|
PLATE-T TI LCP 5H 3.5*74 OB R
|
Facility
|
IP
|
$3,546.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,064.01 |
| Max. Negotiated Rate |
$3,404.82 |
| Rate for Payer: Aetna Commercial |
$2,730.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,766.42
|
| Rate for Payer: Cash Price |
$1,773.34
|
| Rate for Payer: Cigna Commercial |
$2,943.75
|
| Rate for Payer: First Health Commercial |
$3,369.36
|
| Rate for Payer: Humana Commercial |
$3,014.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,908.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,617.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,064.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,121.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,660.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,837.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,085.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,447.22
|
| Rate for Payer: PHCS Commercial |
$3,404.82
|
| Rate for Payer: United Healthcare All Payer |
$3,121.09
|
|
|
PLATE-T TI LCP 6H 3.5*78 R ANG
|
Facility
|
OP
|
$3,558.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.47 |
| Max. Negotiated Rate |
$3,415.91 |
| Rate for Payer: Aetna Commercial |
$2,739.84
|
| Rate for Payer: Anthem Medicaid |
$1,223.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,775.43
|
| Rate for Payer: Cash Price |
$1,779.12
|
| Rate for Payer: Cigna Commercial |
$2,953.34
|
| Rate for Payer: First Health Commercial |
$3,380.33
|
| Rate for Payer: Humana Commercial |
$3,024.50
|
| Rate for Payer: Humana KY Medicaid |
$1,223.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,236.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,917.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,625.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,067.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,248.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,131.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,668.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,095.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,455.19
|
| Rate for Payer: PHCS Commercial |
$3,415.91
|
| Rate for Payer: United Healthcare All Payer |
$3,131.25
|
|
|
PLATE-T TI LCP 6H 3.5*78 R ANG
|
Facility
|
IP
|
$3,558.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,067.47 |
| Max. Negotiated Rate |
$3,415.91 |
| Rate for Payer: Aetna Commercial |
$2,739.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,775.43
|
| Rate for Payer: Cash Price |
$1,779.12
|
| Rate for Payer: Cigna Commercial |
$2,953.34
|
| Rate for Payer: First Health Commercial |
$3,380.33
|
| Rate for Payer: Humana Commercial |
$3,024.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,917.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,625.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,067.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,131.25
|
| Rate for Payer: Ohio Health Group HMO |
$2,668.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,846.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,095.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,455.19
|
| Rate for Payer: PHCS Commercial |
$3,415.91
|
| Rate for Payer: United Healthcare All Payer |
$3,131.25
|
|
|
PLATE-T TI LCP 7H 3.5*87 R ANG
|
Facility
|
IP
|
$3,952.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.64 |
| Max. Negotiated Rate |
$3,794.05 |
| Rate for Payer: Aetna Commercial |
$3,043.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,082.67
|
| Rate for Payer: Cash Price |
$1,976.07
|
| Rate for Payer: Cigna Commercial |
$3,280.28
|
| Rate for Payer: First Health Commercial |
$3,754.53
|
| Rate for Payer: Humana Commercial |
$3,359.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,240.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,916.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,477.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,964.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,161.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,438.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,726.98
|
| Rate for Payer: PHCS Commercial |
$3,794.05
|
| Rate for Payer: United Healthcare All Payer |
$3,477.88
|
|
|
PLATE-T TI LCP 7H 3.5*87 R ANG
|
Facility
|
OP
|
$3,952.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,185.64 |
| Max. Negotiated Rate |
$3,794.05 |
| Rate for Payer: Aetna Commercial |
$3,043.15
|
| Rate for Payer: Anthem Medicaid |
$1,359.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,082.67
|
| Rate for Payer: Cash Price |
$1,976.07
|
| Rate for Payer: Cigna Commercial |
$3,280.28
|
| Rate for Payer: First Health Commercial |
$3,754.53
|
| Rate for Payer: Humana Commercial |
$3,359.32
|
| Rate for Payer: Humana KY Medicaid |
$1,359.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,372.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,240.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,916.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,185.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,386.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,477.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,964.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,161.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,438.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,726.98
|
| Rate for Payer: PHCS Commercial |
$3,794.05
