|
PLATE STD LCK HD VDR 3H 62MM R
|
Facility
|
IP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE STD LCK HD VDR 5H 86MM L
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD LCK HD VDR 5H 86MM L
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD LCK HD VDR 5H 86MM R
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD LCK HD VDR 5H 86MM R
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD LCK HD VDR 9H 135M L
|
Facility
|
IP
|
$9,826.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,948.03 |
| Max. Negotiated Rate |
$9,433.71 |
| Rate for Payer: Aetna Commercial |
$7,566.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.89
|
| Rate for Payer: Cash Price |
$4,913.39
|
| Rate for Payer: Cigna Commercial |
$8,156.23
|
| Rate for Payer: First Health Commercial |
$9,335.44
|
| Rate for Payer: Humana Commercial |
$8,352.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,252.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,370.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,861.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,549.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,780.48
|
| Rate for Payer: PHCS Commercial |
$9,433.71
|
| Rate for Payer: United Healthcare All Payer |
$8,647.57
|
|
|
PLATE STD LCK HD VDR 9H 135M L
|
Facility
|
OP
|
$9,826.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,948.03 |
| Max. Negotiated Rate |
$9,433.71 |
| Rate for Payer: Aetna Commercial |
$7,566.62
|
| Rate for Payer: Anthem Medicaid |
$3,379.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.89
|
| Rate for Payer: Cash Price |
$4,913.39
|
| Rate for Payer: Cigna Commercial |
$8,156.23
|
| Rate for Payer: First Health Commercial |
$9,335.44
|
| Rate for Payer: Humana Commercial |
$8,352.76
|
| Rate for Payer: Humana KY Medicaid |
$3,379.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,413.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,252.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,447.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,370.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,861.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,549.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,780.48
|
| Rate for Payer: PHCS Commercial |
$9,433.71
|
| Rate for Payer: United Healthcare All Payer |
$8,647.57
|
|
|
PLATE STD LCK HD VDR 9H 135M R
|
Facility
|
OP
|
$9,826.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,948.03 |
| Max. Negotiated Rate |
$9,433.71 |
| Rate for Payer: Aetna Commercial |
$7,566.62
|
| Rate for Payer: Anthem Medicaid |
$3,379.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.89
|
| Rate for Payer: Cash Price |
$4,913.39
|
| Rate for Payer: Cigna Commercial |
$8,156.23
|
| Rate for Payer: First Health Commercial |
$9,335.44
|
| Rate for Payer: Humana Commercial |
$8,352.76
|
| Rate for Payer: Humana KY Medicaid |
$3,379.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,413.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,252.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,447.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,370.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,861.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,549.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,780.48
|
| Rate for Payer: PHCS Commercial |
$9,433.71
|
| Rate for Payer: United Healthcare All Payer |
$8,647.57
|
|
|
PLATE STD LCK HD VDR 9H 135M R
|
Facility
|
IP
|
$9,826.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,948.03 |
| Max. Negotiated Rate |
$9,433.71 |
| Rate for Payer: Aetna Commercial |
$7,566.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,664.89
|
| Rate for Payer: Cash Price |
$4,913.39
|
| Rate for Payer: Cigna Commercial |
$8,156.23
|
| Rate for Payer: First Health Commercial |
$9,335.44
|
| Rate for Payer: Humana Commercial |
$8,352.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,057.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,252.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,647.57
|
| Rate for Payer: Ohio Health Group HMO |
$7,370.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,861.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,549.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,780.48
|
| Rate for Payer: PHCS Commercial |
$9,433.71
|
| Rate for Payer: United Healthcare All Payer |
$8,647.57
|
|
|
PLATE STD ORBTL GOLD 1.2M 10H
|
Facility
|
IP
|
$2,181.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.32 |
| Max. Negotiated Rate |
$2,093.83 |
| Rate for Payer: Aetna Commercial |
$1,679.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.23
|
| Rate for Payer: Cash Price |
$1,090.53
|
| Rate for Payer: Cigna Commercial |
$1,810.29
|
| Rate for Payer: First Health Commercial |
$2,072.02
|
| Rate for Payer: Humana Commercial |
$1,853.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,788.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,919.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,897.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.94
|
| Rate for Payer: PHCS Commercial |
$2,093.83
|
| Rate for Payer: United Healthcare All Payer |
$1,919.34
|
|
|
PLATE STD ORBTL GOLD 1.2M 10H
|
Facility
|
OP
|
$2,181.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$654.32 |
| Max. Negotiated Rate |
$2,093.83 |
| Rate for Payer: Aetna Commercial |
$1,679.42
|
| Rate for Payer: Anthem Medicaid |
$750.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,701.23
|
| Rate for Payer: Cash Price |
$1,090.53
|
| Rate for Payer: Cigna Commercial |
$1,810.29
|
| Rate for Payer: First Health Commercial |
$2,072.02
|
| Rate for Payer: Humana Commercial |
$1,853.91
|
| Rate for Payer: Humana KY Medicaid |
$750.07
|
| Rate for Payer: Kentucky WC Medicaid |
$757.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,788.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,609.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$765.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,919.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,635.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,744.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,897.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.94
|
| Rate for Payer: PHCS Commercial |
$2,093.83
|
| Rate for Payer: United Healthcare All Payer |
