|
PLATE T PROFYLE M COMP REG 7H
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE T PROFYLE OBLIQUE 5H LT
|
Facility
|
IP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE T PROFYLE OBLIQUE 5H LT
|
Facility
|
OP
|
$3,590.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,077.00 |
| Max. Negotiated Rate |
$3,446.40 |
| Rate for Payer: Aetna Commercial |
$2,764.30
|
| Rate for Payer: Anthem Medicaid |
$1,234.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,800.20
|
| Rate for Payer: Cash Price |
$1,795.00
|
| Rate for Payer: Cigna Commercial |
$2,979.70
|
| Rate for Payer: First Health Commercial |
$3,410.50
|
| Rate for Payer: Humana Commercial |
$3,051.50
|
| Rate for Payer: Humana KY Medicaid |
$1,234.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,943.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,649.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,259.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,159.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,692.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,872.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,123.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,477.10
|
| Rate for Payer: PHCS Commercial |
$3,446.40
|
| Rate for Payer: United Healthcare All Payer |
$3,159.20
|
|
|
PLATE T PROFYLE OBLIQUE 5H RT
|
Facility
|
OP
|
$2,084.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.30 |
| Max. Negotiated Rate |
$2,000.95 |
| Rate for Payer: Aetna Commercial |
$1,604.93
|
| Rate for Payer: Anthem Medicaid |
$716.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.77
|
| Rate for Payer: Cash Price |
$1,042.16
|
| Rate for Payer: Cigna Commercial |
$1,729.99
|
| Rate for Payer: First Health Commercial |
$1,980.10
|
| Rate for Payer: Humana Commercial |
$1,771.67
|
| Rate for Payer: Humana KY Medicaid |
$716.80
|
| Rate for Payer: Kentucky WC Medicaid |
$724.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$731.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,834.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,667.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,813.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,438.18
|
| Rate for Payer: PHCS Commercial |
$2,000.95
|
| Rate for Payer: United Healthcare All Payer |
$1,834.20
|
|
|
PLATE T PROFYLE OBLIQUE 5H RT
|
Facility
|
IP
|
$2,084.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.30 |
| Max. Negotiated Rate |
$2,000.95 |
| Rate for Payer: Aetna Commercial |
$1,604.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.77
|
| Rate for Payer: Cash Price |
$1,042.16
|
| Rate for Payer: Cigna Commercial |
$1,729.99
|
| Rate for Payer: First Health Commercial |
$1,980.10
|
| Rate for Payer: Humana Commercial |
$1,771.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,834.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,667.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,813.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,438.18
|
| Rate for Payer: PHCS Commercial |
$2,000.95
|
| Rate for Payer: United Healthcare All Payer |
$1,834.20
|
|
|
PLATE T PROFYL LCK NAR 1.7 10H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE T PROFYL LCK NAR 1.7 10H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE T PROFYL LOCK REG 1.7 7H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE T PROFYL LOCK REG 1.7 7H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE TROCHANTERIC MED 200MM
|
Facility
|
IP
|
$12,684.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,805.25 |
| Max. Negotiated Rate |
$12,176.80 |
| Rate for Payer: Aetna Commercial |
$9,766.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,893.65
|
| Rate for Payer: Cash Price |
$6,342.09
|
| Rate for Payer: Cigna Commercial |
$10,527.86
|
| Rate for Payer: First Health Commercial |
$12,049.96
|
| Rate for Payer: Humana Commercial |
$10,781.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,401.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,360.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,805.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,162.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,513.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,147.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,035.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,752.08
|
| Rate for Payer: PHCS Commercial |
$12,176.80
|
| Rate for Payer: United Healthcare All Payer |
$11,162.07
|
|
|
PLATE TROCHANTERIC MED 200MM
|
Facility
|
OP
|
$12,684.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,805.25 |
| Max. Negotiated Rate |
$12,176.80 |
| Rate for Payer: Aetna Commercial |
$9,766.81
|
| Rate for Payer: Anthem Medicaid |
$4,362.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,893.65
|
| Rate for Payer: Cash Price |
$6,342.09
|
| Rate for Payer: Cigna Commercial |
$10,527.86
|
| Rate for Payer: First Health Commercial |
$12,049.96
|
| Rate for Payer: Humana Commercial |
$10,781.54
|
| Rate for Payer: Humana KY Medicaid |
$4,362.09
|
| Rate for Payer: Kentucky WC Medicaid |
