|
PLATE PRX FM LCK 2H 4.5*99MM R
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
PLATE PRX FM LCK 2H 4.5*99MM R
|
Facility
|
IP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
PLATE PRX FM LCK 4H 4.5*144M L
|
Facility
|
IP
|
$7,757.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.22 |
| Max. Negotiated Rate |
$7,447.11 |
| Rate for Payer: Aetna Commercial |
$5,973.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,050.78
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cigna Commercial |
$6,438.65
|
| Rate for Payer: First Health Commercial |
$7,369.54
|
| Rate for Payer: Humana Commercial |
$6,593.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,724.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,826.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,205.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,748.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,352.61
|
| Rate for Payer: PHCS Commercial |
$7,447.11
|
| Rate for Payer: United Healthcare All Payer |
$6,826.52
|
|
|
PLATE PRX FM LCK 4H 4.5*144M L
|
Facility
|
OP
|
$7,757.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.22 |
| Max. Negotiated Rate |
$7,447.11 |
| Rate for Payer: Aetna Commercial |
$5,973.21
|
| Rate for Payer: Anthem Medicaid |
$2,667.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,050.78
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cigna Commercial |
$6,438.65
|
| Rate for Payer: First Health Commercial |
$7,369.54
|
| Rate for Payer: Humana Commercial |
$6,593.80
|
| Rate for Payer: Humana KY Medicaid |
$2,667.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,694.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,724.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,721.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,826.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,205.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,748.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,352.61
|
| Rate for Payer: PHCS Commercial |
$7,447.11
|
| Rate for Payer: United Healthcare All Payer |
$6,826.52
|
|
|
PLATE PRX FM LCK 4H 4.5*144M R
|
Facility
|
IP
|
$7,757.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.22 |
| Max. Negotiated Rate |
$7,447.11 |
| Rate for Payer: Aetna Commercial |
$5,973.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,050.78
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cigna Commercial |
$6,438.65
|
| Rate for Payer: First Health Commercial |
$7,369.54
|
| Rate for Payer: Humana Commercial |
$6,593.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,724.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,826.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,205.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,748.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,352.61
|
| Rate for Payer: PHCS Commercial |
$7,447.11
|
| Rate for Payer: United Healthcare All Payer |
$6,826.52
|
|
|
PLATE PRX FM LCK 4H 4.5*144M R
|
Facility
|
OP
|
$7,757.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,327.22 |
| Max. Negotiated Rate |
$7,447.11 |
| Rate for Payer: Aetna Commercial |
$5,973.21
|
| Rate for Payer: Anthem Medicaid |
$2,667.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,050.78
|
| Rate for Payer: Cash Price |
$3,878.70
|
| Rate for Payer: Cigna Commercial |
$6,438.65
|
| Rate for Payer: First Health Commercial |
$7,369.54
|
| Rate for Payer: Humana Commercial |
$6,593.80
|
| Rate for Payer: Humana KY Medicaid |
$2,667.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,694.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,361.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,724.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,327.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,721.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,826.52
|
| Rate for Payer: Ohio Health Group HMO |
$5,818.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,205.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,748.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,352.61
|
| Rate for Payer: PHCS Commercial |
$7,447.11
|
| Rate for Payer: United Healthcare All Payer |
$6,826.52
|
|
|
PLATE PRX FM LCK 6H 4.5*180M L
|
Facility
|
OP
|
$7,847.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.27 |
| Max. Negotiated Rate |
$7,533.66 |
| Rate for Payer: Aetna Commercial |
$6,042.62
|
| Rate for Payer: Anthem Medicaid |
$2,698.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,121.10
|
| Rate for Payer: Cash Price |
$3,923.78
|
| Rate for Payer: Cigna Commercial |
$6,513.47
|
| Rate for Payer: First Health Commercial |
$7,455.18
|
| Rate for Payer: Humana Commercial |
$6,670.43
|
| Rate for Payer: Humana KY Medicaid |
$2,698.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,726.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,791.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,354.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,752.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,905.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,885.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,278.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,827.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,414.82
|
| Rate for Payer: PHCS Commercial |
$7,533.66
|
