|
PLATE TI LCP 3.5*124MM 9H
|
Facility
|
OP
|
$3,487.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.28 |
| Max. Negotiated Rate |
$3,348.09 |
| Rate for Payer: Aetna Commercial |
$2,685.44
|
| Rate for Payer: Anthem Medicaid |
$1,199.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,720.32
|
| Rate for Payer: Cash Price |
$1,743.79
|
| Rate for Payer: Cigna Commercial |
$2,894.70
|
| Rate for Payer: First Health Commercial |
$3,313.21
|
| Rate for Payer: Humana Commercial |
$2,964.45
|
| Rate for Payer: Humana KY Medicaid |
$1,199.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,211.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,859.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,573.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,046.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,223.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,069.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,615.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,790.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,034.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.44
|
| Rate for Payer: PHCS Commercial |
$3,348.09
|
| Rate for Payer: United Healthcare All Payer |
$3,069.08
|
|
|
PLATE TI LCP 3.5*124MM 9H
|
Facility
|
IP
|
$3,487.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.28 |
| Max. Negotiated Rate |
$3,348.09 |
| Rate for Payer: Aetna Commercial |
$2,685.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,720.32
|
| Rate for Payer: Cash Price |
$1,743.79
|
| Rate for Payer: Cigna Commercial |
$2,894.70
|
| Rate for Payer: First Health Commercial |
$3,313.21
|
| Rate for Payer: Humana Commercial |
$2,964.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,859.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,573.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,046.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,069.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,615.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,790.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,034.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,406.44
|
| Rate for Payer: PHCS Commercial |
$3,348.09
|
| Rate for Payer: United Healthcare All Payer |
$3,069.08
|
|
|
PLATE TI LCP 3.5*137MM 10H
|
Facility
|
IP
|
$3,343.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.02 |
| Max. Negotiated Rate |
$3,209.66 |
| Rate for Payer: Aetna Commercial |
$2,574.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.85
|
| Rate for Payer: Cash Price |
$1,671.70
|
| Rate for Payer: Cigna Commercial |
$2,775.02
|
| Rate for Payer: First Health Commercial |
$3,176.23
|
| Rate for Payer: Humana Commercial |
$2,841.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,942.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.95
|
| Rate for Payer: PHCS Commercial |
$3,209.66
|
| Rate for Payer: United Healthcare All Payer |
$2,942.19
|
|
|
PLATE TI LCP 3.5*137MM 10H
|
Facility
|
OP
|
$3,343.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.02 |
| Max. Negotiated Rate |
$3,209.66 |
| Rate for Payer: Aetna Commercial |
$2,574.42
|
| Rate for Payer: Anthem Medicaid |
$1,149.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,607.85
|
| Rate for Payer: Cash Price |
$1,671.70
|
| Rate for Payer: Cigna Commercial |
$2,775.02
|
| Rate for Payer: First Health Commercial |
$3,176.23
|
| Rate for Payer: Humana Commercial |
$2,841.89
|
| Rate for Payer: Humana KY Medicaid |
$1,149.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,161.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,741.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,467.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,003.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,172.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,942.19
|
| Rate for Payer: Ohio Health Group HMO |
$2,507.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,674.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,908.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.95
|
| Rate for Payer: PHCS Commercial |
$3,209.66
|
| Rate for Payer: United Healthcare All Payer |
$2,942.19
|
|
|
PLATE TI LCP 3.5*163MM 12H
|
Facility
|
IP
|
$3,768.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.44 |
| Max. Negotiated Rate |
$3,617.40 |
| Rate for Payer: Aetna Commercial |
$2,901.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,939.13
|
| Rate for Payer: Cash Price |
$1,884.06
|
| Rate for Payer: Cigna Commercial |
$3,127.54
|
| Rate for Payer: First Health Commercial |
$3,579.71
|
| Rate for Payer: Humana Commercial |