$4,406.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,401.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,360.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,805.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,449.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,162.07
|
| Rate for Payer: Ohio Health Group HMO |
$9,513.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,147.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,035.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,752.08
|
| Rate for Payer: PHCS Commercial |
$12,176.80
|
| Rate for Payer: United Healthcare All Payer |
$11,162.07
|
|
|
PLATE T RT ANGLE SM
|
Facility
|
IP
|
$1,814.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.24 |
| Max. Negotiated Rate |
$1,741.57 |
| Rate for Payer: Aetna Commercial |
$1,396.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.03
|
| Rate for Payer: Cash Price |
$907.07
|
| Rate for Payer: Cigna Commercial |
$1,505.74
|
| Rate for Payer: First Health Commercial |
$1,723.43
|
| Rate for Payer: Humana Commercial |
$1,542.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,487.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,596.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,360.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,451.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.76
|
| Rate for Payer: PHCS Commercial |
$1,741.57
|
| Rate for Payer: United Healthcare All Payer |
$1,596.44
|
|
|
PLATE T RT ANGLE SM
|
Facility
|
OP
|
$1,814.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.24 |
| Max. Negotiated Rate |
$1,741.57 |
| Rate for Payer: Aetna Commercial |
$1,396.89
|
| Rate for Payer: Anthem Medicaid |
$623.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.03
|
| Rate for Payer: Cash Price |
$907.07
|
| Rate for Payer: Cigna Commercial |
$1,505.74
|
| Rate for Payer: First Health Commercial |
$1,723.43
|
| Rate for Payer: Humana Commercial |
$1,542.02
|
| Rate for Payer: Humana KY Medicaid |
$623.88
|
| Rate for Payer: Kentucky WC Medicaid |
$630.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,487.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,596.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,360.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,451.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.76
|
| Rate for Payer: PHCS Commercial |
$1,741.57
|
| Rate for Payer: United Healthcare All Payer |
$1,596.44
|
|
|
PLATE T SM 4H 56MM
|
Facility
|
IP
|
$1,763.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.19 |
| Max. Negotiated Rate |
$1,693.42 |
| Rate for Payer: Aetna Commercial |
$1,358.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.90
|
| Rate for Payer: Cash Price |
$881.99
|
| Rate for Payer: Cigna Commercial |
$1,464.10
|
| Rate for Payer: First Health Commercial |
$1,675.78
|
| Rate for Payer: Humana Commercial |
$1,499.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,446.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,552.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,411.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.15
|
| Rate for Payer: PHCS Commercial |
$1,693.42
|
| Rate for Payer: United Healthcare All Payer |
$1,552.30
|
|
|
PLATE T SM 4H 56MM
|
Facility
|
OP
|
$1,763.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.19 |
| Max. Negotiated Rate |
$1,693.42 |
| Rate for Payer: Aetna Commercial |
$1,358.26
|
| Rate for Payer: Anthem Medicaid |
$606.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.90
|
| Rate for Payer: Cash Price |
$881.99
|
| Rate for Payer: Cigna Commercial |
$1,464.10
|
| Rate for Payer: First Health Commercial |
$1,675.78
|
| Rate for Payer: Humana Commercial |
$1,499.38
|
| Rate for Payer: Humana KY Medicaid |
$606.63
|
| Rate for Payer: Kentucky WC Medicaid |
$612.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,446.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$618.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,552.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,411.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.15
|
| Rate for Payer: PHCS Commercial |
$1,693.42
|
| Rate for Payer: United Healthcare All Payer |
$1,552.30
|
|
|
PLATE T SM 5H 67MM
|
Facility
|
OP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem Medicaid |
$625.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Humana KY Medicaid |
$625.97
|
| Rate for Payer: Kentucky WC Medicaid |
$632.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE T SM 5H 67MM
|
Facility
|
IP
|
$1,820.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.07 |
| Max. Negotiated Rate |
$1,747.41 |
| Rate for Payer: Aetna Commercial |
$1,401.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.77
|
| Rate for Payer: Cash Price |
$910.11
|
| Rate for Payer: Cigna Commercial |
$1,510.78
|
| Rate for Payer: First Health Commercial |
$1,729.21
|
| Rate for Payer: Humana Commercial |
$1,547.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.79
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,255.95
|
| Rate for Payer: PHCS Commercial |
$1,747.41
|
| Rate for Payer: United Healthcare All Payer |
$1,601.79
|
|
|
PLATE T SMALL 4H 71829604
|
Facility
|
OP
|
$1,763.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.08 |
| Max. Negotiated Rate |
