|
PLATE ACU-LOC VDU LEFT STD
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC VDU LEFT STD
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC VDU RIGHT LONG
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC VDU RIGHT LONG
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ACU-LOC VDU RIGHT STD
|
Facility
|
IP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
|
|
PLATE ACU-LOC VDU RIGHT STD
|
Facility
|
OP
|
$4,573.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.49 |
| Max. Negotiated Rate |
$4,390.08 |
| Rate for Payer: Aetna Commercial |
$3,521.21
|
| Rate for Payer: Anthem Medicaid |
$1,572.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,566.94
|
| Rate for Payer: Cash Price |
$2,286.50
|
| Rate for Payer: Cigna Commercial |
$3,795.59
|
| Rate for Payer: First Health Commercial |
$4,344.35
|
| Rate for Payer: Humana Commercial |
$3,887.05
|
| Rate for Payer: Humana KY Medicaid |
$1,572.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,749.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,374.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,371.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,429.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,417.63
|
| Rate for Payer: PHCS Commercial |
$4,390.08
|
| Rate for Payer: United Healthcare All Payer |
$4,024.24
|
|
|
PLATE ADULT BLD 95 50/124 7H
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 50/124 7H
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 50/156 9H
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 50/156 9H
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 50/204 12H
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 50/204 12H
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 50/235 14H
|
Facility
|
OP
|
$7,446.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$7,148.76 |
| Rate for Payer: Humana Commercial |
$6,329.64
|
| Rate for Payer: Humana KY Medicaid |
$2,560.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,586.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,106.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,495.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,612.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,553.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,584.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,308.46
|
| Rate for Payer: PHCS Commercial |
$7,148.76
|
| Rate for Payer: United Healthcare All Payer |
$6,553.03
|
| Rate for Payer: Aetna Commercial |
$5,733.91
|
| Rate for Payer: Anthem Medicaid |
$2,560.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,808.37
|
| Rate for Payer: Cash Price |
$3,723.32
|
| Rate for Payer: Cigna Commercial |
$6,180.70
|
| Rate for Payer: First Health Commercial |
$7,074.30
|
|
|
PLATE ADULT BLD 95 50/235 14H
|
Facility
|
IP
|
$7,446.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$7,148.76 |
| Rate for Payer: Aetna Commercial |
$5,733.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,808.37
|
| Rate for Payer: Cash Price |
$3,723.32
|
| Rate for Payer: Cigna Commercial |
$6,180.70
|
| Rate for Payer: First Health Commercial |
$7,074.30
|
| Rate for Payer: Humana Commercial |
$6,329.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,106.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,495.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,553.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,584.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,308.46
|
| Rate for Payer: PHCS Commercial |
$7,148.76
|
| Rate for Payer: United Healthcare All Payer |
$6,553.03
|
|
|
PLATE ADULT BLD 95 50/92 5H
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 50/92 5H
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 60/124 7H
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 60/124 7H
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 60/156 9H
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 60/156 9H
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 60/204 12H
|
Facility
|
IP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 60/204 12H
|
Facility
|
OP
|
$4,718.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.39 |
| Max. Negotiated Rate |
$4,529.68 |
| Rate for Payer: Aetna Commercial |
$3,633.18
|
| Rate for Payer: Anthem Medicaid |
$1,622.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.37
|
| Rate for Payer: Cash Price |
$2,359.21
|
| Rate for Payer: Cigna Commercial |
$3,916.29
|
| Rate for Payer: First Health Commercial |
$4,482.50
|
| Rate for Payer: Humana Commercial |
$4,010.66
|
| Rate for Payer: Humana KY Medicaid |
$1,622.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,538.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$943.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,462.71
|
| Rate for Payer: PHCS Commercial |
$4,529.68
|
| Rate for Payer: United Healthcare All Payer |
$4,152.21
|
|
|
PLATE ADULT BLD 95 60/235 14H
|
Facility
|
OP
|
$7,446.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$7,148.76 |
| Rate for Payer: Aetna Commercial |
$5,733.91
|
| Rate for Payer: Anthem Medicaid |
$2,560.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,808.37
|
| Rate for Payer: Cash Price |
$3,723.32
|
| Rate for Payer: Cigna Commercial |
$6,180.70
|
| Rate for Payer: First Health Commercial |
$7,074.30
|
| Rate for Payer: Humana Commercial |
$6,329.64
|
| Rate for Payer: Humana KY Medicaid |
$2,560.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,586.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,106.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,495.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,612.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,553.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,584.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,308.46
|
| Rate for Payer: PHCS Commercial |
$7,148.76
|
| Rate for Payer: United Healthcare All Payer |
$6,553.03
|
|
|
PLATE ADULT BLD 95 60/235 14H
|
Facility
|
IP
|
$7,446.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$7,148.76 |
| Rate for Payer: Aetna Commercial |
$5,733.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,808.37
|
| Rate for Payer: Cash Price |
$3,723.32
|
| Rate for Payer: Cigna Commercial |
$6,180.70
|
| Rate for Payer: First Health Commercial |
$7,074.30
|
| Rate for Payer: Humana Commercial |
$6,329.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,106.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,495.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,553.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,584.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,308.46
|
| Rate for Payer: PHCS Commercial |
$7,148.76
|
| Rate for Payer: United Healthcare All Payer |
$6,553.03
|
|
|
PLATE ADULT BLD 95 60/267 16H
|
Facility
|
OP
|
$7,446.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.06 |
| Max. Negotiated Rate |
$7,148.76 |
| Rate for Payer: Aetna Commercial |
$5,733.91
|
| Rate for Payer: Anthem Medicaid |
$2,560.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,808.37
|
| Rate for Payer: Cash Price |
$3,723.32
|
| Rate for Payer: Cigna Commercial |
$6,180.70
|
| Rate for Payer: First Health Commercial |
$7,074.30
|
| Rate for Payer: Humana Commercial |
$6,329.64
|
| Rate for Payer: Humana KY Medicaid |
$2,560.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,586.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,106.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,495.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,233.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,612.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,553.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,584.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,489.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,308.46
|
| Rate for Payer: PHCS Commercial |
$7,148.76
|
| Rate for Payer: United Healthcare All Payer |
$6,553.03
|
|
