|
PLATE T 3H HD 3H SHT 3.5*52 OL
|
Facility
|
OP
|
$3,043.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.99 |
| Max. Negotiated Rate |
$2,921.56 |
| Rate for Payer: Aetna Commercial |
$2,343.33
|
| Rate for Payer: Anthem Medicaid |
$1,046.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,373.77
|
| Rate for Payer: Cash Price |
$1,521.64
|
| Rate for Payer: Cigna Commercial |
$2,525.93
|
| Rate for Payer: First Health Commercial |
$2,891.13
|
| Rate for Payer: Humana Commercial |
$2,586.80
|
| Rate for Payer: Humana KY Medicaid |
$1,046.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,057.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,495.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,245.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$912.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,067.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,678.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,282.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,434.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,647.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,099.87
|
| Rate for Payer: PHCS Commercial |
$2,921.56
|
| Rate for Payer: United Healthcare All Payer |
$2,678.10
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OL
|
Facility
|
OP
|
$3,088.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.43 |
| Max. Negotiated Rate |
$2,964.58 |
| Rate for Payer: Aetna Commercial |
$2,377.84
|
| Rate for Payer: Anthem Medicaid |
$1,062.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.72
|
| Rate for Payer: Cash Price |
$1,544.05
|
| Rate for Payer: Cigna Commercial |
$2,563.12
|
| Rate for Payer: First Health Commercial |
$2,933.70
|
| Rate for Payer: Humana Commercial |
$2,624.89
|
| Rate for Payer: Humana KY Medicaid |
$1,062.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,072.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,532.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,279.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,316.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.79
|
| Rate for Payer: PHCS Commercial |
$2,964.58
|
| Rate for Payer: United Healthcare All Payer |
$2,717.53
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OL
|
Facility
|
IP
|
$3,088.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.43 |
| Max. Negotiated Rate |
$2,964.58 |
| Rate for Payer: Aetna Commercial |
$2,377.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.72
|
| Rate for Payer: Cash Price |
$1,544.05
|
| Rate for Payer: Cigna Commercial |
$2,563.12
|
| Rate for Payer: First Health Commercial |
$2,933.70
|
| Rate for Payer: Humana Commercial |
$2,624.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,532.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,279.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.53
|
| Rate for Payer: Ohio Health Group HMO |
$2,316.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.79
|
| Rate for Payer: PHCS Commercial |
$2,964.58
|
| Rate for Payer: United Healthcare All Payer |
$2,717.53
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OR
|
Facility
|
IP
|
$3,035.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.74 |
| Max. Negotiated Rate |
$2,914.36 |
| Rate for Payer: Aetna Commercial |
$2,337.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,367.92
|
| Rate for Payer: Cash Price |
$1,517.89
|
| Rate for Payer: Cigna Commercial |
$2,519.71
|
| Rate for Payer: First Health Commercial |
$2,884.00
|
| Rate for Payer: Humana Commercial |
$2,580.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.70
|
| Rate for Payer: PHCS Commercial |
$2,914.36
|
| Rate for Payer: United Healthcare All Payer |
$2,671.50
|
|
|
PLATE T 3H HD 4H SHT 3.5*63 OR
|
Facility
|
OP
|
$3,035.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.74 |
| Max. Negotiated Rate |
$2,914.36 |
| Rate for Payer: Aetna Commercial |
$2,337.56
|
| Rate for Payer: Anthem Medicaid |
$1,044.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,367.92
|
| Rate for Payer: Cash Price |
$1,517.89
|
| Rate for Payer: Cigna Commercial |
$2,519.71
|
| Rate for Payer: First Health Commercial |
$2,884.00
|
| Rate for Payer: Humana Commercial |
$2,580.42
|
| Rate for Payer: Humana KY Medicaid |
$1,044.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.70
|
| Rate for Payer: PHCS Commercial |
$2,914.36
|
| Rate for Payer: United Healthcare All Payer |
$2,671.50
|
|
|
PLATE T 3H HD 5H SHFT 3.5*67 R
|
Facility
|
OP
|
$3,554.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.36 |
| Max. Negotiated Rate |
$3,412.34 |
| Rate for Payer: Aetna Commercial |