$3,202.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,089.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,780.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,130.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,315.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,826.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,014.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,278.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,600.00
|
| Rate for Payer: PHCS Commercial |
$3,617.40
|
| Rate for Payer: United Healthcare All Payer |
$3,315.95
|
|
|
PLATE TI LCP 3.5*163MM 12H
|
Facility
|
OP
|
$3,768.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,130.44 |
| Max. Negotiated Rate |
$3,617.40 |
| Rate for Payer: Aetna Commercial |
$2,901.45
|
| Rate for Payer: Anthem Medicaid |
$1,295.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,939.13
|
| Rate for Payer: Cash Price |
$1,884.06
|
| Rate for Payer: Cigna Commercial |
$3,127.54
|
| Rate for Payer: First Health Commercial |
$3,579.71
|
| Rate for Payer: Humana Commercial |
$3,202.90
|
| Rate for Payer: Humana KY Medicaid |
$1,295.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,309.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,089.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,780.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,130.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,321.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,315.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,826.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,014.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,278.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,600.00
|
| Rate for Payer: PHCS Commercial |
$3,617.40
|
| Rate for Payer: United Healthcare All Payer |
$3,315.95
|
|
|
PLATE TI LCP 3.5*189MM 14H
|
Facility
|
OP
|
$4,222.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.72 |
| Max. Negotiated Rate |
$4,053.50 |
| Rate for Payer: Aetna Commercial |
$3,251.25
|
| Rate for Payer: Anthem Medicaid |
$1,452.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.47
|
| Rate for Payer: Cash Price |
$2,111.20
|
| Rate for Payer: Cigna Commercial |
$3,504.59
|
| Rate for Payer: First Health Commercial |
$4,011.28
|
| Rate for Payer: Humana Commercial |
$3,589.04
|
| Rate for Payer: Humana KY Medicaid |
$1,452.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,466.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,715.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,166.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,377.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,673.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.46
|
| Rate for Payer: PHCS Commercial |
$4,053.50
|
| Rate for Payer: United Healthcare All Payer |
$3,715.71
|
|
|
PLATE TI LCP 3.5*189MM 14H
|
Facility
|
IP
|
$4,222.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.72 |
| Max. Negotiated Rate |
$4,053.50 |
| Rate for Payer: Aetna Commercial |
$3,251.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.47
|
| Rate for Payer: Cash Price |
$2,111.20
|
| Rate for Payer: Cigna Commercial |
$3,504.59
|
| Rate for Payer: First Health Commercial |
$4,011.28
|
| Rate for Payer: Humana Commercial |
$3,589.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,715.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,166.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,377.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,673.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,913.46
|
| Rate for Payer: PHCS Commercial |
$4,053.50
|
| Rate for Payer: United Healthcare All Payer |
$3,715.71
|
|
|
PLATE TI LCP 3.5*72MM 5H
|
Facility
|
OP
|
$3,074.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.41 |
| Max. Negotiated Rate |
$2,951.72 |
| Rate for Payer: Aetna Commercial |
$2,367.53
|
| Rate for Payer: Anthem Medicaid |
$1,057.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.27
|
| Rate for Payer: Cash Price |
$1,537.36
|
| Rate for Payer: Cigna Commercial |
$2,552.01
|
| Rate for Payer: First Health Commercial |
$2,920.97
|
| Rate for Payer: Humana Commercial |
$2,613.50
|
| Rate for Payer: Humana KY Medicaid |
$1,057.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,705.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,459.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,675.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.55
|
| Rate for Payer: PHCS Commercial |
$2,951.72
|
| Rate for Payer: United Healthcare All Payer |
$2,705.74
|
|
|
PLATE TI LCP 3.5*72MM 5H
|
Facility
|
IP
|
$3,074.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.41 |
| Max. Negotiated Rate |
$2,951.72 |
| Rate for Payer: Aetna Commercial |
$2,367.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.27
|
| Rate for Payer: Cash Price |
$1,537.36
|
| Rate for Payer: Cigna Commercial |
$2,552.01
|
| Rate for Payer: First Health Commercial |
$2,920.97
|
| Rate for Payer: Humana Commercial |
