|
PLATE ADULT BLD 95 80/235 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 80/235 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 80/267 16H
|
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 80/267 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: 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 80/92 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 80/92 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 ADVMT 5H L 2MM 100D LT
|
Facility
|
OP
|
$2,088.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.45 |
| Max. Negotiated Rate |
$2,004.52 |
| Rate for Payer: Aetna Commercial |
$1,607.79
|
| Rate for Payer: Anthem Medicaid |
$718.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.67
|
| Rate for Payer: Cash Price |
$1,044.02
|
| Rate for Payer: Cigna Commercial |
$1,733.07
|
| Rate for Payer: First Health Commercial |
$1,983.64
|
| Rate for Payer: Humana Commercial |
$1,774.83
|
| Rate for Payer: Humana KY Medicaid |
$718.08
|
| Rate for Payer: Kentucky WC Medicaid |
$725.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.29
|
| Rate for Payer: PHCS Commercial |
$2,004.52
|
| Rate for Payer: United Healthcare All Payer |
$1,837.48
|
|
|
PLATE ADVMT 5H L 2MM 100D LT
|
Facility
|
IP
|
$2,088.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.45 |
| Max. Negotiated Rate |
$2,004.52 |
| Rate for Payer: Aetna Commercial |
$1,607.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.67
|
| Rate for Payer: Cash Price |
$1,044.02
|
| Rate for Payer: Cigna Commercial |
$1,733.07
|
| Rate for Payer: First Health Commercial |
$1,983.64
|
| Rate for Payer: Humana Commercial |
$1,774.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.29
|
| Rate for Payer: PHCS Commercial |
$2,004.52
|
| Rate for Payer: United Healthcare All Payer |
$1,837.48
|
|
|
PLATE ADVMT 5H L 2MM 100D RT
|
Facility
|
IP
|
$2,088.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.45 |
| Max. Negotiated Rate |
$2,004.52 |
| Rate for Payer: Aetna Commercial |
$1,607.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.67
|
| Rate for Payer: Cash Price |
$1,044.02
|
| Rate for Payer: Cigna Commercial |
$1,733.07
|
| Rate for Payer: First Health Commercial |
$1,983.64
|
| Rate for Payer: Humana Commercial |
$1,774.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.29
|
| Rate for Payer: PHCS Commercial |
$2,004.52
|
| Rate for Payer: United Healthcare All Payer |
$1,837.48
|
|
|
PLATE ADVMT 5H L 2MM 100D RT
|
Facility
|
OP
|
$2,088.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.45 |
| Max. Negotiated Rate |
$2,004.52 |
| Rate for Payer: Aetna Commercial |
$1,607.79
|
| Rate for Payer: Anthem Medicaid |
$718.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,628.67
|
| Rate for Payer: Cash Price |
$1,044.02
|
| Rate for Payer: Cigna Commercial |
$1,733.07
|
| Rate for Payer: First Health Commercial |
$1,983.64
|
| Rate for Payer: Humana Commercial |
$1,774.83
|
| Rate for Payer: Humana KY Medicaid |
$718.08
|
| Rate for Payer: Kentucky WC Medicaid |
$725.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,712.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,540.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$626.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$732.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,837.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,566.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$417.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$647.29
|
| Rate for Payer: PHCS Commercial |
$2,004.52
|
| Rate for Payer: United Healthcare All Payer |
$1,837.48
|
|
|
PLATE ADVMT 5H L 5MM 100D LT
|
Facility
|
OP
|
$2,109.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.26 |
| Max. Negotiated Rate |
$2,025.29 |
| Rate for Payer: Aetna Commercial |
$1,624.45
|
| Rate for Payer: Anthem Medicaid |
$725.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.55
|
| Rate for Payer: Cash Price |
$1,054.84
|
| Rate for Payer: Cigna Commercial |
$1,751.03
|
| Rate for Payer: First Health Commercial |
$2,004.20
|
| Rate for Payer: Humana Commercial |
$1,793.23
|
| Rate for Payer: Humana KY Medicaid |
$725.52
|
| Rate for Payer: Kentucky WC Medicaid |
$732.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.00
|
| Rate for Payer: PHCS Commercial |
$2,025.29
|
| Rate for Payer: United Healthcare All Payer |
$1,856.52
|
|
|
PLATE ADVMT 5H L 5MM 100D LT
|
Facility
|
IP
|
$2,109.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.26 |
| Max. Negotiated Rate |
$2,025.29 |
| Rate for Payer: Aetna Commercial |
$1,624.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.55
|
| Rate for Payer: Cash Price |
$1,054.84
|
| Rate for Payer: Cigna Commercial |
$1,751.03
|
| Rate for Payer: First Health Commercial |
$2,004.20
|
| Rate for Payer: Humana Commercial |
$1,793.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.00
|
| Rate for Payer: PHCS Commercial |
$2,025.29
|
| Rate for Payer: United Healthcare All Payer |
