for Payer: Ohio Health Group HMO |
$4,052.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,080.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$702.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,675.10
|
| Rate for Payer: PHCS Commercial |
$5,187.41
|
| Rate for Payer: United Healthcare All Payer |
$4,755.12
|
|
|
PLATE T TI 6H 116MM
|
Facility
|
IP
|
$3,143.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.71 |
| Max. Negotiated Rate |
$3,018.19 |
| Rate for Payer: Aetna Commercial |
$2,420.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,452.28
|
| Rate for Payer: Cash Price |
$1,571.97
|
| Rate for Payer: Cigna Commercial |
$2,609.48
|
| Rate for Payer: First Health Commercial |
$2,986.75
|
| Rate for Payer: Humana Commercial |
$2,672.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,578.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,320.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,766.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,357.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$974.62
|
| Rate for Payer: PHCS Commercial |
$3,018.19
|
| Rate for Payer: United Healthcare All Payer |
$2,766.68
|
|
|
PLATE T TI 6H 116MM
|
Facility
|
OP
|
$3,143.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$408.71 |
| Max. Negotiated Rate |
$3,018.19 |
| Rate for Payer: Aetna Commercial |
$2,420.84
|
| Rate for Payer: Anthem Medicaid |
$1,081.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,452.28
|
| Rate for Payer: Cash Price |
$1,571.97
|
| Rate for Payer: Cigna Commercial |
$2,609.48
|
| Rate for Payer: First Health Commercial |
$2,986.75
|
| Rate for Payer: Humana Commercial |
$2,672.36
|
| Rate for Payer: Humana KY Medicaid |
$1,081.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,092.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,578.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,320.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$943.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,102.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,766.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,357.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$628.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$408.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$974.62
|
| Rate for Payer: PHCS Commercial |
$3,018.19
|
| Rate for Payer: United Healthcare All Payer |
$2,766.68
|
|
|
PLATE T TI 8H 148MM
|
Facility
|
IP
|
$3,443.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.64 |
| Max. Negotiated Rate |
$3,305.67 |
| Rate for Payer: Aetna Commercial |
$2,651.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,685.86
|
| Rate for Payer: Cash Price |
$1,721.70
|
| Rate for Payer: Cigna Commercial |
$2,858.03
|
| Rate for Payer: First Health Commercial |
$3,271.24
|
| Rate for Payer: Humana Commercial |
$2,926.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,823.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,541.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,030.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,582.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,067.46
|
| Rate for Payer: PHCS Commercial |
$3,305.67
|
| Rate for Payer: United Healthcare All Payer |
$3,030.20
|
|
|
PLATE T TI 8H 148MM
|
Facility
|
OP
|
$3,443.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$447.64 |
| Max. Negotiated Rate |
$3,305.67 |
| Rate for Payer: Aetna Commercial |
$2,651.43
|
| Rate for Payer: Anthem Medicaid |
$1,184.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,685.86
|
| Rate for Payer: Cash Price |
$1,721.70
|
| Rate for Payer: Cigna Commercial |
$2,858.03
|
| Rate for Payer: First Health Commercial |
$3,271.24
|
| Rate for Payer: Humana Commercial |
$2,926.90
|
| Rate for Payer: Humana KY Medicaid |
$1,184.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,196.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,823.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,541.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,033.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,207.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,030.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,582.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$688.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$447.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,067.46
|
| Rate for Payer: PHCS Commercial |
$3,305.67
|
| Rate for Payer: United Healthcare All Payer |
$3,030.20
|
|
|
PLATE-T TI LCP 3H 3.5*50 R ANG
|
Facility
|
OP
|
$3,292.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.07 |
| Max. Negotiated Rate |
$3,161.16 |
| Rate for Payer: Aetna Commercial |