$1,693.06 |
| Rate for Payer: Aetna Commercial |
$1,357.97
|
| Rate for Payer: Anthem Medicaid |
$606.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.61
|
| Rate for Payer: Cash Price |
$881.80
|
| Rate for Payer: Cigna Commercial |
$1,463.79
|
| Rate for Payer: First Health Commercial |
$1,675.42
|
| Rate for Payer: Humana Commercial |
$1,499.06
|
| Rate for Payer: Humana KY Medicaid |
$606.50
|
| Rate for Payer: Kentucky WC Medicaid |
$612.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,446.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$618.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.88
|
| Rate for Payer: PHCS Commercial |
$1,693.06
|
| Rate for Payer: United Healthcare All Payer |
$1,551.97
|
|
|
PLATE T SMALL 4H 71829604
|
Facility
|
IP
|
$1,763.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$529.08 |
| Max. Negotiated Rate |
$1,693.06 |
| Rate for Payer: Aetna Commercial |
$1,357.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.61
|
| Rate for Payer: Cash Price |
$881.80
|
| Rate for Payer: Cigna Commercial |
$1,463.79
|
| Rate for Payer: First Health Commercial |
$1,675.42
|
| Rate for Payer: Humana Commercial |
$1,499.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,446.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$529.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.97
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,410.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,534.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,216.88
|
| Rate for Payer: PHCS Commercial |
$1,693.06
|
| Rate for Payer: United Healthcare All Payer |
$1,551.97
|
|
|
PLATE T SMALL 5H 71829605
|
Facility
|
OP
|
$1,820.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.18 |
| Max. Negotiated Rate |
$1,747.78 |
| Rate for Payer: Aetna Commercial |
$1,401.86
|
| Rate for Payer: Anthem Medicaid |
$626.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.07
|
| Rate for Payer: Cash Price |
$910.30
|
| Rate for Payer: Cigna Commercial |
$1,511.10
|
| Rate for Payer: First Health Commercial |
$1,729.57
|
| Rate for Payer: Humana Commercial |
$1,547.51
|
| Rate for Payer: Humana KY Medicaid |
$626.10
|
| Rate for Payer: Kentucky WC Medicaid |
$632.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.21
|
| Rate for Payer: PHCS Commercial |
$1,747.78
|
| Rate for Payer: United Healthcare All Payer |
$1,602.13
|
|
|
PLATE T SMALL 5H 71829605
|
Facility
|
IP
|
$1,820.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.18 |
| Max. Negotiated Rate |
$1,747.78 |
| Rate for Payer: Aetna Commercial |
$1,401.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,420.07
|
| Rate for Payer: Cash Price |
$910.30
|
| Rate for Payer: Cigna Commercial |
$1,511.10
|
| Rate for Payer: First Health Commercial |
$1,729.57
|
| Rate for Payer: Humana Commercial |
$1,547.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,343.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,602.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,365.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,456.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,583.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.21
|
| Rate for Payer: PHCS Commercial |
$1,747.78
|
| Rate for Payer: United Healthcare All Payer |
$1,602.13
|
|
|
PLATE T SMALL W PF 3H
|
Facility
|
OP
|
$1,876.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$1,801.40 |
| Rate for Payer: Aetna Commercial |
$1,444.87
|
| Rate for Payer: Anthem Medicaid |
$645.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.64
|
| Rate for Payer: Cash Price |
$938.23
|
| Rate for Payer: Cigna Commercial |
$1,557.46
|
| Rate for Payer: First Health Commercial |
$1,782.64
|
| Rate for Payer: Humana Commercial |
$1,594.99
|
| Rate for Payer: Humana KY Medicaid |
$645.31
|
| Rate for Payer: Kentucky WC Medicaid |
$651.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,501.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.76
|
| Rate for Payer: PHCS Commercial |
$1,801.40
|
| Rate for Payer: United Healthcare All Payer |
$1,651.28
|
|
|
PLATE T SMALL W PF 3H
|
Facility
|
IP
|
$1,876.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$1,801.40 |
| Rate for Payer: Aetna Commercial |
$1,444.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.64
|
| Rate for Payer: Cash Price |
$938.23
|
| Rate for Payer: Cigna Commercial |
$1,557.46
|
| Rate for Payer: First Health Commercial |
$1,782.64
|
| Rate for Payer: Humana Commercial |
$1,594.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,501.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,632.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,294.76
|
| Rate for Payer: PHCS Commercial |
$1,801.40
|
| Rate for Payer: United Healthcare All Payer |
$1,651.28
|
|
|
PLATE T SMALL W PF 4H
|
Facility
|
IP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
PLATE T SMALL W PF 4H
|
Facility
|
OP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem Medicaid |
$650.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Humana KY Medicaid |
$650.67
|
| Rate for Payer: Kentucky WC Medicaid |
$657.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