| Rate for Payer: United Healthcare All Payer |
$6,905.85
|
|
|
PLATE PRX FM LCK 6H 4.5*180M L
|
Facility
|
IP
|
$7,847.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.27 |
| Max. Negotiated Rate |
$7,533.66 |
| Rate for Payer: Aetna Commercial |
$6,042.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,121.10
|
| Rate for Payer: Cash Price |
$3,923.78
|
| Rate for Payer: Cigna Commercial |
$6,513.47
|
| Rate for Payer: First Health Commercial |
$7,455.18
|
| Rate for Payer: Humana Commercial |
$6,670.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,791.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,354.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,905.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,885.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,278.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,827.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,414.82
|
| Rate for Payer: PHCS Commercial |
$7,533.66
|
| Rate for Payer: United Healthcare All Payer |
$6,905.85
|
|
|
PLATE PRX FM LCK 6H 4.5*180M R
|
Facility
|
OP
|
$7,847.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.27 |
| Max. Negotiated Rate |
$7,533.66 |
| Rate for Payer: Aetna Commercial |
$6,042.62
|
| Rate for Payer: Anthem Medicaid |
$2,698.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,121.10
|
| Rate for Payer: Cash Price |
$3,923.78
|
| Rate for Payer: Cigna Commercial |
$6,513.47
|
| Rate for Payer: First Health Commercial |
$7,455.18
|
| Rate for Payer: Humana Commercial |
$6,670.43
|
| Rate for Payer: Humana KY Medicaid |
$2,698.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,726.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,791.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,354.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,752.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,905.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,885.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,278.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,827.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,414.82
|
| Rate for Payer: PHCS Commercial |
$7,533.66
|
| Rate for Payer: United Healthcare All Payer |
$6,905.85
|
|
|
PLATE PRX FM LCK 6H 4.5*180M R
|
Facility
|
IP
|
$7,847.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.27 |
| Max. Negotiated Rate |
$7,533.66 |
| Rate for Payer: Aetna Commercial |
$6,042.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,121.10
|
| Rate for Payer: Cash Price |
$3,923.78
|
| Rate for Payer: Cigna Commercial |
$6,513.47
|
| Rate for Payer: First Health Commercial |
$7,455.18
|
| Rate for Payer: Humana Commercial |
$6,670.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,435.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,791.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,354.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,905.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,885.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,278.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,827.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,414.82
|
| Rate for Payer: PHCS Commercial |
$7,533.66
|
| Rate for Payer: United Healthcare All Payer |
$6,905.85
|
|
|
PLATE PRX FM LCK 9H 4.5*234M L
|
Facility
|
IP
|
$8,034.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.44 |
| Max. Negotiated Rate |
$7,713.42 |
| Rate for Payer: Aetna Commercial |
$6,186.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,267.15
|
| Rate for Payer: Cash Price |
$4,017.41
|
| Rate for Payer: Cigna Commercial |
$6,668.89
|
| Rate for Payer: First Health Commercial |
$7,633.07
|
| Rate for Payer: Humana Commercial |
$6,829.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,588.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,929.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,070.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,026.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,427.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,990.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,544.02
|
| Rate for Payer: PHCS Commercial |
$7,713.42
|
| Rate for Payer: United Healthcare All Payer |
$7,070.63
|
|
|
PLATE PRX FM LCK 9H 4.5*234M L
|
Facility
|
OP
|
$8,034.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.44 |
| Max. Negotiated Rate |
$7,713.42 |
| Rate for Payer: Aetna Commercial |
$6,186.80
|
| Rate for Payer: Anthem Medicaid |
$2,763.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,267.15
|
| Rate for Payer: Cash Price |
$4,017.41
|
| Rate for Payer: Cigna Commercial |
$6,668.89
|
| Rate for Payer: First Health Commercial |
$7,633.07
|
| Rate for Payer: Humana Commercial |
$6,829.59
|
| Rate for Payer: Humana KY Medicaid |
$2,763.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,791.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,588.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,929.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,410.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,818.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,070.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,026.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,427.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,990.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,544.02