$2,736.98
|
| Rate for Payer: Anthem Medicaid |
$1,222.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,772.53
|
| Rate for Payer: Cash Price |
$1,777.26
|
| Rate for Payer: Cigna Commercial |
$2,950.25
|
| Rate for Payer: First Health Commercial |
$3,376.79
|
| Rate for Payer: Humana Commercial |
$3,021.34
|
| Rate for Payer: Humana KY Medicaid |
$1,222.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,234.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,914.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,623.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,246.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,127.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,665.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,843.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,092.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.62
|
| Rate for Payer: PHCS Commercial |
$3,412.34
|
| Rate for Payer: United Healthcare All Payer |
$3,127.98
|
|
|
PLATE T 3H HD 5H SHFT 3.5*67 R
|
Facility
|
IP
|
$3,554.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.36 |
| Max. Negotiated Rate |
$3,412.34 |
| Rate for Payer: Aetna Commercial |
$2,736.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,772.53
|
| Rate for Payer: Cash Price |
$1,777.26
|
| Rate for Payer: Cigna Commercial |
$2,950.25
|
| Rate for Payer: First Health Commercial |
$3,376.79
|
| Rate for Payer: Humana Commercial |
$3,021.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,914.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,623.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,127.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,665.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,843.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,092.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.62
|
| Rate for Payer: PHCS Commercial |
$3,412.34
|
| Rate for Payer: United Healthcare All Payer |
$3,127.98
|
|
|
PLATE T 3H HD 5H SHFT 3.5*74OL
|
Facility
|
OP
|
$3,129.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.99 |
| Max. Negotiated Rate |
$3,004.75 |
| Rate for Payer: Aetna Commercial |
$2,410.06
|
| Rate for Payer: Anthem Medicaid |
$1,076.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.36
|
| Rate for Payer: Cash Price |
$1,564.97
|
| Rate for Payer: Cigna Commercial |
$2,597.86
|
| Rate for Payer: First Health Commercial |
$2,973.45
|
| Rate for Payer: Humana Commercial |
$2,660.46
|
| Rate for Payer: Humana KY Medicaid |
$1,076.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.67
|
| Rate for Payer: PHCS Commercial |
$3,004.75
|
| Rate for Payer: United Healthcare All Payer |
$2,754.36
|
|
|
PLATE T 3H HD 5H SHFT 3.5*74OL
|
Facility
|
IP
|
$3,129.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.99 |
| Max. Negotiated Rate |
$3,004.75 |
| Rate for Payer: Aetna Commercial |
$2,410.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.36
|
| Rate for Payer: Cash Price |
$1,564.97
|
| Rate for Payer: Cigna Commercial |
$2,597.86
|
| Rate for Payer: First Health Commercial |
$2,973.45
|
| Rate for Payer: Humana Commercial |
$2,660.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.67
|
| Rate for Payer: PHCS Commercial |
$3,004.75
|
| Rate for Payer: United Healthcare All Payer |
$2,754.36
|
|
|
PLATE T 3H HD 5H SHT 3.5*74 OR
|
Facility
|
OP
|
$3,129.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.99 |
| Max. Negotiated Rate |
$3,004.75 |
| Rate for Payer: Aetna Commercial |
$2,410.06
|
| Rate for Payer: Anthem Medicaid |
$1,076.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.36
|
| Rate for Payer: Cash Price |
$1,564.97
|
| Rate for Payer: Cigna Commercial |
$2,597.86
|
| Rate for Payer: First Health Commercial |
$2,973.45
|
| Rate for Payer: Humana Commercial |
$2,660.46
|
| Rate for Payer: Humana KY Medicaid |
$1,076.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,097.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.67
|
| Rate for Payer: PHCS Commercial |
$3,004.75
|
| Rate for Payer: United Healthcare All Payer |
$2,754.36
|
|
|
PLATE T 3H HD 5H SHT 3.5*74 OR
|
Facility
|
IP
|
$3,129.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.99 |
| Max. Negotiated Rate |
$3,004.75 |
| Rate for Payer: Aetna Commercial |
$2,410.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.36
|
| Rate for Payer: Cash Price |
$1,564.97
|
| Rate for Payer: Cigna Commercial |
$2,597.86
|
| Rate for Payer: First Health Commercial |
$2,973.45
|
| Rate for Payer: Humana Commercial |
$2,660.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$938.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,503.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.67
