|
PLATE PRX HUM LK 3H 3.5X89M L
|
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 HUM LK 5H 3.5X115M L
|
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 LK 5H 3.5X115M L
|
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 LK 7H 3.5X140M L
|
Facility
|
OP
|
$8,179.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,453.75 |
| Max. Negotiated Rate |
$7,852.00 |
| Rate for Payer: Aetna Commercial |
$6,297.96
|
| Rate for Payer: Anthem Medicaid |
$2,812.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,379.75
|
| Rate for Payer: Cash Price |
$4,089.58
|
| Rate for Payer: Cigna Commercial |
$6,788.71
|
| Rate for Payer: First Health Commercial |
$7,770.21
|
| Rate for Payer: Humana Commercial |
$6,952.29
|
| Rate for Payer: Humana KY Medicaid |
$2,812.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,841.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,706.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,036.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,869.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,197.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,543.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,115.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,643.63
|
| Rate for Payer: PHCS Commercial |
$7,852.00
|
| Rate for Payer: United Healthcare All Payer |
$7,197.67
|
|
|
PLATE PRX HUM LK 7H 3.5X140M L
|
Facility
|
IP
|
$8,179.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,453.75 |
| Max. Negotiated Rate |
$7,852.00 |
| Rate for Payer: Aetna Commercial |
$6,297.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,379.75
|
| Rate for Payer: Cash Price |
$4,089.58
|
| Rate for Payer: Cigna Commercial |
$6,788.71
|
| Rate for Payer: First Health Commercial |
$7,770.21
|
| Rate for Payer: Humana Commercial |
$6,952.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,706.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,036.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,197.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,543.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,115.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,643.63
|
| Rate for Payer: PHCS Commercial |
$7,852.00
|
| Rate for Payer: United Healthcare All Payer |
$7,197.67
|
|
|
PLATE PRX HUM LK 9H 3.5X165M L
|
Facility
|
OP
|
$8,179.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,453.75 |
| Max. Negotiated Rate |
$7,852.00 |
| Rate for Payer: Aetna Commercial |
$6,297.96
|
| Rate for Payer: Anthem Medicaid |
$2,812.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,379.75
|
| Rate for Payer: Cash Price |
$4,089.58
|
| Rate for Payer: Cigna Commercial |
$6,788.71
|
| Rate for Payer: First Health Commercial |
$7,770.21
|
| Rate for Payer: Humana Commercial |
$6,952.29
|
| Rate for Payer: Humana KY Medicaid |
$2,812.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,841.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,706.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,036.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,453.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,869.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,197.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,543.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,115.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,643.63
|
| Rate for Payer: PHCS Commercial |
$7,852.00
|
| Rate for Payer: United Healthcare All Payer |
$7,197.67
|
|
|
PLATE PRX HUM LK 9H 3.5X165M L
|
Facility
|
IP
|
$8,179.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,453.75 |
| Max. Negotiated Rate |
$7,852.00 |
| Rate for Payer: Aetna Commercial |
$6,297.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,379.75
|
| Rate for Payer: Cash Price |
$4,089.58
|
| Rate for Payer: Cigna Commercial |
$6,788.71
|
| Rate for Payer: First Health Commercial |
$7,770.21
|
| Rate for Payer: Humana Commercial |
$6,952.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,706.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,036.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,453.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,197.67
|
| Rate for Payer: Ohio Health Group HMO |
$6,134.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,543.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,115.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,643.63
|
| Rate for Payer: PHCS Commercial |
$7,852.00
|
| Rate for Payer: United Healthcare All Payer |
$7,197.67
|
|
|
PLATE QUARTER-TUBULAR
|
Facility
|
OP
|
$1,198.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$1,150.56 |
| Rate for Payer: Aetna Commercial |
$922.85
|
| Rate for Payer: Anthem Medicaid |
$412.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.83
|
| Rate for Payer: Cash Price |
$599.25
|
| Rate for Payer: Cigna Commercial |
$994.75
|
| Rate for Payer: First Health Commercial |
$1,138.58
|
| Rate for Payer: Humana Commercial |
$1,018.73
|
| Rate for Payer: Humana KY Medicaid |
$412.16
|
| Rate for Payer: Kentucky WC Medicaid |
$416.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$420.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.68
|
| Rate for Payer: Ohio Health Group HMO |
$898.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.97
|
| Rate for Payer: PHCS Commercial |
$1,150.56
|
| Rate for Payer: United Healthcare All Payer |
$1,054.68
|
|
|
PLATE QUARTER-TUBULAR
|
Facility
|
IP
|
$1,198.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$359.55 |
| Max. Negotiated Rate |
$1,150.56 |
| Rate for Payer: Aetna Commercial |
$922.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$934.83
|
| Rate for Payer: Cash Price |
$599.25
|
| Rate for Payer: Cigna Commercial |
$994.75
|
| Rate for Payer: First Health Commercial |
$1,138.58
|
| Rate for Payer: Humana Commercial |
$1,018.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$982.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$884.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$359.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,054.68
|
| Rate for Payer: Ohio Health Group HMO |
$898.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,042.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$826.97
|
| Rate for Payer: PHCS Commercial |
$1,150.56
|
| Rate for Payer: United Healthcare All Payer |
$1,054.68
|
|
|
PLATE QUARTER-TUBULAR 7H
|
Facility
|
IP
|
$1,550.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.17 |