$1,856.52
|
|
|
PLATE ADVMT 5H L 5MM 100D RT
|
Facility
|
IP
|
$2,109.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.26 |
| Max. Negotiated Rate |
$2,025.29 |
| Rate for Payer: Aetna Commercial |
$1,624.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.55
|
| Rate for Payer: Cash Price |
$1,054.84
|
| Rate for Payer: Cigna Commercial |
$1,751.03
|
| Rate for Payer: First Health Commercial |
$2,004.20
|
| Rate for Payer: Humana Commercial |
$1,793.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.00
|
| Rate for Payer: PHCS Commercial |
$2,025.29
|
| Rate for Payer: United Healthcare All Payer |
$1,856.52
|
|
|
PLATE ADVMT 5H L 5MM 100D RT
|
Facility
|
OP
|
$2,109.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.26 |
| Max. Negotiated Rate |
$2,025.29 |
| Rate for Payer: Aetna Commercial |
$1,624.45
|
| Rate for Payer: Anthem Medicaid |
$725.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.55
|
| Rate for Payer: Cash Price |
$1,054.84
|
| Rate for Payer: Cigna Commercial |
$1,751.03
|
| Rate for Payer: First Health Commercial |
$2,004.20
|
| Rate for Payer: Humana Commercial |
$1,793.23
|
| Rate for Payer: Humana KY Medicaid |
$725.52
|
| Rate for Payer: Kentucky WC Medicaid |
$732.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.00
|
| Rate for Payer: PHCS Commercial |
$2,025.29
|
| Rate for Payer: United Healthcare All Payer |
$1,856.52
|
|
|
PLATE ADVMT 6H L 12MM 100D RT
|
Facility
|
IP
|
$2,156.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.34 |
| Max. Negotiated Rate |
$2,070.24 |
| Rate for Payer: Aetna Commercial |
$1,660.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,682.07
|
| Rate for Payer: Cash Price |
$1,078.25
|
| Rate for Payer: Cigna Commercial |
$1,789.90
|
| Rate for Payer: First Health Commercial |
$2,048.68
|
| Rate for Payer: Humana Commercial |
$1,833.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,897.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.52
|
| Rate for Payer: PHCS Commercial |
$2,070.24
|
| Rate for Payer: United Healthcare All Payer |
$1,897.72
|
|
|
PLATE ADVMT 6H L 12MM 100D RT
|
Facility
|
OP
|
$2,156.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.34 |
| Max. Negotiated Rate |
$2,070.24 |
| Rate for Payer: Aetna Commercial |
$1,660.50
|
| Rate for Payer: Anthem Medicaid |
$741.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,682.07
|
| Rate for Payer: Cash Price |
$1,078.25
|
| Rate for Payer: Cigna Commercial |
$1,789.90
|
| Rate for Payer: First Health Commercial |
$2,048.68
|
| Rate for Payer: Humana Commercial |
$1,833.02
|
| Rate for Payer: Humana KY Medicaid |
$741.62
|
| Rate for Payer: Kentucky WC Medicaid |
$749.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$756.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,897.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.52
|
| Rate for Payer: PHCS Commercial |
$2,070.24
|
| Rate for Payer: United Healthcare All Payer |
$1,897.72
|
|
|
PLATE ADVMT 6H L 8MM 100D LT
|
Facility
|
IP
|
$2,138.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.01 |
| Max. Negotiated Rate |
$2,053.01 |
| Rate for Payer: Aetna Commercial |
$1,646.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,668.07
|
| Rate for Payer: Cash Price |
$1,069.28
|
| Rate for Payer: Cigna Commercial |
$1,775.00
|
| Rate for Payer: First Health Commercial |
$2,031.62
|
| Rate for Payer: Humana Commercial |
$1,817.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,578.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.95
|
| Rate for Payer: PHCS Commercial |
$2,053.01
|
| Rate for Payer: United Healthcare All Payer |
$1,881.92
|
|
|
PLATE ADVMT 6H L 8MM 100D LT
|
Facility
|
OP
|
$2,138.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.01 |
| Max. Negotiated Rate |
$2,053.01 |
| Rate for Payer: Aetna Commercial |
$1,646.68
|
| Rate for Payer: Anthem Medicaid |
$735.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,668.07
|
| Rate for Payer: Cash Price |
$1,069.28
|
| Rate for Payer: Cigna Commercial |
$1,775.00
|
| Rate for Payer: First Health Commercial |
$2,031.62
|
| Rate for Payer: Humana Commercial |
$1,817.77
|
| Rate for Payer: Humana KY Medicaid |
$735.45
|
| Rate for Payer: Kentucky WC Medicaid |
$742.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,578.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$750.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.95
|
| Rate for Payer: PHCS Commercial |
$2,053.01
|
| Rate for Payer: United Healthcare All Payer |
$1,881.92
|
|
|
PLATE ADVMT 6H L 8MM 100D RT
|
Facility
|
OP
|
$2,138.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.01 |
| Max. Negotiated Rate |
$2,053.01 |
| Rate for Payer: Aetna Commercial |
$1,646.68
|
| Rate for Payer: Anthem Medicaid |
$735.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,668.07
|
| Rate for Payer: Cash Price |
$1,069.28
|
| Rate for Payer: Cigna Commercial |
$1,775.00
|
| Rate for Payer: First Health Commercial |