|
| Rate for Payer: PHCS Commercial |
$3,004.75
|
| Rate for Payer: United Healthcare All Payer |
$2,754.36
|
|
|
PLATE T 3H HD 7H SHFT 3.5*87 R
|
Facility
|
IP
|
$4,082.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$3,919.51 |
| Rate for Payer: Aetna Commercial |
$3,143.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,184.60
|
| Rate for Payer: Cash Price |
$2,041.41
|
| Rate for Payer: Cigna Commercial |
$3,388.74
|
| Rate for Payer: First Health Commercial |
$3,878.68
|
| Rate for Payer: Humana Commercial |
$3,470.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,347.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,013.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,592.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,062.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,266.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,552.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,817.15
|
| Rate for Payer: PHCS Commercial |
$3,919.51
|
| Rate for Payer: United Healthcare All Payer |
$3,592.88
|
|
|
PLATE T 3H HD 7H SHFT 3.5*87 R
|
Facility
|
OP
|
$4,082.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,224.85 |
| Max. Negotiated Rate |
$3,919.51 |
| Rate for Payer: Aetna Commercial |
$3,143.77
|
| Rate for Payer: Anthem Medicaid |
$1,404.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,184.60
|
| Rate for Payer: Cash Price |
$2,041.41
|
| Rate for Payer: Cigna Commercial |
$3,388.74
|
| Rate for Payer: First Health Commercial |
$3,878.68
|
| Rate for Payer: Humana Commercial |
$3,470.40
|
| Rate for Payer: Humana KY Medicaid |
$1,404.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,418.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,347.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,013.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,224.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,432.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,592.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,062.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,266.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,552.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,817.15
|
| Rate for Payer: PHCS Commercial |
$3,919.51
|
| Rate for Payer: United Healthcare All Payer |
$3,592.88
|
|
|
PLATE T 3H HD 7H SHFT 3.5*96OL
|
Facility
|
IP
|
$3,231.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.33 |
| Max. Negotiated Rate |
$3,101.85 |
| Rate for Payer: Aetna Commercial |
$2,487.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,520.25
|
| Rate for Payer: Cash Price |
$1,615.54
|
| Rate for Payer: Cigna Commercial |
$2,681.80
|
| Rate for Payer: First Health Commercial |
$3,069.54
|
| Rate for Payer: Humana Commercial |
$2,746.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,649.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,384.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,843.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,423.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,811.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.45
|
| Rate for Payer: PHCS Commercial |
$3,101.85
|
| Rate for Payer: United Healthcare All Payer |
$2,843.36
|
|
|
PLATE T 3H HD 7H SHFT 3.5*96OL
|
Facility
|
OP
|
$3,231.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.33 |
| Max. Negotiated Rate |
$3,101.85 |
| Rate for Payer: Aetna Commercial |
$2,487.94
|
| Rate for Payer: Anthem Medicaid |
$1,111.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,520.25
|
| Rate for Payer: Cash Price |
$1,615.54
|
| Rate for Payer: Cigna Commercial |
$2,681.80
|
| Rate for Payer: First Health Commercial |
$3,069.54
|
| Rate for Payer: Humana Commercial |
$2,746.43
|
| Rate for Payer: Humana KY Medicaid |
$1,111.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,649.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,384.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,843.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,423.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,811.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.45
|
| Rate for Payer: PHCS Commercial |
$3,101.85
|
| Rate for Payer: United Healthcare All Payer |
$2,843.36
|
|
|
PLATE T 3H HD 7H SHT 3.5*96 OR
|
Facility
|
IP
|
$3,231.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.33 |
| Max. Negotiated Rate |
$3,101.85 |
| Rate for Payer: Aetna Commercial |
$2,487.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,520.25
|
| Rate for Payer: Cash Price |
$1,615.54
|
