|
PLATE BONE 12.00
|
Facility
|
OP
|
$4,620.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.68 |
| Max. Negotiated Rate |
$4,435.78 |
| Rate for Payer: Anthem Medicaid |
$1,589.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,604.07
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$3,835.10
|
| Rate for Payer: First Health Commercial |
$4,389.57
|
| Rate for Payer: Humana Commercial |
$3,927.51
|
| Rate for Payer: Humana KY Medicaid |
$1,589.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,605.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,410.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,620.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.39
|
| Rate for Payer: PHCS Commercial |
$4,435.78
|
| Rate for Payer: United Healthcare All Payer |
$4,066.13
|
| Rate for Payer: Aetna Commercial |
$3,557.86
|
|
|
PLATE BONE 12.00
|
Facility
|
IP
|
$4,620.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.68 |
| Max. Negotiated Rate |
$4,435.78 |
| Rate for Payer: Aetna Commercial |
$3,557.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,604.07
|
| Rate for Payer: Cash Price |
$2,310.30
|
| Rate for Payer: Cigna Commercial |
$3,835.10
|
| Rate for Payer: First Health Commercial |
$4,389.57
|
| Rate for Payer: Humana Commercial |
$3,927.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,788.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,410.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,386.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,066.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,465.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$924.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$600.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,432.39
|
| Rate for Payer: PHCS Commercial |
$4,435.78
|
| Rate for Payer: United Healthcare All Payer |
$4,066.13
|
|
|
PLATE BONE 6.5
|
Facility
|
IP
|
$4,527.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.58 |
| Max. Negotiated Rate |
$4,346.40 |
| Rate for Payer: Aetna Commercial |
$3,486.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,531.45
|
| Rate for Payer: Cash Price |
$2,263.75
|
| Rate for Payer: Cigna Commercial |
$3,757.82
|
| Rate for Payer: First Health Commercial |
$4,301.12
|
| Rate for Payer: Humana Commercial |
$3,848.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,712.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,341.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,984.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,395.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.52
|
| Rate for Payer: PHCS Commercial |
$4,346.40
|
| Rate for Payer: United Healthcare All Payer |
$3,984.20
|
|
|
PLATE BONE 6.5
|
Facility
|
OP
|
$4,527.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.58 |
| Max. Negotiated Rate |
$4,346.40 |
| Rate for Payer: Aetna Commercial |
$3,486.18
|
| Rate for Payer: Anthem Medicaid |
$1,557.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,531.45
|
| Rate for Payer: Cash Price |
$2,263.75
|
| Rate for Payer: Cigna Commercial |
$3,757.82
|
| Rate for Payer: First Health Commercial |
$4,301.12
|
| Rate for Payer: Humana Commercial |
$3,848.38
|
| Rate for Payer: Humana KY Medicaid |
$1,557.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,572.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,712.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,341.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,358.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,588.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,984.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,395.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$905.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$588.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,403.52
|
| Rate for Payer: PHCS Commercial |
$4,346.40
|
| Rate for Payer: United Healthcare All Payer |
$3,984.20
|
|
|
PLATE BONE 8.0
|
Facility
|
IP
|
$4,036.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.78 |
| Max. Negotiated Rate |
$3,875.33 |
| Rate for Payer: Aetna Commercial |
$3,108.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.70
|
| Rate for Payer: Cash Price |
$2,018.40
|
| Rate for Payer: Cigna Commercial |
$3,350.54
|
| Rate for Payer: First Health Commercial |
$3,834.96
|
| Rate for Payer: Humana Commercial |
$3,431.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,552.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.41
|
| Rate for Payer: PHCS Commercial |
$3,875.33
|
| Rate for Payer: United Healthcare All Payer |
$3,552.38
|
|
|
PLATE BONE 8.0
|
Facility
|
OP
|
$4,036.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.78 |
| Max. Negotiated Rate |
$3,875.33 |
| Rate for Payer: Aetna Commercial |
$3,108.34
|
| Rate for Payer: Anthem Medicaid |
$1,388.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,148.70
|
| Rate for Payer: Cash Price |
$2,018.40
|
| Rate for Payer: Cigna Commercial |
$3,350.54
|
| Rate for Payer: First Health Commercial |
$3,834.96
|
| Rate for Payer: Humana Commercial |
$3,431.28
|
| Rate for Payer: Humana KY Medicaid |
$1,388.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,552.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.41
|
| Rate for Payer: PHCS Commercial |
$3,875.33
|
| Rate for Payer: United Healthcare All Payer |
$3,552.38
|
|
|
PLATE BONE BROAD Y 5H
|
Facility
|
IP
|
$7,178.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.15 |
| Max. Negotiated Rate |
$6,890.95 |
| Rate for Payer: Aetna Commercial |
