|
PLATE TUB LK 3.5MM 107MM 8H
|
Facility
|
IP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LK 3.5MM 107MM 8H
|
Facility
|
OP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem Medicaid |
$676.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Humana KY Medicaid |
$676.74
|
| Rate for Payer: Kentucky WC Medicaid |
$683.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LK 3.5MM 120MM 9H
|
Facility
|
IP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUB LK 3.5MM 120MM 9H
|
Facility
|
OP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem Medicaid |
$662.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Humana KY Medicaid |
$662.24
|
| Rate for Payer: Kentucky WC Medicaid |
$668.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUB LK 3.5MM 133MM 10H
|
Facility
|
OP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem Medicaid |
$676.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Humana KY Medicaid |
$676.74
|
| Rate for Payer: Kentucky WC Medicaid |
$683.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LK 3.5MM 133MM 10H
|
Facility
|
IP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LK 3.5MM 158MM 12H
|
Facility
|
OP
|
$1,988.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.68 |
| Max. Negotiated Rate |
$1,909.38 |
| Rate for Payer: Aetna Commercial |
$1,531.48
|
| Rate for Payer: Anthem Medicaid |
$684.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.37
|
| Rate for Payer: Cash Price |
$994.47
|
| Rate for Payer: Cigna Commercial |
$1,650.82
|
| Rate for Payer: First Health Commercial |
$1,889.49
|
| Rate for Payer: Humana Commercial |
$1,690.60
|
| Rate for Payer: Humana KY Medicaid |
$684.00
|
| Rate for Payer: Kentucky WC Medicaid |
$690.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.37
|
| Rate for Payer: PHCS Commercial |
$1,909.38
|
| Rate for Payer: United Healthcare All Payer |
$1,750.27
|
|
|
PLATE TUB LK 3.5MM 158MM 12H
|
Facility
|
IP
|
$1,988.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.68 |
| Max. Negotiated Rate |
$1,909.38 |
| Rate for Payer: Aetna Commercial |
$1,531.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.37
|
| Rate for Payer: Cash Price |
$994.47
|
| Rate for Payer: Cigna Commercial |
$1,650.82
|
| Rate for Payer: First Health Commercial |
$1,889.49
|
| Rate for Payer: Humana Commercial |
$1,690.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,750.27
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,591.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,730.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,372.37
|
| Rate for Payer: PHCS Commercial |
$1,909.38
|
| Rate for Payer: United Healthcare All Payer |
$1,750.27
|
|
|
PLATE TUB LK 3.5MM 57MM 4H
|
Facility
|
IP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LK 3.5MM 57MM 4H
|
Facility
|
OP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem Medicaid |
$659.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Humana KY Medicaid |
$659.82
|
| Rate for Payer: Kentucky WC Medicaid |
$666.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LK 3.5MM 70MM 5H
|
Facility
|
OP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem Medicaid |
$647.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Humana KY Medicaid |
$647.73
|
| Rate for Payer: Kentucky WC Medicaid |
$654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE TUB LK 3.5MM 70MM 5H
|
Facility
|
IP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE TUB LK 3.5MM 82MM 6H
|
Facility
|
OP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem Medicaid |
$659.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Humana KY Medicaid |
$659.82
|
| Rate for Payer: Kentucky WC Medicaid |
$666.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LK 3.5MM 82MM 6H
|
Facility
|
IP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LK 3.5MM 95MM 7H
|
Facility
|
OP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem Medicaid |
$662.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Humana KY Medicaid |
$662.24
|
| Rate for Payer: Kentucky WC Medicaid |
$668.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUB LK 3.5MM 95MM 7H
|
Facility
|
IP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUBULAR 1/3 10H*119MM
|
Facility
|
IP
|
$3,171.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.38 |
| Max. Negotiated Rate |
$3,044.43 |
| Rate for Payer: Aetna Commercial |
$2,441.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.60
|
| Rate for Payer: Cash Price |
$1,585.64
|
| Rate for Payer: Cigna Commercial |
$2,632.16
|
| Rate for Payer: First Health Commercial |
$3,012.72
|
| Rate for Payer: Humana Commercial |
$2,695.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,537.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,188.18
|
| Rate for Payer: PHCS Commercial |
$3,044.43
|
| Rate for Payer: United Healthcare All Payer |
$2,790.73
|
|
|
PLATE TUBULAR 1/3 10H*119MM
|
Facility
|
OP
|
$3,171.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$951.38 |
| Max. Negotiated Rate |
$3,044.43 |
| Rate for Payer: Aetna Commercial |
$2,441.89
|
| Rate for Payer: Anthem Medicaid |
$1,090.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,473.60
|
| Rate for Payer: Cash Price |
$1,585.64
|
| Rate for Payer: Cigna Commercial |
$2,632.16
|
| Rate for Payer: First Health Commercial |
$3,012.72
|
| Rate for Payer: Humana Commercial |
$2,695.59
|
| Rate for Payer: Humana KY Medicaid |
$1,090.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,101.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,600.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,340.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$951.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,112.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,790.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,378.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,537.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,759.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,188.18
|
| Rate for Payer: PHCS Commercial |
$3,044.43
|
| Rate for Payer: United Healthcare All Payer |
$2,790.73
|
|
|
PLATE TUBULAR 1/3 12H*143MM
|
Facility
|
OP
|
$3,368.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.62 |
| Max. Negotiated Rate |
$3,234.00 |
| Rate for Payer: Aetna Commercial |
$2,593.94
|
| Rate for Payer: Anthem Medicaid |
$1,158.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.62
|
| Rate for Payer: Cash Price |
$1,684.38
|
| Rate for Payer: Cigna Commercial |
$2,796.06
|
| Rate for Payer: First Health Commercial |