| Rate for Payer: Cigna Commercial |
$2,681.80
|
| Rate for Payer: First Health Commercial |
$3,069.54
|
| Rate for Payer: Humana Commercial |
$2,746.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,649.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,384.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,843.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,423.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,811.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.45
|
| Rate for Payer: PHCS Commercial |
$3,101.85
|
| Rate for Payer: United Healthcare All Payer |
$2,843.36
|
|
|
PLATE T 3H HD 7H SHT 3.5*96 OR
|
Facility
|
OP
|
$3,231.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$969.33 |
| Max. Negotiated Rate |
$3,101.85 |
| Rate for Payer: Aetna Commercial |
$2,487.94
|
| Rate for Payer: Anthem Medicaid |
$1,111.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,520.25
|
| Rate for Payer: Cash Price |
$1,615.54
|
| Rate for Payer: Cigna Commercial |
$2,681.80
|
| Rate for Payer: First Health Commercial |
$3,069.54
|
| Rate for Payer: Humana Commercial |
$2,746.43
|
| Rate for Payer: Humana KY Medicaid |
$1,111.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,649.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,384.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,843.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,423.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,584.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,811.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,229.45
|
| Rate for Payer: PHCS Commercial |
$3,101.85
|
| Rate for Payer: United Healthcare All Payer |
$2,843.36
|
|
|
PLATE T 3H HED/SHFT 3.5*52 OR
|
Facility
|
OP
|
$3,035.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.74 |
| Max. Negotiated Rate |
$2,914.36 |
| Rate for Payer: Aetna Commercial |
$2,337.56
|
| Rate for Payer: Anthem Medicaid |
$1,044.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,367.92
|
| Rate for Payer: Cash Price |
$1,517.89
|
| Rate for Payer: Cigna Commercial |
$2,519.71
|
| Rate for Payer: First Health Commercial |
$2,884.00
|
| Rate for Payer: Humana Commercial |
$2,580.42
|
| Rate for Payer: Humana KY Medicaid |
$1,044.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,054.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.70
|
| Rate for Payer: PHCS Commercial |
$2,914.36
|
| Rate for Payer: United Healthcare All Payer |
$2,671.50
|
|
|
PLATE T 3H HED/SHFT 3.5*52 OR
|
Facility
|
IP
|
$3,035.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.74 |
| Max. Negotiated Rate |
$2,914.36 |
| Rate for Payer: Aetna Commercial |
$2,337.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,367.92
|
| Rate for Payer: Cash Price |
$1,517.89
|
| Rate for Payer: Cigna Commercial |
$2,519.71
|
| Rate for Payer: First Health Commercial |
$2,884.00
|
| Rate for Payer: Humana Commercial |
$2,580.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,489.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,240.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,671.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,276.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,428.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,641.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,094.70
|
| Rate for Payer: PHCS Commercial |
$2,914.36
|
| Rate for Payer: United Healthcare All Payer |
$2,671.50
|
|
|
PLATE T 3 HOLE 68MM
|
Facility
|
OP
|
$3,289.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$986.94 |
| Max. Negotiated Rate |
$3,158.22 |
| Rate for Payer: Aetna Commercial |
$2,533.15
|
| Rate for Payer: Anthem Medicaid |
$1,131.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.05
|
| Rate for Payer: Cash Price |
$1,644.91
|
| Rate for Payer: Cigna Commercial |
$2,730.54
|
| Rate for Payer: First Health Commercial |
$3,125.32
|
| Rate for Payer: Humana Commercial |
$2,796.34
|
| Rate for Payer: Humana KY Medicaid |
$1,131.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,142.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,427.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,269.97
|
| Rate for Payer: PHCS Commercial |
$3,158.22
|
| Rate for Payer: United Healthcare All Payer |
$2,895.03
|
|
|
PLATE T 3 HOLE 68MM
|
Facility
|
IP
|
$3,289.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$986.94 |
| Max. Negotiated Rate |
$3,158.22 |
| Rate for Payer: Aetna Commercial |
$2,533.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,566.05
|
| Rate for Payer: Cash Price |
$1,644.91
|
| Rate for Payer: Cigna Commercial |
$2,730.54
|
| Rate for Payer: First Health Commercial |
