|
PLATE STRAIGHT 2.0MM 3H
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE STRAIGHT 2.0MM 3H
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem Medicaid |
$391.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Humana KY Medicaid |
$391.01
|
| Rate for Payer: Kentucky WC Medicaid |
$394.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE STRAIGHT 2.0MM 4H
|
Facility
|
OP
|
$1,167.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.32 |
| Max. Negotiated Rate |
$1,121.04 |
| Rate for Payer: Aetna Commercial |
$899.17
|
| Rate for Payer: Anthem Medicaid |
$401.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.85
|
| Rate for Payer: Cash Price |
$583.88
|
| Rate for Payer: Cigna Commercial |
$969.23
|
| Rate for Payer: First Health Commercial |
$1,109.36
|
| Rate for Payer: Humana Commercial |
$992.59
|
| Rate for Payer: Humana KY Medicaid |
$401.59
|
| Rate for Payer: Kentucky WC Medicaid |
$405.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$957.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,027.62
|
| Rate for Payer: Ohio Health Group HMO |
$875.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$934.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.75
|
| Rate for Payer: PHCS Commercial |
$1,121.04
|
| Rate for Payer: United Healthcare All Payer |
$1,027.62
|
|
|
PLATE STRAIGHT 2.0MM 4H
|
Facility
|
IP
|
$1,167.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$350.32 |
| Max. Negotiated Rate |
$1,121.04 |
| Rate for Payer: Aetna Commercial |
$899.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$910.85
|
| Rate for Payer: Cash Price |
$583.88
|
| Rate for Payer: Cigna Commercial |
$969.23
|
| Rate for Payer: First Health Commercial |
$1,109.36
|
| Rate for Payer: Humana Commercial |
$992.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$957.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$861.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,027.62
|
| Rate for Payer: Ohio Health Group HMO |
$875.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$934.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,015.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$805.75
|
| Rate for Payer: PHCS Commercial |
$1,121.04
|
| Rate for Payer: United Healthcare All Payer |
$1,027.62
|
|
|
PLATE STRAIGHT 2.0MM 5H
|
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 STRAIGHT 2.0MM 5H
|
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 STRAIGHT 2.0MM 6H
|
Facility
|
IP
|
$3,437.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.27 |
| Max. Negotiated Rate |
$3,300.06 |
| Rate for Payer: Aetna Commercial |
$2,646.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,681.30
|
| Rate for Payer: Cash Price |
$1,718.78
|
| Rate for Payer: Cigna Commercial |
$2,853.17
|
| Rate for Payer: First Health Commercial |
$3,265.68
|
| Rate for Payer: Humana Commercial |
$2,921.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,818.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,536.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,025.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,578.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,750.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,990.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,371.92
|
| Rate for Payer: PHCS Commercial |
$3,300.06
|
| Rate for Payer: United Healthcare All Payer |
$3,025.05
|
|
|
PLATE STRAIGHT 2.0MM 6H
|
Facility
|
OP
|
$3,437.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,031.27 |
| Max. Negotiated Rate |
$3,300.06 |
| Rate for Payer: Aetna Commercial |
$2,646.92
|
| Rate for Payer: Anthem Medicaid |
$1,182.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,681.30
|
| Rate for Payer: Cash Price |
$1,718.78
|
| Rate for Payer: Cigna Commercial |
$2,853.17
|
| Rate for Payer: First Health Commercial |
$3,265.68
|
| Rate for Payer: Humana Commercial |
$2,921.93
|
| Rate for Payer: Humana KY Medicaid |
$1,182.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,194.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,818.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,536.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,031.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,205.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,025.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,578.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,750.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,990.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,371.92
|
| Rate for Payer: PHCS Commercial |
$3,300.06
|
| Rate for Payer: United Healthcare All Payer |
$3,025.05
|
|
|
PLATE STRAIGHT AR-9943C-04
|
Facility
|
OP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem Medicaid |
$1,268.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,293.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
PLATE STRAIGHT AR-9943C-04
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
|
PLATE STRAIGHT AR-9943C-06
|
Facility
|
OP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem Medicaid |
$1,300.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Humana KY Medicaid |
$1,300.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,313.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,326.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
PLATE STRAIGHT AR-9943C-06
|
Facility
|
IP
|
$3,781.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$3,630.00 |
| Rate for Payer: Aetna Commercial |
$2,911.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,949.38
|
| Rate for Payer: Cash Price |
$1,890.62
|
| Rate for Payer: Cigna Commercial |
$3,138.44
|
| Rate for Payer: First Health Commercial |
$3,592.19
|
| Rate for Payer: Humana Commercial |
$3,214.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,100.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,790.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,134.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,327.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,835.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,025.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,289.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,609.06
|