$5,527.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,598.89
|
| Rate for Payer: Cash Price |
$3,589.03
|
| Rate for Payer: Cigna Commercial |
$5,957.80
|
| Rate for Payer: First Health Commercial |
$6,819.17
|
| Rate for Payer: Humana Commercial |
$6,101.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,886.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,297.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,316.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,383.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.20
|
| Rate for Payer: PHCS Commercial |
$6,890.95
|
| Rate for Payer: United Healthcare All Payer |
$6,316.70
|
|
|
PLATE BONE BROAD Y 5H
|
Facility
|
OP
|
$7,178.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.15 |
| Max. Negotiated Rate |
$6,890.95 |
| Rate for Payer: Aetna Commercial |
$5,527.11
|
| Rate for Payer: Anthem Medicaid |
$2,468.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,598.89
|
| Rate for Payer: Cash Price |
$3,589.03
|
| Rate for Payer: Cigna Commercial |
$5,957.80
|
| Rate for Payer: First Health Commercial |
$6,819.17
|
| Rate for Payer: Humana Commercial |
$6,101.36
|
| Rate for Payer: Humana KY Medicaid |
$2,468.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,493.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,886.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,297.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,316.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,383.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.20
|
| Rate for Payer: PHCS Commercial |
$6,890.95
|
| Rate for Payer: United Healthcare All Payer |
$6,316.70
|
|
|
PLATE BONE CBL RDY 8H 246MM
|
Facility
|
IP
|
$7,734.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.52 |
| Max. Negotiated Rate |
$7,425.41 |
| Rate for Payer: Aetna Commercial |
$5,955.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.14
|
| Rate for Payer: Cash Price |
$3,867.40
|
| Rate for Payer: Cigna Commercial |
$6,419.88
|
| Rate for Payer: First Health Commercial |
$7,348.06
|
| Rate for Payer: Humana Commercial |
$6,574.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,806.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.79
|
| Rate for Payer: PHCS Commercial |
$7,425.41
|
| Rate for Payer: United Healthcare All Payer |
$6,806.62
|
|
|
PLATE BONE CBL RDY 8H 246MM
|
Facility
|
OP
|
$7,734.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.52 |
| Max. Negotiated Rate |
$7,425.41 |
| Rate for Payer: Aetna Commercial |
$5,955.80
|
| Rate for Payer: Anthem Medicaid |
$2,660.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.14
|
| Rate for Payer: Cash Price |
$3,867.40
|
| Rate for Payer: Cigna Commercial |
$6,419.88
|
| Rate for Payer: First Health Commercial |
$7,348.06
|
| Rate for Payer: Humana Commercial |
$6,574.58
|
| Rate for Payer: Humana KY Medicaid |
$2,660.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,687.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,713.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,806.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,397.79
|
| Rate for Payer: PHCS Commercial |
$7,425.41
|
| Rate for Payer: United Healthcare All Payer |
$6,806.62
|
|
|
PLATE BOW 4MM
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE BOW 4MM
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE BRD LCKG COMP 4.5MM 6H
|
Facility
|
IP
|
$3,852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.76 |
| Max. Negotiated Rate |
$3,697.92 |
| Rate for Payer: Aetna Commercial |
$2,966.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.56
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cigna Commercial |
$3,197.16
|
| Rate for Payer: First Health Commercial |
$3,659.40
|
| Rate for Payer: Humana Commercial |
$3,274.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,842.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,389.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,194.12
|
| Rate for Payer: PHCS Commercial |
$3,697.92
|
| Rate for Payer: United Healthcare All Payer |
$3,389.76
|
|
|
PLATE BRD LCKG COMP 4.5MM 6H
|
Facility
|
OP
|
$3,852.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.76 |
| Max. Negotiated Rate |
$3,697.92 |
| Rate for Payer: Aetna Commercial |
$2,966.04
|
| Rate for Payer: Anthem Medicaid |
$1,324.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.56
|
| Rate for Payer: Cash Price |
$1,926.00
|
| Rate for Payer: Cigna Commercial |
$3,197.16
|
| Rate for Payer: First Health Commercial |
$3,659.40
|
| Rate for Payer: Humana Commercial |
$3,274.20
|
| Rate for Payer: Humana KY Medicaid |
$1,324.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,338.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,842.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,351.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,389.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$770.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,194.12
|
| Rate for Payer: PHCS Commercial |
$3,697.92
|
| Rate for Payer: United Healthcare All Payer |
$3,389.76
|
|
|
PLATE BRD LCKG COMP 4.5MM 7H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE BRD LCKG COMP 4.5MM 7H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
|
|
PLATE BRD LCKG COMP 4.5MM 8H
|
Facility
|
OP
|
$4,048.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$3,886.08 |
| Rate for Payer: Aetna Commercial |
$3,116.96
|
| Rate for Payer: Anthem Medicaid |
$1,392.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.44
|
| Rate for Payer: Cash Price |
$2,024.00
|
| Rate for Payer: Cigna Commercial |
