|
PLATE PROX WDG 3MM TI LCK 4.0M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 4.5M
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE PROX WDG 3MM TI LCK 4.5M
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE PROX WDG 3MM TI LCK 5.0M
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE PROX WDG 3MM TI LCK 5.0M
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE PROX WDG 3MM TI LCK 5.5M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 5.5M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 6.0M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 6.0M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 6.5M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 6.5M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 7.0M
|
Facility
|
OP
|
$5,524.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.22 |
| Max. Negotiated Rate |
$5,303.10 |
| Rate for Payer: Aetna Commercial |
$4,253.53
|
| Rate for Payer: Anthem Medicaid |
$1,899.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,308.77
|
| Rate for Payer: Cash Price |
$2,762.03
|
| Rate for Payer: Cigna Commercial |
$4,584.97
|
| Rate for Payer: First Health Commercial |
$5,247.86
|
| Rate for Payer: Humana Commercial |
$4,695.45
|
| Rate for Payer: Humana KY Medicaid |
$1,899.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,529.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,076.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,937.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,861.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,419.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,811.60
|
| Rate for Payer: PHCS Commercial |
$5,303.10
|
| Rate for Payer: United Healthcare All Payer |
$4,861.17
|
|
|
PLATE PROX WDG 3MM TI LCK 7.0M
|
Facility
|
IP
|
$5,524.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.22 |
| Max. Negotiated Rate |
$5,303.10 |
| Rate for Payer: Aetna Commercial |
$4,253.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,308.77
|
| Rate for Payer: Cash Price |
$2,762.03
|
| Rate for Payer: Cigna Commercial |
$4,584.97
|
| Rate for Payer: First Health Commercial |
$5,247.86
|
| Rate for Payer: Humana Commercial |
$4,695.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,529.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,076.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,861.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,419.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,805.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,811.60
|
| Rate for Payer: PHCS Commercial |
$5,303.10
|
| Rate for Payer: United Healthcare All Payer |
$4,861.17
|
|
|
PLATE PRX FMLCK 12H 4.5*288M L
|
Facility
|
OP
|
$8,880.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.26 |
| Max. Negotiated Rate |
$8,525.64 |
| Rate for Payer: Aetna Commercial |
$6,838.28
|
| Rate for Payer: Anthem Medicaid |
$3,054.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,927.09
|
| Rate for Payer: Cash Price |
$4,440.44
|
| Rate for Payer: Cigna Commercial |
$7,371.13
|
| Rate for Payer: First Health Commercial |
$8,436.84
|
| Rate for Payer: Humana Commercial |
$7,548.75
|
| Rate for Payer: Humana KY Medicaid |
$3,054.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,085.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,282.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,554.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,664.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,115.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,815.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,660.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,104.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,726.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.81
|
| Rate for Payer: PHCS Commercial |
$8,525.64
|
| Rate for Payer: United Healthcare All Payer |
$7,815.17
|
|
|
PLATE PRX FMLCK 12H 4.5*288M L
|
Facility
|
IP
|
$8,880.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.26 |
| Max. Negotiated Rate |
$8,525.64 |
| Rate for Payer: Aetna Commercial |
$6,838.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,927.09
|
| Rate for Payer: Cash Price |
$4,440.44
|
| Rate for Payer: Cigna Commercial |
$7,371.13
|
| Rate for Payer: First Health Commercial |
$8,436.84
|
| Rate for Payer: Humana Commercial |
$7,548.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,282.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,554.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,664.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,815.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,660.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,104.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,726.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.81
|
| Rate for Payer: PHCS Commercial |
$8,525.64
|
| Rate for Payer: United Healthcare All Payer |
$7,815.17
|
|
|
PLATE PRX FMLCK 12H 4.5*288M R
|
Facility
|
IP
|
$8,880.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.26 |
| Max. Negotiated Rate |
$8,525.64 |
| Rate for Payer: Aetna Commercial |
$6,838.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,927.09
|
| Rate for Payer: Cash Price |
$4,440.44
|
| Rate for Payer: Cigna Commercial |
$7,371.13
|
| Rate for Payer: First Health Commercial |
$8,436.84
|
| Rate for Payer: Humana Commercial |