|
| Rate for Payer: United Healthcare All Payer |
$3,477.88
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB L
|
Facility
|
OP
|
$3,539.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.72 |
| Max. Negotiated Rate |
$3,397.51 |
| Rate for Payer: Aetna Commercial |
$2,725.08
|
| Rate for Payer: Anthem Medicaid |
$1,217.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,760.47
|
| Rate for Payer: Cash Price |
$1,769.54
|
| Rate for Payer: Cigna Commercial |
$2,937.43
|
| Rate for Payer: First Health Commercial |
$3,362.12
|
| Rate for Payer: Humana Commercial |
$3,008.21
|
| Rate for Payer: Humana KY Medicaid |
$1,217.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,229.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,902.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,611.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,241.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,114.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,654.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,078.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.96
|
| Rate for Payer: PHCS Commercial |
$3,397.51
|
| Rate for Payer: United Healthcare All Payer |
$3,114.38
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB L
|
Facility
|
IP
|
$3,539.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.72 |
| Max. Negotiated Rate |
$3,397.51 |
| Rate for Payer: Aetna Commercial |
$2,725.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,760.47
|
| Rate for Payer: Cash Price |
$1,769.54
|
| Rate for Payer: Cigna Commercial |
$2,937.43
|
| Rate for Payer: First Health Commercial |
$3,362.12
|
| Rate for Payer: Humana Commercial |
$3,008.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,902.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,611.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,114.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,654.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,078.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,441.96
|
| Rate for Payer: PHCS Commercial |
$3,397.51
|
| Rate for Payer: United Healthcare All Payer |
$3,114.38
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB R
|
Facility
|
IP
|
$3,539.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.95 |
| Max. Negotiated Rate |
$3,398.23 |
| Rate for Payer: Aetna Commercial |
$2,725.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,761.06
|
| Rate for Payer: Cash Price |
$1,769.91
|
| Rate for Payer: Cigna Commercial |
$2,938.05
|
| Rate for Payer: First Health Commercial |
$3,362.83
|
| Rate for Payer: Humana Commercial |
$3,008.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,902.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,612.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,115.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,654.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,079.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,442.48
|
| Rate for Payer: PHCS Commercial |
$3,398.23
|
| Rate for Payer: United Healthcare All Payer |
$3,115.04
|
|
|
PLATE-T TI LCP 7H 3.5*96 OB R
|
Facility
|
OP
|
$3,539.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.95 |
| Max. Negotiated Rate |
$3,398.23 |
| Rate for Payer: Aetna Commercial |
$2,725.66
|
| Rate for Payer: Anthem Medicaid |
$1,217.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,761.06
|
| Rate for Payer: Cash Price |
$1,769.91
|
| Rate for Payer: Cigna Commercial |
$2,938.05
|
| Rate for Payer: First Health Commercial |
$3,362.83
|
| Rate for Payer: Humana Commercial |
$3,008.85
|
| Rate for Payer: Humana KY Medicaid |
$1,217.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,229.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,902.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,612.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,241.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,115.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,654.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,831.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,079.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,442.48
|
| Rate for Payer: PHCS Commercial |
$3,398.23
|
| Rate for Payer: United Healthcare All Payer |
$3,115.04
|
|
|
PLATE TUB 1/3 10H 122MM
|
Facility
|
IP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3 10H 122MM
|
Facility
|
OP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem Medicaid |
$410.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Humana KY Medicaid |
$410.01
|
| Rate for Payer: Kentucky WC Medicaid |
$414.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3*122 10HL
|
Facility
|
OP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem Medicaid |
$410.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Humana KY Medicaid |
$410.01
|
| Rate for Payer: Kentucky WC Medicaid |
$414.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3*122 10HL
|
Facility
|
IP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3*26M 2HL
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.70 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$765.21
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
PLATE TUB 1/3*26M 2HL
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.70 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem Medicaid |
$381.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Humana KY Medicaid |