|
| Rate for Payer: PHCS Commercial |
$7,713.42
|
| Rate for Payer: United Healthcare All Payer |
$7,070.63
|
|
|
PLATE PRX FM LCK 9H 4.5*234M R
|
Facility
|
IP
|
$8,034.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.44 |
| Max. Negotiated Rate |
$7,713.42 |
| Rate for Payer: Aetna Commercial |
$6,186.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,267.15
|
| Rate for Payer: Cash Price |
$4,017.41
|
| Rate for Payer: Cigna Commercial |
$6,668.89
|
| Rate for Payer: First Health Commercial |
$7,633.07
|
| Rate for Payer: Humana Commercial |
$6,829.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,588.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,929.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,410.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,070.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,026.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,427.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,990.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,544.02
|
| Rate for Payer: PHCS Commercial |
$7,713.42
|
| Rate for Payer: United Healthcare All Payer |
$7,070.63
|
|
|
PLATE PRX FM LCK 9H 4.5*234M R
|
Facility
|
OP
|
$8,034.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,410.44 |
| Max. Negotiated Rate |
$7,713.42 |
| Rate for Payer: Aetna Commercial |
$6,186.80
|
| Rate for Payer: Anthem Medicaid |
$2,763.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,267.15
|
| Rate for Payer: Cash Price |
$4,017.41
|
| Rate for Payer: Cigna Commercial |
$6,668.89
|
| Rate for Payer: First Health Commercial |
$7,633.07
|
| Rate for Payer: Humana Commercial |
$6,829.59
|
| Rate for Payer: Humana KY Medicaid |
$2,763.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,791.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,588.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,929.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,410.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,818.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,070.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,026.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,427.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,990.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,544.02
|
| Rate for Payer: PHCS Commercial |
$7,713.42
|
| Rate for Payer: United Healthcare All Payer |
$7,070.63
|
|
|
PLATE PRX FM LK 4.5M 12 288M L
|
Facility
|
IP
|
$8,846.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,653.86 |
| Max. Negotiated Rate |
$8,492.35 |
| Rate for Payer: Aetna Commercial |
$6,811.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,900.04
|
| Rate for Payer: Cash Price |
$4,423.10
|
| Rate for Payer: Cigna Commercial |
$7,342.35
|
| Rate for Payer: First Health Commercial |
$8,403.89
|
| Rate for Payer: Humana Commercial |
$7,519.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,653.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,696.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.88
|
| Rate for Payer: PHCS Commercial |
$8,492.35
|
| Rate for Payer: United Healthcare All Payer |
$7,784.66
|
|
|
PLATE PRX FM LK 4.5M 12 288M L
|
Facility
|
OP
|
$8,846.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,653.86 |
| Max. Negotiated Rate |
$8,492.35 |
| Rate for Payer: Aetna Commercial |
$6,811.57
|
| Rate for Payer: Anthem Medicaid |
$3,042.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,900.04
|
| Rate for Payer: Cash Price |
$4,423.10
|
| Rate for Payer: Cigna Commercial |
$7,342.35
|
| Rate for Payer: First Health Commercial |
$8,403.89
|
| Rate for Payer: Humana Commercial |
$7,519.27
|
| Rate for Payer: Humana KY Medicaid |
$3,042.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,073.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,653.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,103.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,696.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.88
|
| Rate for Payer: PHCS Commercial |
$8,492.35
|
| Rate for Payer: United Healthcare All Payer |
$7,784.66
|
|
|
PLATE PRX HM LK 13H 3.5X216M L
|
Facility
|
OP
|
$8,678.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,603.66 |
| Max. Negotiated Rate |
$8,331.70 |
| Rate for Payer: Aetna Commercial |
$6,682.71
|
| Rate for Payer: Anthem Medicaid |
$2,984.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,769.50
|
| Rate for Payer: Cash Price |
$4,339.43
|
| Rate for Payer: Cigna Commercial |
$7,203.45
|
| Rate for Payer: First Health Commercial |
$8,244.91
|
| Rate for Payer: Humana Commercial |
$7,377.02
|
| Rate for Payer: Humana KY Medicaid |
$2,984.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,116.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,404.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,603.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,044.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,637.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,509.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,943.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,550.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,988.41
|
| Rate for Payer: PHCS Commercial |
$8,331.70
|
| Rate for Payer: United Healthcare All Payer |
$7,637.39
|
|
|