$2,535.52
|
| Rate for Payer: Anthem Medicaid |
$1,132.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,568.45
|
| Rate for Payer: Cash Price |
$1,646.44
|
| Rate for Payer: Cigna Commercial |
$2,733.09
|
| Rate for Payer: First Health Commercial |
$3,128.24
|
| Rate for Payer: Humana Commercial |
$2,798.95
|
| Rate for Payer: Humana KY Medicaid |
$1,132.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,143.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,897.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,469.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,020.79
|
| Rate for Payer: PHCS Commercial |
$3,161.16
|
| Rate for Payer: United Healthcare All Payer |
$2,897.73
|
|
|
PLATE-T TI LCP 3H 3.5*50 R ANG
|
Facility
|
IP
|
$3,292.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$428.07 |
| Max. Negotiated Rate |
$3,161.16 |
| Rate for Payer: Aetna Commercial |
$2,535.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,568.45
|
| Rate for Payer: Cash Price |
$1,646.44
|
| Rate for Payer: Cigna Commercial |
$2,733.09
|
| Rate for Payer: First Health Commercial |
$3,128.24
|
| Rate for Payer: Humana Commercial |
$2,798.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,897.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,469.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$658.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$428.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,020.79
|
| Rate for Payer: PHCS Commercial |
$3,161.16
|
| Rate for Payer: United Healthcare All Payer |
$2,897.73
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB L
|
Facility
|
IP
|
$3,410.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.36 |
| Max. Negotiated Rate |
$3,274.06 |
| Rate for Payer: Aetna Commercial |
$2,626.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,660.17
|
| Rate for Payer: Cash Price |
$1,705.24
|
| Rate for Payer: Cigna Commercial |
$2,830.70
|
| Rate for Payer: First Health Commercial |
$3,239.96
|
| Rate for Payer: Humana Commercial |
$2,898.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,001.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.25
|
| Rate for Payer: PHCS Commercial |
$3,274.06
|
| Rate for Payer: United Healthcare All Payer |
$3,001.22
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB L
|
Facility
|
OP
|
$3,410.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.36 |
| Max. Negotiated Rate |
$3,274.06 |
| Rate for Payer: Aetna Commercial |
$2,626.07
|
| Rate for Payer: Anthem Medicaid |
$1,172.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,660.17
|
| Rate for Payer: Cash Price |
$1,705.24
|
| Rate for Payer: Cigna Commercial |
$2,830.70
|
| Rate for Payer: First Health Commercial |
$3,239.96
|
| Rate for Payer: Humana Commercial |
$2,898.91
|
| Rate for Payer: Humana KY Medicaid |
$1,172.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,001.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.25
|
| Rate for Payer: PHCS Commercial |
$3,274.06
|
| Rate for Payer: United Healthcare All Payer |
$3,001.22
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB R
|
Facility
|
IP
|
$3,410.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.36 |
| Max. Negotiated Rate |
$3,274.06 |
| Rate for Payer: Aetna Commercial |
$2,626.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,660.17
|
| Rate for Payer: Cash Price |
$1,705.24
|
| Rate for Payer: Cigna Commercial |
$2,830.70
|
| Rate for Payer: First Health Commercial |
$3,239.96
|
| Rate for Payer: Humana Commercial |
$2,898.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,001.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.25
|
| Rate for Payer: PHCS Commercial |
$3,274.06
|
| Rate for Payer: United Healthcare All Payer |
$3,001.22
|
|
|
PLATE-T TI LCP 3H 3.5*52 OB R
|
Facility
|
OP
|
$3,410.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$443.36 |
| Max. Negotiated Rate |
$3,274.06 |
| Rate for Payer: Aetna Commercial |
$2,626.07
|
| Rate for Payer: Anthem Medicaid |
$1,172.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,660.17
|
| Rate for Payer: Cash Price |
$1,705.24
|
| Rate for Payer: Cigna Commercial |
$2,830.70
|
| Rate for Payer: First Health Commercial |
$3,239.96
|
| Rate for Payer: Humana Commercial |
$2,898.91
|
| Rate for Payer: Humana KY Medicaid |
$1,172.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,001.22
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$682.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$443.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,057.25
|
| Rate for Payer: PHCS Commercial |
$3,274.06
|
| Rate for Payer: United Healthcare All Payer |
$3,001.22
|
|