$381.39
|
| Rate for Payer: Kentucky WC Medicaid |
$385.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$765.21
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
PLATE TUB 1/3 2H 26MM
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.70 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$765.21
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
PLATE TUB 1/3 2H 26MM
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$332.70 |
| Max. Negotiated Rate |
$1,064.64 |
| Rate for Payer: Aetna Commercial |
$853.93
|
| Rate for Payer: Anthem Medicaid |
$381.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$865.02
|
| Rate for Payer: Cash Price |
$554.50
|
| Rate for Payer: Cigna Commercial |
$920.47
|
| Rate for Payer: First Health Commercial |
$1,053.55
|
| Rate for Payer: Humana Commercial |
$942.65
|
| Rate for Payer: Humana KY Medicaid |
$381.39
|
| Rate for Payer: Kentucky WC Medicaid |
$385.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$909.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$818.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$332.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$389.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$975.92
|
| Rate for Payer: Ohio Health Group HMO |
$831.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$887.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$964.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$765.21
|
| Rate for Payer: PHCS Commercial |
$1,064.64
|
| Rate for Payer: United Healthcare All Payer |
$975.92
|
|
|
PLATE TUB 1/3*38 3HL
|
Facility
|
OP
|
$1,127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,082.40 |
| Rate for Payer: Aetna Commercial |
$868.17
|
| Rate for Payer: Anthem Medicaid |
$387.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.45
|
| Rate for Payer: Cash Price |
$563.75
|
| Rate for Payer: Cigna Commercial |
$935.83
|
| Rate for Payer: First Health Commercial |
$1,071.12
|
| Rate for Payer: Humana Commercial |
$958.38
|
| Rate for Payer: Humana KY Medicaid |
$387.75
|
| Rate for Payer: Kentucky WC Medicaid |
$391.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.20
|
| Rate for Payer: Ohio Health Group HMO |
$845.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$777.98
|
| Rate for Payer: PHCS Commercial |
$1,082.40
|
| Rate for Payer: United Healthcare All Payer |
$992.20
|
|
|
PLATE TUB 1/3*38 3HL
|
Facility
|
IP
|
$1,127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,082.40 |
| Rate for Payer: Aetna Commercial |
$868.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.45
|
| Rate for Payer: Cash Price |
$563.75
|
| Rate for Payer: Cigna Commercial |
$935.83
|
| Rate for Payer: First Health Commercial |
$1,071.12
|
| Rate for Payer: Humana Commercial |
$958.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.20
|
| Rate for Payer: Ohio Health Group HMO |
$845.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$777.98
|
| Rate for Payer: PHCS Commercial |
$1,082.40
|
| Rate for Payer: United Healthcare All Payer |
$992.20
|
|
|
PLATE TUB 1/3 3H 38MM
|
Facility
|
IP
|
$1,127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,082.40 |
| Rate for Payer: Aetna Commercial |
$868.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.45
|
| Rate for Payer: Cash Price |
$563.75
|
| Rate for Payer: Cigna Commercial |
$935.83
|
| Rate for Payer: First Health Commercial |
$1,071.12
|
| Rate for Payer: Humana Commercial |
$958.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.20
|
| Rate for Payer: Ohio Health Group HMO |
$845.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$777.98
|
| Rate for Payer: PHCS Commercial |
$1,082.40
|
| Rate for Payer: United Healthcare All Payer |
$992.20
|
|
|
PLATE TUB 1/3 3H 38MM
|
Facility
|
OP
|
$1,127.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.25 |
| Max. Negotiated Rate |
$1,082.40 |
| Rate for Payer: Aetna Commercial |
$868.17
|
| Rate for Payer: Anthem Medicaid |
$387.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.45
|
| Rate for Payer: Cash Price |
$563.75
|
| Rate for Payer: Cigna Commercial |
$935.83
|
| Rate for Payer: First Health Commercial |
$1,071.12
|
| Rate for Payer: Humana Commercial |
$958.38
|
| Rate for Payer: Humana KY Medicaid |
$387.75
|
| Rate for Payer: Kentucky WC Medicaid |
$391.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.20
|
| Rate for Payer: Ohio Health Group HMO |
$845.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$980.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$777.98
|
| Rate for Payer: PHCS Commercial |
$1,082.40
|
| Rate for Payer: United Healthcare All Payer |
$992.20
|
|
|
PLATE TUB 1/3 4H 50MM
|
Facility
|
OP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem Medicaid |
$403.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Humana KY Medicaid |
$403.65
|
| Rate for Payer: Kentucky WC Medicaid |
$407.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
|
PLATE TUB 1/3 4H 50MM
|
Facility
|
IP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
|
PLATE TUB 1/3*50 4HL
|
Facility
|
IP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
|
PLATE TUB 1/3*50 4HL
|
Facility
|
OP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem Medicaid |
$403.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Humana KY Medicaid |
$403.65
|
| Rate for Payer: Kentucky WC Medicaid |
$407.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