PLATE PRX HM LK 13H 3.5X216M L
|
Facility
|
IP
|
$8,678.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,603.66 |
| Max. Negotiated Rate |
$8,331.70 |
| Rate for Payer: Aetna Commercial |
$6,682.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,769.50
|
| Rate for Payer: Cash Price |
$4,339.43
|
| Rate for Payer: Cigna Commercial |
$7,203.45
|
| Rate for Payer: First Health Commercial |
$8,244.91
|
| Rate for Payer: Humana Commercial |
$7,377.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,116.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,404.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,603.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,637.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,509.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,943.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,550.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,988.41
|
| Rate for Payer: PHCS Commercial |
$8,331.70
|
| Rate for Payer: United Healthcare All Payer |
$7,637.39
|
|
|
PLATE PRX HUM LCK 3H 3.5X115 R
|
Facility
|
OP
|
$8,023.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.16 |
| Max. Negotiated Rate |
$7,702.91 |
| Rate for Payer: Aetna Commercial |
$6,178.37
|
| Rate for Payer: Anthem Medicaid |
$2,759.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,258.61
|
| Rate for Payer: Cash Price |
$4,011.93
|
| Rate for Payer: Cigna Commercial |
$6,659.80
|
| Rate for Payer: First Health Commercial |
$7,622.67
|
| Rate for Payer: Humana Commercial |
$6,820.28
|
| Rate for Payer: Humana KY Medicaid |
$2,759.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,787.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,579.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,921.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,814.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,061.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,419.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,980.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,536.46
|
| Rate for Payer: PHCS Commercial |
$7,702.91
|
| Rate for Payer: United Healthcare All Payer |
$7,061.00
|
|
|
PLATE PRX HUM LCK 3H 3.5X115 R
|
Facility
|
IP
|
$8,023.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.16 |
| Max. Negotiated Rate |
$7,702.91 |
| Rate for Payer: Aetna Commercial |
$6,178.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,258.61
|
| Rate for Payer: Cash Price |
$4,011.93
|
| Rate for Payer: Cigna Commercial |
$6,659.80
|
| Rate for Payer: First Health Commercial |
$7,622.67
|
| Rate for Payer: Humana Commercial |
$6,820.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,579.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,921.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,061.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,419.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,980.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,536.46
|
| Rate for Payer: PHCS Commercial |
$7,702.91
|
| Rate for Payer: United Healthcare All Payer |
$7,061.00
|
|
|
PLATE PRX HUM LCK 3H 3.5X89 R
|
Facility
|
IP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE PRX HUM LCK 3H 3.5X89 R
|
Facility
|
OP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem Medicaid |
$2,710.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Humana KY Medicaid |
$2,710.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE PRX HUMLK 11H 3.5X191M L
|
Facility
|
IP
|
$8,530.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.09 |
| Max. Negotiated Rate |
$8,189.09 |
| Rate for Payer: Aetna Commercial |
$6,568.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.63
|
| Rate for Payer: Cash Price |
$4,265.15
|
| Rate for Payer: Cigna Commercial |
$7,080.15
|
| Rate for Payer: First Health Commercial |
$8,103.78
|
| Rate for Payer: Humana Commercial |
$7,250.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,994.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,824.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,421.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,885.91
|
| Rate for Payer: PHCS Commercial |
$8,189.09
|
| Rate for Payer: United Healthcare All Payer |
$7,506.66
|
|
|
PLATE PRX HUMLK 11H 3.5X191M L
|
Facility
|
OP
|
$8,530.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.09 |
| Max. Negotiated Rate |
$8,189.09 |
| Rate for Payer: Aetna Commercial |
$6,568.33
|
| Rate for Payer: Anthem Medicaid |
$2,933.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.63
|
| Rate for Payer: Cash Price |
$4,265.15
|
| Rate for Payer: Cigna Commercial |
$7,080.15
|
| Rate for Payer: First Health Commercial |
$8,103.78
|
| Rate for Payer: Humana Commercial |
$7,250.76
|
| Rate for Payer: Humana KY Medicaid |
$2,933.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,963.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,994.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,992.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,824.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,421.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,885.91
|
| Rate for Payer: PHCS Commercial |
$8,189.09
|
| Rate for Payer: United Healthcare All Payer |
$7,506.66
|
|
|
PLATE PRX HUM LK 3H 3.5X89M L
|
Facility
|
IP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