$1,919.34
|
|
|
PLATE STD V-D-R HD LK 3 62MM L
|
Facility
|
OP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem Medicaid |
$1,725.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Humana KY Medicaid |
$1,725.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE STD V-D-R HD LK 3 62MM L
|
Facility
|
IP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE STD V-D-R HD LK 3 62MM R
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD V-D-R HD LK 3 62MM R
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD V-D-R HD LK 5 86MM L
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD V-D-R HD LK 5 86MM L
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD V-D-R HD LK 5 86MM R
|
Facility
|
OP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem Medicaid |
$1,787.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Humana KY Medicaid |
$1,787.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,805.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,823.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE STD V-D-R HD LK 5 86MM R
|
Facility
|
IP
|
$5,198.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,559.46 |
| Max. Negotiated Rate |
$4,990.26 |
| Rate for Payer: Aetna Commercial |
$4,002.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,054.59
|
| Rate for Payer: Cash Price |
$2,599.09
|
| Rate for Payer: Cigna Commercial |
$4,314.50
|
| Rate for Payer: First Health Commercial |
$4,938.28
|
| Rate for Payer: Humana Commercial |
$4,418.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,262.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,836.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,559.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,574.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,898.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,158.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,522.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,586.75
|
| Rate for Payer: PHCS Commercial |
$4,990.26
|
| Rate for Payer: United Healthcare All Payer |
$4,574.41
|
|
|
PLATE ST NARROW 54 4H
|
Facility
|
OP
|
$3,480.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.27 |
| Max. Negotiated Rate |
$3,341.67 |
| Rate for Payer: Aetna Commercial |
$2,680.30
|
| Rate for Payer: Anthem Medicaid |
$1,197.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.11
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cigna Commercial |
$2,889.16
|
| Rate for Payer: First Health Commercial |
$3,306.86
|
| Rate for Payer: Humana Commercial |
$2,958.77
|
| Rate for Payer: Humana KY Medicaid |
$1,197.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,568.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,784.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,401.83
|
| Rate for Payer: PHCS Commercial |
$3,341.67
|
| Rate for Payer: United Healthcare All Payer |
$3,063.20
|
|
|
PLATE ST NARROW 54 4H
|
Facility
|
IP
|
$3,480.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.27 |
| Max. Negotiated Rate |
$3,341.67 |
| Rate for Payer: Aetna Commercial |
$2,680.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.11
|
| Rate for Payer: Cash Price |
$1,740.46
|
| Rate for Payer: Cigna Commercial |
$2,889.16
|
| Rate for Payer: First Health Commercial |
$3,306.86
|
| Rate for Payer: Humana Commercial |
$2,958.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,568.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,784.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,401.83
|
| Rate for Payer: PHCS Commercial |
$3,341.67
|
| Rate for Payer: United Healthcare All Payer |
$3,063.20
|
|
|
PLATE STRAIGHT 1.5MM
|
Facility
|
IP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
PLATE STRAIGHT 1.5MM
|
Facility
|
OP
|
$2,234.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.44 |
| Max. Negotiated Rate |
$2,145.41 |
| Rate for Payer: Aetna Commercial |
$1,720.80
|
| Rate for Payer: Anthem Medicaid |
$768.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,743.14
|
| Rate for Payer: Cash Price |
$1,117.40
|
| Rate for Payer: Cigna Commercial |
$1,854.88
|
| Rate for Payer: First Health Commercial |
$2,123.06
|
| Rate for Payer: Humana Commercial |
$1,899.58
|
| Rate for Payer: Humana KY Medicaid |
$768.55
|
| Rate for Payer: Kentucky WC Medicaid |
$776.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,832.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,649.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$670.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$783.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,966.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,676.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,787.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,944.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,542.01
|
| Rate for Payer: PHCS Commercial |
$2,145.41
|
| Rate for Payer: United Healthcare All Payer |
$1,966.62
|
|
|
PLATE STRAIGHT 2.0MM 20H
|
Facility
|
OP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem Medicaid |
$765.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Humana KY Medicaid |
$765.87
|
| Rate for Payer: Kentucky WC Medicaid |
$773.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$781.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
|
PLATE STRAIGHT 2.0MM 20H
|
Facility
|
IP
|
$2,227.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.10 |
| Max. Negotiated Rate |
$2,137.93 |
| Rate for Payer: Aetna Commercial |
$1,714.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,737.07
|
| Rate for Payer: Cash Price |
$1,113.51
|
| Rate for Payer: Cigna Commercial |
$1,848.42
|
| Rate for Payer: First Health Commercial |
$2,115.66
|
| Rate for Payer: Humana Commercial |
$1,892.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,826.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,643.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$668.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,959.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,670.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,781.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,937.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,536.64
|
| Rate for Payer: PHCS Commercial |
$2,137.93
|
| Rate for Payer: United Healthcare All Payer |
$1,959.77
|
|