$7,548.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,282.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,554.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,664.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,815.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,660.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,104.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,726.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.81
|
| Rate for Payer: PHCS Commercial |
$8,525.64
|
| Rate for Payer: United Healthcare All Payer |
$7,815.17
|
|
|
PLATE PRX FMLCK 12H 4.5*288M R
|
Facility
|
OP
|
$8,880.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,664.26 |
| Max. Negotiated Rate |
$8,525.64 |
| Rate for Payer: Aetna Commercial |
$6,838.28
|
| Rate for Payer: Anthem Medicaid |
$3,054.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,927.09
|
| Rate for Payer: Cash Price |
$4,440.44
|
| Rate for Payer: Cigna Commercial |
$7,371.13
|
| Rate for Payer: First Health Commercial |
$8,436.84
|
| Rate for Payer: Humana Commercial |
$7,548.75
|
| Rate for Payer: Humana KY Medicaid |
$3,054.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,085.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,282.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,554.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,664.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,115.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,815.17
|
| Rate for Payer: Ohio Health Group HMO |
$6,660.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,104.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,726.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,127.81
|
| Rate for Payer: PHCS Commercial |
$8,525.64
|
| Rate for Payer: United Healthcare All Payer |
$7,815.17
|
|
|
PLATE PRX FMLCK 15H 4.5*342M L
|
Facility
|
OP
|
$9,352.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.74 |
| Max. Negotiated Rate |
$8,978.36 |
| Rate for Payer: Aetna Commercial |
$7,201.39
|
| Rate for Payer: Anthem Medicaid |
$3,216.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.92
|
| Rate for Payer: Cash Price |
$4,676.23
|
| Rate for Payer: Cigna Commercial |
$7,762.54
|
| Rate for Payer: First Health Commercial |
$8,884.84
|
| Rate for Payer: Humana Commercial |
$7,949.59
|
| Rate for Payer: Humana KY Medicaid |
$3,216.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,249.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,669.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,902.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,280.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,014.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,481.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,136.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,453.20
|
| Rate for Payer: PHCS Commercial |
$8,978.36
|
| Rate for Payer: United Healthcare All Payer |
$8,230.16
|
|
|
PLATE PRX FMLCK 15H 4.5*342M L
|
Facility
|
IP
|
$9,352.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,805.74 |
| Max. Negotiated Rate |
$8,978.36 |
| Rate for Payer: Aetna Commercial |
$7,201.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,294.92
|
| Rate for Payer: Cash Price |
$4,676.23
|
| Rate for Payer: Cigna Commercial |
$7,762.54
|
| Rate for Payer: First Health Commercial |
$8,884.84
|
| Rate for Payer: Humana Commercial |
$7,949.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,669.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,902.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,805.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,230.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,014.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,481.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,136.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,453.20
|
| Rate for Payer: PHCS Commercial |
$8,978.36
|
| Rate for Payer: United Healthcare All Payer |
$8,230.16
|
|
|
PLATE PRX FMLCK 15H 4.5*342M R
|
Facility
|
IP
|
$9,303.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.18 |
| Max. Negotiated Rate |
$8,931.76 |
| Rate for Payer: Aetna Commercial |
$7,164.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,257.06
|
| Rate for Payer: Cash Price |
$4,651.96
|
| Rate for Payer: Cigna Commercial |
$7,722.25
|
| Rate for Payer: First Health Commercial |
$8,838.72
|
| Rate for Payer: Humana Commercial |
$7,908.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,629.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,866.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,791.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,187.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,977.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,443.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,094.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,419.70
|
| Rate for Payer: PHCS Commercial |
$8,931.76
|
| Rate for Payer: United Healthcare All Payer |
$8,187.45
|
|
|
PLATE PRX FMLCK 15H 4.5*342M R
|
Facility
|
OP
|
$9,303.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,791.18 |
| Max. Negotiated Rate |
$8,931.76 |
| Rate for Payer: Aetna Commercial |
$7,164.02
|
| Rate for Payer: Anthem Medicaid |
$3,199.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,257.06
|
| Rate for Payer: Cash Price |
$4,651.96
|
| Rate for Payer: Cigna Commercial |
