|
PLATE 1.3MM ROLANDO FX HOOK
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 1.3MM ROLANDO FX HOOK
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 1.3MM ROTATIONAL CORR
|
Facility
|
IP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
|
|
PLATE 1.3MM ROTATIONAL CORR
|
Facility
|
OP
|
$3,603.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.46 |
| Max. Negotiated Rate |
$3,459.36 |
| Rate for Payer: Aetna Commercial |
$2,774.70
|
| Rate for Payer: Anthem Medicaid |
$1,239.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,810.73
|
| Rate for Payer: Cash Price |
$1,801.75
|
| Rate for Payer: Cigna Commercial |
$2,990.90
|
| Rate for Payer: First Health Commercial |
$3,423.32
|
| Rate for Payer: Humana Commercial |
$3,062.98
|
| Rate for Payer: Humana KY Medicaid |
$1,239.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,251.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,954.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,702.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.08
|
| Rate for Payer: PHCS Commercial |
$3,459.36
|
| Rate for Payer: United Healthcare All Payer |
$3,171.08
|
|
|
PLATE 1.3MM STR 10H
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 1.3MM STR 10H
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 1.3MM T
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 1.3MM T
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE 1/3 TUB 10H 122 71829440
|
Facility
|
IP
|
$1,147.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$1,101.66 |
| Rate for Payer: Aetna Commercial |
$883.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$895.10
|
| Rate for Payer: Cash Price |
$573.78
|
| Rate for Payer: Cigna Commercial |
$952.47
|
| Rate for Payer: First Health Commercial |
$1,090.18
|
| Rate for Payer: Humana Commercial |
$975.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$941.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.85
|
| Rate for Payer: Ohio Health Group HMO |
$860.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.74
|
| Rate for Payer: PHCS Commercial |
$1,101.66
|
| Rate for Payer: United Healthcare All Payer |
$1,009.85
|
|
|
PLATE 1/3 TUB 10H 122 71829440
|
Facility
|
OP
|
$1,147.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$1,101.66 |
| Rate for Payer: Aetna Commercial |
$883.62
|
| Rate for Payer: Anthem Medicaid |
$394.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$895.10
|
| Rate for Payer: Cash Price |
$573.78
|
| Rate for Payer: Cigna Commercial |
$952.47
|
| Rate for Payer: First Health Commercial |
$1,090.18
|
| Rate for Payer: Humana Commercial |
$975.43
|
| Rate for Payer: Humana KY Medicaid |
$394.65
|
| Rate for Payer: Kentucky WC Medicaid |
$398.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$941.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$402.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.85
|
| Rate for Payer: Ohio Health Group HMO |
$860.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.74
|
| Rate for Payer: PHCS Commercial |
$1,101.66
|
| Rate for Payer: United Healthcare All Payer |
$1,009.85
|
|
|
PLATE 1/3 TUB 3.5MM 3H
|
Facility
|
IP
|
$2,175.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.81 |
| Max. Negotiated Rate |
$2,088.46 |
| Rate for Payer: Aetna Commercial |
$1,675.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.87
|
| Rate for Payer: Cash Price |
$1,087.74
|
| Rate for Payer: Cigna Commercial |
$1,805.65
|
| Rate for Payer: First Health Commercial |
$2,066.71
|
| Rate for Payer: Humana Commercial |
$1,849.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,783.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.40
|
| Rate for Payer: PHCS Commercial |
$2,088.46
|
| Rate for Payer: United Healthcare All Payer |
$1,914.42
|
|
|
PLATE 1/3 TUB 3.5MM 3H
|
Facility
|
OP
|
$2,175.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.81 |
| Max. Negotiated Rate |
$2,088.46 |
| Rate for Payer: Humana Commercial |
$1,849.16
|
| Rate for Payer: Humana KY Medicaid |
$748.15
|
| Rate for Payer: Kentucky WC Medicaid |
$755.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,783.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.40
|
| Rate for Payer: PHCS Commercial |
$2,088.46
|
| Rate for Payer: United Healthcare All Payer |
$1,914.42
|
| Rate for Payer: Aetna Commercial |
$1,675.12
|
| Rate for Payer: Anthem Medicaid |
$748.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.87
|
| Rate for Payer: Cash Price |
$1,087.74
|
| Rate for Payer: Cigna Commercial |
$1,805.65
|
| Rate for Payer: First Health Commercial |
$2,066.71
|
|
|
PLATE 1/3 TUB 3.5MM 4H
|
Facility
|
OP
|
$2,175.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.81 |
| Max. Negotiated Rate |
$2,088.46 |
| Rate for Payer: Aetna Commercial |
$1,675.12
|
| Rate for Payer: Anthem Medicaid |
$748.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.87