$2,613.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,705.74
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,459.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,675.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,121.55
|
| Rate for Payer: PHCS Commercial |
$2,951.72
|
| Rate for Payer: United Healthcare All Payer |
$2,705.74
|
|
|
PLATE TI LCP 3.5*85MM 6H
|
Facility
|
OP
|
$3,368.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.59 |
| Max. Negotiated Rate |
$3,233.89 |
| Rate for Payer: Aetna Commercial |
$2,593.85
|
| Rate for Payer: Anthem Medicaid |
$1,158.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.54
|
| Rate for Payer: Cash Price |
$1,684.32
|
| Rate for Payer: Cigna Commercial |
$2,795.97
|
| Rate for Payer: First Health Commercial |
$3,200.21
|
| Rate for Payer: Humana Commercial |
$2,863.34
|
| Rate for Payer: Humana KY Medicaid |
$1,158.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.36
|
| Rate for Payer: PHCS Commercial |
$3,233.89
|
| Rate for Payer: United Healthcare All Payer |
$2,964.40
|
|
|
PLATE TI LCP 3.5*85MM 6H
|
Facility
|
IP
|
$3,368.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.59 |
| Max. Negotiated Rate |
$3,233.89 |
| Rate for Payer: Aetna Commercial |
$2,593.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.54
|
| Rate for Payer: Cash Price |
$1,684.32
|
| Rate for Payer: Cigna Commercial |
$2,795.97
|
| Rate for Payer: First Health Commercial |
$3,200.21
|
| Rate for Payer: Humana Commercial |
$2,863.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.36
|
| Rate for Payer: PHCS Commercial |
$3,233.89
|
| Rate for Payer: United Healthcare All Payer |
$2,964.40
|
|
|
PLATE TI LCP PROX HM 3H 3.5*90
|
Facility
|
OP
|
$9,333.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,800.03 |
| Max. Negotiated Rate |
$8,960.10 |
| Rate for Payer: Aetna Commercial |
$7,186.75
|
| Rate for Payer: Anthem Medicaid |
$3,209.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,280.08
|
| Rate for Payer: Cash Price |
$4,666.72
|
| Rate for Payer: Cigna Commercial |
$7,746.76
|
| Rate for Payer: First Health Commercial |
$8,866.77
|
| Rate for Payer: Humana Commercial |
$7,933.42
|
| Rate for Payer: Humana KY Medicaid |
$3,209.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,653.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,888.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,213.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,000.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,120.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,440.07
|
| Rate for Payer: PHCS Commercial |
$8,960.10
|
| Rate for Payer: United Healthcare All Payer |
$8,213.43
|
|
|
PLATE TI LCP PROX HM 3H 3.5*90
|
Facility
|
IP
|
$9,333.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,800.03 |
| Max. Negotiated Rate |
$8,960.10 |
| Rate for Payer: Aetna Commercial |
$7,186.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,280.08
|
| Rate for Payer: Cash Price |
$4,666.72
|
| Rate for Payer: Cigna Commercial |
$7,746.76
|
| Rate for Payer: First Health Commercial |
$8,866.77
|
| Rate for Payer: Humana Commercial |
$7,933.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,653.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,888.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,213.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,000.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,120.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,440.07
|
| Rate for Payer: PHCS Commercial |
$8,960.10
|
| Rate for Payer: United Healthcare All Payer |
$8,213.43
|
|
|
PLATE TI LCP PRX HM 5H 3.5*114
|
Facility
|
IP
|
$8,478.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,543.67 |
| Max. Negotiated Rate |
$8,139.75 |
| Rate for Payer: Aetna Commercial |
$6,528.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,613.55
|
| Rate for Payer: Cash Price |
$4,239.45
|
| Rate for Payer: Cigna Commercial |
$7,037.50
|
| Rate for Payer: First Health Commercial |
$8,054.96
|
| Rate for Payer: Humana Commercial |
$7,207.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,952.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,543.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,461.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,359.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,783.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,376.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,850.45
|
| Rate for Payer: PHCS Commercial |
$8,139.75
|
| Rate for Payer: United Healthcare All Payer |
$7,461.44
|
|
|
PLATE TI LCP PRX HM 5H 3.5*114
|
Facility
|
OP
|
$8,478.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,543.67 |
| Max. Negotiated Rate |
$8,139.75 |
| Rate for Payer: Aetna Commercial |
$6,528.76
|
| Rate for Payer: Anthem Medicaid |