$3,125.32
|
| Rate for Payer: Humana Commercial |
$2,796.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,697.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,427.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$986.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,895.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,467.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,631.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,862.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,269.97
|
| Rate for Payer: PHCS Commercial |
$3,158.22
|
| Rate for Payer: United Healthcare All Payer |
$2,895.03
|
|
|
PLATE T 4.5 LCP 4H 83MM
|
Facility
|
OP
|
$4,350.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,305.26 |
| Max. Negotiated Rate |
$4,176.84 |
| Rate for Payer: Aetna Commercial |
$3,350.18
|
| Rate for Payer: Anthem Medicaid |
$1,496.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.69
|
| Rate for Payer: Cash Price |
$2,175.44
|
| Rate for Payer: Cigna Commercial |
$3,611.23
|
| Rate for Payer: First Health Commercial |
$4,133.34
|
| Rate for Payer: Humana Commercial |
$3,698.25
|
| Rate for Payer: Humana KY Medicaid |
$1,496.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,567.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,210.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,828.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,480.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,785.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.11
|
| Rate for Payer: PHCS Commercial |
$4,176.84
|
| Rate for Payer: United Healthcare All Payer |
$3,828.77
|
|
|
PLATE T 4.5 LCP 4H 83MM
|
Facility
|
IP
|
$4,350.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,305.26 |
| Max. Negotiated Rate |
$4,176.84 |
| Rate for Payer: Aetna Commercial |
$3,350.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,393.69
|
| Rate for Payer: Cash Price |
$2,175.44
|
| Rate for Payer: Cigna Commercial |
$3,611.23
|
| Rate for Payer: First Health Commercial |
$4,133.34
|
| Rate for Payer: Humana Commercial |
$3,698.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,567.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,210.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,828.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,480.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,785.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,002.11
|
| Rate for Payer: PHCS Commercial |
$4,176.84
|
| Rate for Payer: United Healthcare All Payer |
$3,828.77
|
|
|
PLATE T 4.5 LCP 6H 115MM
|
Facility
|
OP
|
$4,585.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,375.76 |
| Max. Negotiated Rate |
$4,402.42 |
| Rate for Payer: Aetna Commercial |
$3,531.10
|
| Rate for Payer: Anthem Medicaid |
$1,577.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,292.93
|
| Rate for Payer: Cigna Commercial |
$3,806.26
|
| Rate for Payer: First Health Commercial |
$4,356.56
|
| Rate for Payer: Humana Commercial |
$3,897.97
|
| Rate for Payer: Humana KY Medicaid |
$1,577.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,760.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,384.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,608.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,035.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,439.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,668.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,989.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,164.24
|
| Rate for Payer: PHCS Commercial |
$4,402.42
|
| Rate for Payer: United Healthcare All Payer |
$4,035.55
|
|
|
PLATE T 4.5 LCP 6H 115MM
|
Facility
|
IP
|
$4,585.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,375.76 |
| Max. Negotiated Rate |
$4,402.42 |
| Rate for Payer: Aetna Commercial |
$3,531.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,576.96
|
| Rate for Payer: Cash Price |
$2,292.93
|
| Rate for Payer: Cigna Commercial |
$3,806.26
|
| Rate for Payer: First Health Commercial |
$4,356.56
|
| Rate for Payer: Humana Commercial |
$3,897.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,760.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,384.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,035.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,439.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,668.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,989.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,164.24
|
| Rate for Payer: PHCS Commercial |
$4,402.42
|
| Rate for Payer: United Healthcare All Payer |
$4,035.55
|
|