|
| Rate for Payer: Cash Price |
$1,087.74
|
| Rate for Payer: Cigna Commercial |
$1,805.65
|
| Rate for Payer: First Health Commercial |
$2,066.71
|
| Rate for Payer: Humana Commercial |
$1,849.16
|
| Rate for Payer: Humana KY Medicaid |
$748.15
|
| Rate for Payer: Kentucky WC Medicaid |
$755.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,783.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.40
|
| Rate for Payer: PHCS Commercial |
$2,088.46
|
| Rate for Payer: United Healthcare All Payer |
$1,914.42
|
|
|
PLATE 1/3 TUB 3.5MM 4H
|
Facility
|
IP
|
$2,175.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.81 |
| Max. Negotiated Rate |
$2,088.46 |
| Rate for Payer: Aetna Commercial |
$1,675.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,696.87
|
| Rate for Payer: Cash Price |
$1,087.74
|
| Rate for Payer: Cigna Commercial |
$1,805.65
|
| Rate for Payer: First Health Commercial |
$2,066.71
|
| Rate for Payer: Humana Commercial |
$1,849.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,783.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,631.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.40
|
| Rate for Payer: PHCS Commercial |
$2,088.46
|
| Rate for Payer: United Healthcare All Payer |
$1,914.42
|
|
|
PLATE 1/3 TUB 3H 38 71829433
|
Facility
|
OP
|
$1,089.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$1,045.52 |
| Rate for Payer: Aetna Commercial |
$838.59
|
| Rate for Payer: Anthem Medicaid |
$374.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.48
|
| Rate for Payer: Cash Price |
$544.54
|
| Rate for Payer: Cigna Commercial |
$903.94
|
| Rate for Payer: First Health Commercial |
$1,034.63
|
| Rate for Payer: Humana Commercial |
$925.72
|
| Rate for Payer: Humana KY Medicaid |
$374.53
|
| Rate for Payer: Kentucky WC Medicaid |
$378.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.39
|
| Rate for Payer: Ohio Health Group HMO |
$816.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.61
|
| Rate for Payer: PHCS Commercial |
$1,045.52
|
| Rate for Payer: United Healthcare All Payer |
$958.39
|
|
|
PLATE 1/3 TUB 3H 38 71829433
|
Facility
|
IP
|
$1,089.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.58 |
| Max. Negotiated Rate |
$1,045.52 |
| Rate for Payer: Aetna Commercial |
$838.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.48
|
| Rate for Payer: Cash Price |
$544.54
|
| Rate for Payer: Cigna Commercial |
$903.94
|
| Rate for Payer: First Health Commercial |
$1,034.63
|
| Rate for Payer: Humana Commercial |
$925.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$893.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.39
|
| Rate for Payer: Ohio Health Group HMO |
$816.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.61
|
| Rate for Payer: PHCS Commercial |
$1,045.52
|
| Rate for Payer: United Healthcare All Payer |
$958.39
|
|
|
PLATE 1/3 TUB 4H 50 71829434
|
Facility
|
IP
|
$1,127.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$1,082.87 |
| Rate for Payer: Aetna Commercial |
$868.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.83
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.23
|
| Rate for Payer: First Health Commercial |
$1,071.59
|
| Rate for Payer: Humana Commercial |
$958.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.63
|
| Rate for Payer: Ohio Health Group HMO |
$845.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.68
|
| Rate for Payer: PHCS Commercial |
$1,082.87
|
| Rate for Payer: United Healthcare All Payer |
$992.63
|
|
|
PLATE 1/3 TUB 4H 50 71829434
|
Facility
|
OP
|
$1,127.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$1,082.87 |
| Rate for Payer: Aetna Commercial |
$868.55
|
| Rate for Payer: Anthem Medicaid |
$387.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.83
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.23
|
| Rate for Payer: First Health Commercial |
$1,071.59
|
| Rate for Payer: Humana Commercial |
$958.79
|
| Rate for Payer: Humana KY Medicaid |
$387.92
|
| Rate for Payer: Kentucky WC Medicaid |
$391.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.63
|
| Rate for Payer: Ohio Health Group HMO |
$845.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.68
|
| Rate for Payer: PHCS Commercial |
$1,082.87
|
| Rate for Payer: United Healthcare All Payer |
$992.63
|
|
|
PLATE 1/3 TUB 5H 62 71829435
|
Facility
|
OP
|
$1,127.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$1,082.87 |
| Rate for Payer: Aetna Commercial |
$868.55
|
| Rate for Payer: Anthem Medicaid |
$387.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.83
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.23
|
| Rate for Payer: First Health Commercial |
$1,071.59
|
| Rate for Payer: Humana Commercial |
$958.79
|
| Rate for Payer: Humana KY Medicaid |
$387.92
|
| Rate for Payer: Kentucky WC Medicaid |