$2,915.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,613.55
|
| Rate for Payer: Cash Price |
$4,239.45
|
| Rate for Payer: Cigna Commercial |
$7,037.50
|
| Rate for Payer: First Health Commercial |
$8,054.96
|
| Rate for Payer: Humana Commercial |
$7,207.07
|
| Rate for Payer: Humana KY Medicaid |
$2,915.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,945.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,952.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,543.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,974.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,461.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,359.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,783.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,376.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,850.45
|
| Rate for Payer: PHCS Commercial |
$8,139.75
|
| Rate for Payer: United Healthcare All Payer |
$7,461.44
|
|
|
PLATE TI LCP RECON 3.5*112 8H
|
Facility
|
IP
|
$4,195.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.53 |
| Max. Negotiated Rate |
$4,027.30 |
| Rate for Payer: Aetna Commercial |
$3,230.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.18
|
| Rate for Payer: Cash Price |
$2,097.55
|
| Rate for Payer: Cigna Commercial |
$3,481.93
|
| Rate for Payer: First Health Commercial |
$3,985.34
|
| Rate for Payer: Humana Commercial |
$3,565.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,439.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,095.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,691.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,649.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,894.62
|
| Rate for Payer: PHCS Commercial |
$4,027.30
|
| Rate for Payer: United Healthcare All Payer |
$3,691.69
|
|
|
PLATE TI LCP RECON 3.5*112 8H
|
Facility
|
OP
|
$4,195.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,258.53 |
| Max. Negotiated Rate |
$4,027.30 |
| Rate for Payer: Aetna Commercial |
$3,230.23
|
| Rate for Payer: Anthem Medicaid |
$1,442.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,272.18
|
| Rate for Payer: Cash Price |
$2,097.55
|
| Rate for Payer: Cigna Commercial |
$3,481.93
|
| Rate for Payer: First Health Commercial |
$3,985.34
|
| Rate for Payer: Humana Commercial |
$3,565.84
|
| Rate for Payer: Humana KY Medicaid |
$1,442.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,457.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,439.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,095.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,258.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,471.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,691.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,146.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,356.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,649.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,894.62
|
| Rate for Payer: PHCS Commercial |
$4,027.30
|
| Rate for Payer: United Healthcare All Payer |
$3,691.69
|
|
|
PLATE TI LCP RECON 3.5*140 10H
|
Facility
|
OP
|
$4,365.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.75 |
| Max. Negotiated Rate |
$4,191.21 |
| Rate for Payer: Aetna Commercial |
$3,361.70
|
| Rate for Payer: Anthem Medicaid |
$1,501.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,405.36
|
| Rate for Payer: Cash Price |
$2,182.92
|
| Rate for Payer: Cigna Commercial |
$3,623.65
|
| Rate for Payer: First Health Commercial |
$4,147.55
|
| Rate for Payer: Humana Commercial |
$3,710.96
|
| Rate for Payer: Humana KY Medicaid |
$1,501.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,516.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,531.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,841.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,274.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,492.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,798.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.43
|
| Rate for Payer: PHCS Commercial |
$4,191.21
|
| Rate for Payer: United Healthcare All Payer |
$3,841.94
|
|
|
PLATE TI LCP RECON 3.5*140 10H
|
Facility
|
IP
|
$4,365.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,309.75 |
| Max. Negotiated Rate |
$4,191.21 |
| Rate for Payer: Aetna Commercial |
$3,361.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,405.36
|
| Rate for Payer: Cash Price |
$2,182.92
|
| Rate for Payer: Cigna Commercial |
$3,623.65
|
| Rate for Payer: First Health Commercial |
$4,147.55
|
| Rate for Payer: Humana Commercial |
$3,710.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,579.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,221.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,309.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,841.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,274.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,492.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,798.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,012.43