$2,031.62
|
| Rate for Payer: Humana Commercial |
$1,817.77
|
| Rate for Payer: Humana KY Medicaid |
$735.45
|
| Rate for Payer: Kentucky WC Medicaid |
$742.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,578.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$750.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.95
|
| Rate for Payer: PHCS Commercial |
$2,053.01
|
| Rate for Payer: United Healthcare All Payer |
$1,881.92
|
|
|
PLATE ADVMT 6H L 8MM 100D RT
|
Facility
|
IP
|
$2,138.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.01 |
| Max. Negotiated Rate |
$2,053.01 |
| Rate for Payer: Aetna Commercial |
$1,646.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,668.07
|
| Rate for Payer: Cash Price |
$1,069.28
|
| Rate for Payer: Cigna Commercial |
$1,775.00
|
| Rate for Payer: First Health Commercial |
$2,031.62
|
| Rate for Payer: Humana Commercial |
$1,817.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,753.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,578.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.92
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.95
|
| Rate for Payer: PHCS Commercial |
$2,053.01
|
| Rate for Payer: United Healthcare All Payer |
$1,881.92
|
|
|
PLATE ANATOMIC LK 4H
|
Facility
|
OP
|
$4,730.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.96 |
| Max. Negotiated Rate |
$4,541.28 |
| Rate for Payer: Anthem Medicaid |
$1,626.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.79
|
| Rate for Payer: Cash Price |
$2,365.25
|
| Rate for Payer: Cigna Commercial |
$3,926.32
|
| Rate for Payer: First Health Commercial |
$4,493.98
|
| Rate for Payer: Humana Commercial |
$4,020.92
|
| Rate for Payer: Humana KY Medicaid |
$1,626.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.46
|
| Rate for Payer: PHCS Commercial |
$4,541.28
|
| Rate for Payer: United Healthcare All Payer |
$4,162.84
|
| Rate for Payer: Aetna Commercial |
$3,642.48
|
|
|
PLATE ANATOMIC LK 4H
|
Facility
|
IP
|
$4,730.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.96 |
| Max. Negotiated Rate |
$4,541.28 |
| Rate for Payer: Aetna Commercial |
$3,642.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.79
|
| Rate for Payer: Cash Price |
$2,365.25
|
| Rate for Payer: Cigna Commercial |
$3,926.32
|
| Rate for Payer: First Health Commercial |
$4,493.98
|
| Rate for Payer: Humana Commercial |
$4,020.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,879.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,491.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,466.46
|
| Rate for Payer: PHCS Commercial |
$4,541.28
|
| Rate for Payer: United Healthcare All Payer |
$4,162.84
|
|
|
PLATE ANATOMIC TIB LOCKING 6H
|
Facility
|
OP
|
$5,115.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.02 |
| Max. Negotiated Rate |
$4,910.88 |
| Rate for Payer: Aetna Commercial |
$3,938.94
|
| Rate for Payer: Anthem Medicaid |
$1,759.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,990.09
|
| Rate for Payer: Cash Price |
$2,557.75
|
| Rate for Payer: Cigna Commercial |
$4,245.86
|
| Rate for Payer: First Health Commercial |
$4,859.72
|
| Rate for Payer: Humana Commercial |
$4,348.18
|
| Rate for Payer: Humana KY Medicaid |
$1,759.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,777.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,194.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,775.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,534.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,794.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,501.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,836.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,585.80
|
| Rate for Payer: PHCS Commercial |
$4,910.88
|
| Rate for Payer: United Healthcare All Payer |
$4,501.64
|
|
|
PLATE ANATOMIC TIB LOCKING 6H
|
Facility
|
IP
|
$5,115.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$665.02 |
| Max. Negotiated Rate |
$4,910.88 |
| Rate for Payer: Aetna Commercial |
$3,938.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,990.09
|
| Rate for Payer: Cash Price |
$2,557.75
|
| Rate for Payer: Cigna Commercial |
$4,245.86
|
| Rate for Payer: First Health Commercial |
$4,859.72
|
| Rate for Payer: Humana Commercial |
$4,348.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,194.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,775.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,534.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,501.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,836.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,023.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$665.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,585.80
|
| Rate for Payer: PHCS Commercial |
$4,910.88
|
| Rate for Payer: United Healthcare All Payer |
$4,501.64
|
|
|
PLATE ANTERIOR CLAVICLE 10H
|
Facility
|
IP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