| Rate for Payer: PHCS Commercial |
$3,630.00
|
| Rate for Payer: United Healthcare All Payer |
$3,327.50
|
|
|
PLATE STRAIGHT AR-9943C-07
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE STRAIGHT AR-9943C-07
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE STRAIGHT AR-9943C-08
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
PLATE STRAIGHT AR-9943C-08
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
PLATE STRAIGHT AR-9943C-10
|
Facility
|
IP
|
$4,231.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,269.38 |
| Max. Negotiated Rate |
$4,062.00 |
| Rate for Payer: Aetna Commercial |
$3,258.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,300.38
|
| Rate for Payer: Cash Price |
$2,115.62
|
| Rate for Payer: Cigna Commercial |
$3,511.94
|
| Rate for Payer: First Health Commercial |
$4,019.69
|
| Rate for Payer: Humana Commercial |
$3,596.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,469.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,122.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,723.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,173.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,681.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.56
|
| Rate for Payer: PHCS Commercial |
$4,062.00
|
| Rate for Payer: United Healthcare All Payer |
$3,723.50
|
|
|
PLATE STRAIGHT AR-9943C-10
|
Facility
|
OP
|
$4,231.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,269.38 |
| Max. Negotiated Rate |
$4,062.00 |
| Rate for Payer: Aetna Commercial |
$3,258.06
|
| Rate for Payer: Anthem Medicaid |
$1,455.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,300.38
|
| Rate for Payer: Cash Price |
$2,115.62
|
| Rate for Payer: Cigna Commercial |
$3,511.94
|
| Rate for Payer: First Health Commercial |
$4,019.69
|
| Rate for Payer: Humana Commercial |
$3,596.56
|
| Rate for Payer: Humana KY Medicaid |
$1,455.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,469.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,122.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,484.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,723.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,173.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,681.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.56
|
| Rate for Payer: PHCS Commercial |
$4,062.00
|
| Rate for Payer: United Healthcare All Payer |
$3,723.50
|
|
|
PLATE STRAIGHT AR-9943C-12
|
Facility
|
IP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE STRAIGHT AR-9943C-12
|
Facility
|
OP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem Medicaid |
$1,584.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Humana KY Medicaid |
$1,584.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,615.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE STRAIGHT FRAGMENT
|
Facility
|
OP
|
$3,856.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem Medicaid |
$1,326.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Humana KY Medicaid |
$1,326.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
PLATE STRAIGHT FRAGMENT
|
Facility
|
IP
|
$3,856.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
PLATE STR NAR 7H*90MM 4LCKING
|
Facility
|
OP
|
$3,432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.75 |
| Max. Negotiated Rate |
$3,295.20 |
| Rate for Payer: Aetna Commercial |
$2,643.03
|
| Rate for Payer: Anthem Medicaid |
$1,180.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,677.35
|
| Rate for Payer: Cash Price |
$1,716.25
|
| Rate for Payer: Cigna Commercial |
$2,848.97
|
| Rate for Payer: First Health Commercial |
$3,260.88
|
| Rate for Payer: Humana Commercial |
$2,917.62
|
| Rate for Payer: Humana KY Medicaid |
$1,180.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,192.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,986.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.43
|
| Rate for Payer: PHCS Commercial |
$3,295.20
|
| Rate for Payer: United Healthcare All Payer |
$3,020.60
|
|
|
PLATE STR NAR 7H*90MM 4LCKING
|
Facility
|
IP
|
$3,432.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.75 |
| Max. Negotiated Rate |
$3,295.20 |
| Rate for Payer: Aetna Commercial |
$2,643.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,677.35
|
| Rate for Payer: Cash Price |
$1,716.25
|
| Rate for Payer: Cigna Commercial |
$2,848.97
|
| Rate for Payer: First Health Commercial |
$3,260.88
|
| Rate for Payer: Humana Commercial |
$2,917.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,814.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,533.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,029.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,020.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,574.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,746.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,986.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,368.43
|
| Rate for Payer: PHCS Commercial |
$3,295.20
|
| Rate for Payer: United Healthcare All Payer |
$3,020.60
|
|
|
PLATE STRNL LSS STR 2.3MM 14HO
|
Facility
|
OP
|
$8,652.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.88 |
| Max. Negotiated Rate |
$8,306.82 |
| Rate for Payer: Aetna Commercial |
$6,662.76
|
| Rate for Payer: Anthem Medicaid |
$2,975.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,749.29
|
| Rate for Payer: Cash Price |
$4,326.47
|
| Rate for Payer: Cigna Commercial |
$7,181.94
|
| Rate for Payer: First Health Commercial |
$8,220.29
|
| Rate for Payer: Humana Commercial |
$7,355.00
|
| Rate for Payer: Humana KY Medicaid |
$2,975.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,006.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,385.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,595.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,035.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,614.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,489.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,922.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,528.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,970.53
|
| Rate for Payer: PHCS Commercial |
$8,306.82
|
| Rate for Payer: United Healthcare All Payer |
$7,614.59
|
|