$391.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.63
|
| Rate for Payer: Ohio Health Group HMO |
$845.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.68
|
| Rate for Payer: PHCS Commercial |
$1,082.87
|
| Rate for Payer: United Healthcare All Payer |
$992.63
|
|
|
PLATE 1/3 TUB 5H 62 71829435
|
Facility
|
IP
|
$1,127.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.64 |
| Max. Negotiated Rate |
$1,082.87 |
| Rate for Payer: Aetna Commercial |
$868.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.83
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.23
|
| Rate for Payer: First Health Commercial |
$1,071.59
|
| Rate for Payer: Humana Commercial |
$958.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.63
|
| Rate for Payer: Ohio Health Group HMO |
$845.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.68
|
| Rate for Payer: PHCS Commercial |
$1,082.87
|
| Rate for Payer: United Healthcare All Payer |
$992.63
|
|
|
PLATE 1/3 TUB 6H 74 71829436
|
Facility
|
IP
|
$1,137.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,092.36 |
| Rate for Payer: Aetna Commercial |
$876.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.55
|
| Rate for Payer: Cash Price |
$568.94
|
| Rate for Payer: Cigna Commercial |
$944.44
|
| Rate for Payer: First Health Commercial |
$1,080.99
|
| Rate for Payer: Humana Commercial |
$967.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.33
|
| Rate for Payer: Ohio Health Group HMO |
$853.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.74
|
| Rate for Payer: PHCS Commercial |
$1,092.36
|
| Rate for Payer: United Healthcare All Payer |
$1,001.33
|
|
|
PLATE 1/3 TUB 6H 74 71829436
|
Facility
|
OP
|
$1,137.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,092.36 |
| Rate for Payer: Aetna Commercial |
$876.17
|
| Rate for Payer: Anthem Medicaid |
$391.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.55
|
| Rate for Payer: Cash Price |
$568.94
|
| Rate for Payer: Cigna Commercial |
$944.44
|
| Rate for Payer: First Health Commercial |
$1,080.99
|
| Rate for Payer: Humana Commercial |
$967.20
|
| Rate for Payer: Humana KY Medicaid |
$391.32
|
| Rate for Payer: Kentucky WC Medicaid |
$395.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.33
|
| Rate for Payer: Ohio Health Group HMO |
$853.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.74
|
| Rate for Payer: PHCS Commercial |
$1,092.36
|
| Rate for Payer: United Healthcare All Payer |
$1,001.33
|
|
|
PLATE 1/3 TUB 7H 86 71829437
|
Facility
|
OP
|
$1,137.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,092.36 |
| Rate for Payer: Aetna Commercial |
$876.17
|
| Rate for Payer: Anthem Medicaid |
$391.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.55
|
| Rate for Payer: Cash Price |
$568.94
|
| Rate for Payer: Cigna Commercial |
$944.44
|
| Rate for Payer: First Health Commercial |
$1,080.99
|
| Rate for Payer: Humana Commercial |
$967.20
|
| Rate for Payer: Humana KY Medicaid |
$391.32
|
| Rate for Payer: Kentucky WC Medicaid |
$395.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$399.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.33
|
| Rate for Payer: Ohio Health Group HMO |
$853.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.74
|
| Rate for Payer: PHCS Commercial |
$1,092.36
|
| Rate for Payer: United Healthcare All Payer |
$1,001.33
|
|
|
PLATE 1/3 TUB 7H 86 71829437
|
Facility
|
IP
|
$1,137.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.92 |
| Max. Negotiated Rate |
$1,092.36 |
| Rate for Payer: Aetna Commercial |
$876.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$887.55
|
| Rate for Payer: Cash Price |
$568.94
|
| Rate for Payer: Cigna Commercial |
$944.44
|
| Rate for Payer: First Health Commercial |
$1,080.99
|
| Rate for Payer: Humana Commercial |
$967.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$933.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,001.33
|
| Rate for Payer: Ohio Health Group HMO |
$853.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.74
|
| Rate for Payer: PHCS Commercial |
$1,092.36
|
| Rate for Payer: United Healthcare All Payer |
$1,001.33
|
|
|
PLATE 1/3 TUB 8H 98 71829438
|
Facility
|
IP
|
$1,147.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$1,101.66 |
| Rate for Payer: Aetna Commercial |
$883.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$895.10
|
| Rate for Payer: Cash Price |
$573.78
|
| Rate for Payer: Cigna Commercial |
$952.47
|
| Rate for Payer: First Health Commercial |
$1,090.18
|
| Rate for Payer: Humana Commercial |
$975.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$941.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.85
|
| Rate for Payer: Ohio Health Group HMO |
$860.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.74
|
| Rate for Payer: PHCS Commercial |
$1,101.66
|
| Rate for Payer: United Healthcare All Payer |
$1,009.85
|
|