|
| Rate for Payer: PHCS Commercial |
$4,191.21
|
| Rate for Payer: United Healthcare All Payer |
$3,841.94
|
|
|
PLATE TI LCP RECON 3.5*154 11H
|
Facility
|
OP
|
$4,277.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,283.21 |
| Max. Negotiated Rate |
$4,106.28 |
| Rate for Payer: Aetna Commercial |
$3,293.58
|
| Rate for Payer: Anthem Medicaid |
$1,470.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,336.36
|
| Rate for Payer: Cash Price |
$2,138.69
|
| Rate for Payer: Cigna Commercial |
$3,550.23
|
| Rate for Payer: First Health Commercial |
$4,063.51
|
| Rate for Payer: Humana Commercial |
$3,635.77
|
| Rate for Payer: Humana KY Medicaid |
$1,470.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,485.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,507.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,156.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,500.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,764.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,208.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,421.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,721.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,951.39
|
| Rate for Payer: PHCS Commercial |
$4,106.28
|
| Rate for Payer: United Healthcare All Payer |
$3,764.09
|
|
|
PLATE TI LCP RECON 3.5*154 11H
|
Facility
|
IP
|
$4,277.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,283.21 |
| Max. Negotiated Rate |
$4,106.28 |
| Rate for Payer: Aetna Commercial |
$3,293.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,336.36
|
| Rate for Payer: Cash Price |
$2,138.69
|
| Rate for Payer: Cigna Commercial |
$3,550.23
|
| Rate for Payer: First Health Commercial |
$4,063.51
|
| Rate for Payer: Humana Commercial |
$3,635.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,507.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,156.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,764.09
|
| Rate for Payer: Ohio Health Group HMO |
$3,208.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,421.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,721.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,951.39
|
| Rate for Payer: PHCS Commercial |
$4,106.28
|
| Rate for Payer: United Healthcare All Payer |
$3,764.09
|
|
|
PLATE TI LCP RECON 3.5*168 12H
|
Facility
|
IP
|
$4,463.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.96 |
| Max. Negotiated Rate |
$4,284.66 |
| Rate for Payer: Aetna Commercial |
$3,436.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.29
|
| Rate for Payer: Cash Price |
$2,231.59
|
| Rate for Payer: Cigna Commercial |
$3,704.45
|
| Rate for Payer: First Health Commercial |
$4,240.03
|
| Rate for Payer: Humana Commercial |
$3,793.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.60
|
| Rate for Payer: PHCS Commercial |
$4,284.66
|
| Rate for Payer: United Healthcare All Payer |
$3,927.61
|
|
|
PLATE TI LCP RECON 3.5*168 12H
|
Facility
|
OP
|
$4,463.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.96 |
| Max. Negotiated Rate |
$4,284.66 |
| Rate for Payer: Aetna Commercial |
$3,436.66
|
| Rate for Payer: Anthem Medicaid |
$1,534.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,481.29
|
| Rate for Payer: Cash Price |
$2,231.59
|
| Rate for Payer: Cigna Commercial |
$3,704.45
|
| Rate for Payer: First Health Commercial |
$4,240.03
|
| Rate for Payer: Humana Commercial |
$3,793.71
|
| Rate for Payer: Humana KY Medicaid |
$1,534.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.60
|
| Rate for Payer: PHCS Commercial |
$4,284.66
|
| Rate for Payer: United Healthcare All Payer |
$3,927.61
|
|
|
PLATE TI LCP RECON 3.5*70 5H
|
Facility
|
IP
|
$3,653.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,096.04 |
| Max. Negotiated Rate |
$3,507.31 |
| Rate for Payer: Aetna Commercial |
$2,813.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,849.69
|
| Rate for Payer: Cash Price |
$1,826.72
|
| Rate for Payer: Cigna Commercial |
$3,032.36
|
| Rate for Payer: First Health Commercial |
$3,470.78
|
| Rate for Payer: Humana Commercial |
$3,105.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,995.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,696.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,215.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,740.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,922.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,178.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.88
|
| Rate for Payer: PHCS Commercial |
$3,507.31
|
| Rate for Payer: United Healthcare All Payer |
$3,215.04
|
|