| Max. Negotiated Rate |
$1,488.53 |
| Rate for Payer: Aetna Commercial |
$1,193.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.43
|
| Rate for Payer: Cash Price |
$775.28
|
| Rate for Payer: Cigna Commercial |
$1,286.96
|
| Rate for Payer: First Health Commercial |
$1,473.02
|
| Rate for Payer: Humana Commercial |
$1,317.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,144.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.88
|
| Rate for Payer: PHCS Commercial |
$1,488.53
|
| Rate for Payer: United Healthcare All Payer |
$1,364.48
|
|
|
PLATE QUARTER-TUBULAR 7H
|
Facility
|
OP
|
$1,550.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.17 |
| Max. Negotiated Rate |
$1,488.53 |
| Rate for Payer: Aetna Commercial |
$1,193.92
|
| Rate for Payer: Anthem Medicaid |
$533.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,209.43
|
| Rate for Payer: Cash Price |
$775.28
|
| Rate for Payer: Cigna Commercial |
$1,286.96
|
| Rate for Payer: First Health Commercial |
$1,473.02
|
| Rate for Payer: Humana Commercial |
$1,317.97
|
| Rate for Payer: Humana KY Medicaid |
$533.23
|
| Rate for Payer: Kentucky WC Medicaid |
$538.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,271.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,144.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$465.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$543.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,364.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,162.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,240.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,348.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.88
|
| Rate for Payer: PHCS Commercial |
$1,488.53
|
| Rate for Payer: United Healthcare All Payer |
$1,364.48
|
|
|
PLATE QUART TUB 3 HOLE 2.7MM
|
Facility
|
IP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 3 HOLE 2.7MM
|
Facility
|
OP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem Medicaid |
$1,272.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Humana KY Medicaid |
$1,272.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 4 HOLE 2.7MM
|
Facility
|
OP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem Medicaid |
$1,272.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Humana KY Medicaid |
$1,272.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 4 HOLE 2.7MM
|
Facility
|
IP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 5 HOLE 2.7MM
|
Facility
|
IP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 5 HOLE 2.7MM
|
Facility
|
OP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem Medicaid |
$1,272.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Humana KY Medicaid |
$1,272.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 6 HOLE 2.7MM
|
Facility
|
IP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 6 HOLE 2.7MM
|
Facility
|
OP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem Medicaid |
$1,272.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Humana KY Medicaid |
$1,272.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 7 HOLE 2.7MM
|
Facility
|
IP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 7 HOLE 2.7MM
|
Facility
|
OP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem Medicaid |
$1,272.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Humana KY Medicaid |
$1,272.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 8 HOLE 2.7MM
|
Facility
|
IP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB 8 HOLE 2.7MM
|
Facility
|
OP
|
$3,699.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.79 |
| Max. Negotiated Rate |
$3,551.34 |
| Rate for Payer: Aetna Commercial |
$2,848.47
|
| Rate for Payer: Anthem Medicaid |
$1,272.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.46
|
| Rate for Payer: Cash Price |
$1,849.66
|
| Rate for Payer: Cigna Commercial |
$3,070.43
|
| Rate for Payer: First Health Commercial |
$3,514.34
|
| Rate for Payer: Humana Commercial |
$3,144.41
|
| Rate for Payer: Humana KY Medicaid |
$1,272.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,730.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.39
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.52
|
| Rate for Payer: PHCS Commercial |
$3,551.34
|
| Rate for Payer: United Healthcare All Payer |
$3,255.39
|
|
|
PLATE QUART TUB COMP 3 H 2.7MM
|
Facility
|
OP
|
$4,663.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.97 |
| Max. Negotiated Rate |
$4,476.72 |
| Rate for Payer: Aetna Commercial |
$3,590.70
|
| Rate for Payer: Anthem Medicaid |
$1,603.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,637.34
|
| Rate for Payer: Cash Price |
$2,331.62
|
| Rate for Payer: Cigna Commercial |
$3,870.50
|
| Rate for Payer: First Health Commercial |
$4,430.09
|
| Rate for Payer: Humana Commercial |
$3,963.76
|
| Rate for Payer: Humana KY Medicaid |
$1,603.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,620.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,441.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,635.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,103.66
|
| Rate for Payer: Ohio Health Group HMO |
$3,497.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,730.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,057.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,217.64
|
| Rate for Payer: PHCS Commercial |
$4,476.72
|
| Rate for Payer: United Healthcare All Payer |
$4,103.66
|
|
|
PLATE QUART TUB COMP 3 H 2.7MM
|
Facility
|
IP
|
$4,663.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,398.97 |
| Max. Negotiated Rate |
$4,476.72 |
| Rate for Payer: Aetna Commercial |
$3,590.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,637.34
|
| Rate for Payer: Cash Price |
$2,331.62
|
| Rate for Payer: Cigna Commercial |
$3,870.50
|
| Rate for Payer: First Health Commercial |
$4,430.09
|
| Rate for Payer: Humana Commercial |
$3,963.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,823.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,441.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,103.66
|
| Rate for Payer: Ohio Health Group HMO |
$3,497.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,730.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,057.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,217.64
|
| Rate for Payer: PHCS Commercial |
$4,476.72
|
| Rate for Payer: United Healthcare All Payer |
$4,103.66
|
|