$7,722.25
|
| Rate for Payer: First Health Commercial |
$8,838.72
|
| Rate for Payer: Humana Commercial |
$7,908.33
|
| Rate for Payer: Humana KY Medicaid |
$3,199.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,232.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,629.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,866.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,791.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,263.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,187.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,977.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,443.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,094.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,419.70
|
| Rate for Payer: PHCS Commercial |
$8,931.76
|
| Rate for Payer: United Healthcare All Payer |
$8,187.45
|
|
|
PLATE PRX FMLCK 18H 4.5*396M L
|
Facility
|
IP
|
$9,824.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,947.21 |
| Max. Negotiated Rate |
$9,431.08 |
| Rate for Payer: Aetna Commercial |
$7,564.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,662.75
|
| Rate for Payer: Cash Price |
$4,912.02
|
| Rate for Payer: Cigna Commercial |
$8,153.95
|
| Rate for Payer: First Health Commercial |
$9,332.84
|
| Rate for Payer: Humana Commercial |
$8,350.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,055.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,250.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,645.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,368.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,859.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,546.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,778.59
|
| Rate for Payer: PHCS Commercial |
$9,431.08
|
| Rate for Payer: United Healthcare All Payer |
$8,645.16
|
|
|
PLATE PRX FMLCK 18H 4.5*396M L
|
Facility
|
OP
|
$9,824.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,947.21 |
| Max. Negotiated Rate |
$9,431.08 |
| Rate for Payer: Aetna Commercial |
$7,564.51
|
| Rate for Payer: Anthem Medicaid |
$3,378.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,662.75
|
| Rate for Payer: Cash Price |
$4,912.02
|
| Rate for Payer: Cigna Commercial |
$8,153.95
|
| Rate for Payer: First Health Commercial |
$9,332.84
|
| Rate for Payer: Humana Commercial |
$8,350.43
|
| Rate for Payer: Humana KY Medicaid |
$3,378.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,412.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,055.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,250.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,947.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,446.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,645.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,368.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,859.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,546.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,778.59
|
| Rate for Payer: PHCS Commercial |
$9,431.08
|
| Rate for Payer: United Healthcare All Payer |
$8,645.16
|
|
|
PLATE PRX FMLCK 18H 4.5*396M R
|
Facility
|
IP
|
$9,761.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,928.49 |
| Max. Negotiated Rate |
$9,371.16 |
| Rate for Payer: Aetna Commercial |
$7,516.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,614.06
|
| Rate for Payer: Cash Price |
$4,880.81
|
| Rate for Payer: Cigna Commercial |
$8,102.14
|
| Rate for Payer: First Health Commercial |
$9,273.54
|
| Rate for Payer: Humana Commercial |
$8,297.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,004.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,204.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,928.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,590.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,321.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,809.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,492.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,735.52
|
| Rate for Payer: PHCS Commercial |
$9,371.16
|
| Rate for Payer: United Healthcare All Payer |
$8,590.23
|
|
|
PLATE PRX FMLCK 18H 4.5*396M R
|
Facility
|
OP
|
$9,761.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,928.49 |
| Max. Negotiated Rate |
$9,371.16 |
| Rate for Payer: Aetna Commercial |
$7,516.45
|
| Rate for Payer: Anthem Medicaid |
$3,357.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,614.06
|
| Rate for Payer: Cash Price |
$4,880.81
|
| Rate for Payer: Cigna Commercial |
$8,102.14
|
| Rate for Payer: First Health Commercial |
$9,273.54
|
| Rate for Payer: Humana Commercial |
$8,297.38
|
| Rate for Payer: Humana KY Medicaid |
$3,357.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,391.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,004.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,204.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,928.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,424.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,590.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,321.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,809.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,492.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,735.52
|
| Rate for Payer: PHCS Commercial |
$9,371.16
|
| Rate for Payer: United Healthcare All Payer |
$8,590.23
|
|