$3,200.31
|
| Rate for Payer: Humana Commercial |
$2,863.44
|
| Rate for Payer: Humana KY Medicaid |
$1,158.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,695.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.44
|
| Rate for Payer: PHCS Commercial |
$3,234.00
|
| Rate for Payer: United Healthcare All Payer |
$2,964.50
|
|
|
PLATE TUBULAR 1/3 12H*143MM
|
Facility
|
IP
|
$3,368.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.62 |
| Max. Negotiated Rate |
$3,234.00 |
| Rate for Payer: Aetna Commercial |
$2,593.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.62
|
| Rate for Payer: Cash Price |
$1,684.38
|
| Rate for Payer: Cigna Commercial |
$2,796.06
|
| Rate for Payer: First Health Commercial |
$3,200.31
|
| Rate for Payer: Humana Commercial |
$2,863.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,695.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.44
|
| Rate for Payer: PHCS Commercial |
$3,234.00
|
| Rate for Payer: United Healthcare All Payer |
$2,964.50
|
|
|
PLATE TUBULAR 1/3 14H*167MM
|
Facility
|
IP
|
$6,690.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,007.05 |
| Max. Negotiated Rate |
$6,422.54 |
| Rate for Payer: Aetna Commercial |
$5,151.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,218.32
|
| Rate for Payer: Cash Price |
$3,345.07
|
| Rate for Payer: Cigna Commercial |
$5,552.82
|
| Rate for Payer: First Health Commercial |
$6,355.64
|
| Rate for Payer: Humana Commercial |
$5,686.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,485.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,937.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,007.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,887.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,017.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,352.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,820.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,616.20
|
| Rate for Payer: PHCS Commercial |
$6,422.54
|
| Rate for Payer: United Healthcare All Payer |
$5,887.33
|
|
|
PLATE TUBULAR 1/3 14H*167MM
|
Facility
|
OP
|
$6,690.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,007.05 |
| Max. Negotiated Rate |
$6,422.54 |
| Rate for Payer: Aetna Commercial |
$5,151.42
|
| Rate for Payer: Anthem Medicaid |
$2,300.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,218.32
|
| Rate for Payer: Cash Price |
$3,345.07
|
| Rate for Payer: Cigna Commercial |
$5,552.82
|
| Rate for Payer: First Health Commercial |
$6,355.64
|
| Rate for Payer: Humana Commercial |
$5,686.63
|
| Rate for Payer: Humana KY Medicaid |
$2,300.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,324.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,485.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,937.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,007.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,346.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,887.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,017.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,352.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,820.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,616.20
|
| Rate for Payer: PHCS Commercial |
$6,422.54
|
| Rate for Payer: United Healthcare All Payer |
$5,887.33
|
|
|
PLATE TUBULAR 1/3 16H*191MM
|
Facility
|
IP
|
$6,690.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,007.05 |
| Max. Negotiated Rate |
$6,422.54 |
| Rate for Payer: Aetna Commercial |
$5,151.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,218.32
|
| Rate for Payer: Cash Price |
$3,345.07
|
| Rate for Payer: Cigna Commercial |
$5,552.82
|
| Rate for Payer: First Health Commercial |
$6,355.64
|
| Rate for Payer: Humana Commercial |
$5,686.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,485.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,937.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,007.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,887.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,017.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,352.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,820.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,616.20
|
| Rate for Payer: PHCS Commercial |
$6,422.54
|
| Rate for Payer: United Healthcare All Payer |
$5,887.33
|
|
|
PLATE TUBULAR 1/3 16H*191MM
|
Facility
|
OP
|
$6,690.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,007.05 |
| Max. Negotiated Rate |
$6,422.54 |
| Rate for Payer: Aetna Commercial |
$5,151.42
|
| Rate for Payer: Anthem Medicaid |
$2,300.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,218.32
|
| Rate for Payer: Cash Price |
$3,345.07
|
| Rate for Payer: Cigna Commercial |
$5,552.82
|
| Rate for Payer: First Health Commercial |
$6,355.64
|
| Rate for Payer: Humana Commercial |
$5,686.63
|
| Rate for Payer: Humana KY Medicaid |
$2,300.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,324.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,485.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,937.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,007.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,346.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,887.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,017.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,352.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,820.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,616.20
|
| Rate for Payer: PHCS Commercial |
$6,422.54
|
| Rate for Payer: United Healthcare All Payer |
$5,887.33
|
|
|
PLATE TUBULAR 1/3 2H*23MM
|
Facility
|
IP
|
$2,121.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.59 |
| Max. Negotiated Rate |
$2,037.10 |
| Rate for Payer: Aetna Commercial |
$1,633.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,655.14
|
| Rate for Payer: Cash Price |
$1,060.99
|
| Rate for Payer: Cigna Commercial |
$1,761.24
|
| Rate for Payer: First Health Commercial |
$2,015.88
|
| Rate for Payer: Humana Commercial |
$1,803.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,740.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,566.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,867.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,591.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,697.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,846.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,464.17
|
| Rate for Payer: PHCS Commercial |
$2,037.10
|
| Rate for Payer: United Healthcare All Payer |
$1,867.34
|
|