$3,359.84
|
| Rate for Payer: First Health Commercial |
$3,845.60
|
| Rate for Payer: Humana Commercial |
$3,440.80
|
| Rate for Payer: Humana KY Medicaid |
$1,392.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,406.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,319.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,420.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,562.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,254.88
|
| Rate for Payer: PHCS Commercial |
$3,886.08
|
| Rate for Payer: United Healthcare All Payer |
$3,562.24
|
|
|
PLATE BRD LCKG COMP 4.5MM 8H
|
Facility
|
IP
|
$4,048.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.24 |
| Max. Negotiated Rate |
$3,886.08 |
| Rate for Payer: Aetna Commercial |
$3,116.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.44
|
| Rate for Payer: Cash Price |
$2,024.00
|
| Rate for Payer: Cigna Commercial |
$3,359.84
|
| Rate for Payer: First Health Commercial |
$3,845.60
|
| Rate for Payer: Humana Commercial |
$3,440.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,319.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,562.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$809.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,254.88
|
| Rate for Payer: PHCS Commercial |
$3,886.08
|
| Rate for Payer: United Healthcare All Payer |
$3,562.24
|
|
|
PLATE BRD LCKG COMP 4.5MM 9H
|
Facility
|
OP
|
$4,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.44 |
| Max. Negotiated Rate |
$4,020.48 |
| Rate for Payer: Aetna Commercial |
$3,224.76
|
| Rate for Payer: Anthem Medicaid |
$1,440.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,266.64
|
| Rate for Payer: Cash Price |
$2,094.00
|
| Rate for Payer: Cigna Commercial |
$3,476.04
|
| Rate for Payer: First Health Commercial |
$3,978.60
|
| Rate for Payer: Humana Commercial |
$3,559.80
|
| Rate for Payer: Humana KY Medicaid |
$1,440.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,454.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,434.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,090.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,256.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,469.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,685.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.28
|
| Rate for Payer: PHCS Commercial |
$4,020.48
|
| Rate for Payer: United Healthcare All Payer |
$3,685.44
|
|
|
PLATE BRD LCKG COMP 4.5MM 9H
|
Facility
|
IP
|
$4,188.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.44 |
| Max. Negotiated Rate |
$4,020.48 |
| Rate for Payer: Aetna Commercial |
$3,224.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,266.64
|
| Rate for Payer: Cash Price |
$2,094.00
|
| Rate for Payer: Cigna Commercial |
$3,476.04
|
| Rate for Payer: First Health Commercial |
$3,978.60
|
| Rate for Payer: Humana Commercial |
$3,559.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,434.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,090.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,256.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,685.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,141.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.28
|
| Rate for Payer: PHCS Commercial |
$4,020.48
|
| Rate for Payer: United Healthcare All Payer |
$3,685.44
|
|
|
PLATE BROAD 4.5*123 6H
|
Facility
|
IP
|
$3,857.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$3,703.30 |
| Rate for Payer: Aetna Commercial |
$2,970.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.93
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cigna Commercial |
$3,201.81
|
| Rate for Payer: First Health Commercial |
$3,664.72
|
| Rate for Payer: Humana Commercial |
$3,278.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,163.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,893.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.86
|
| Rate for Payer: PHCS Commercial |
$3,703.30
|
| Rate for Payer: United Healthcare All Payer |
$3,394.69
|
|
|
PLATE BROAD 4.5*123 6H
|
Facility
|
OP
|
$3,857.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.49 |
| Max. Negotiated Rate |
$3,703.30 |
| Rate for Payer: Aetna Commercial |
$2,970.35
|
| Rate for Payer: Anthem Medicaid |
$1,326.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.93
|
| Rate for Payer: Cash Price |
$1,928.80
|
| Rate for Payer: Cigna Commercial |
$3,201.81
|
| Rate for Payer: First Health Commercial |
$3,664.72
|
| Rate for Payer: Humana Commercial |
$3,278.96
|
| Rate for Payer: Humana KY Medicaid |
$1,326.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,340.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,163.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,353.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,394.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,893.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.86
|
| Rate for Payer: PHCS Commercial |
$3,703.30
|
| Rate for Payer: United Healthcare All Payer |
$3,394.69
|
|
|
PLATE BROAD 4.5*141 7H
|
Facility
|
IP
|
$2,068.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.93 |
| Max. Negotiated Rate |
$1,985.97 |
| Rate for Payer: Aetna Commercial |
$1,592.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.60
|
| Rate for Payer: Cash Price |
$1,034.36
|
| Rate for Payer: Cigna Commercial |
$1,717.04
|
| Rate for Payer: First Health Commercial |
$1,965.28
|
| Rate for Payer: Humana Commercial |
$1,758.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.30
|
| Rate for Payer: PHCS Commercial |
$1,985.97
|
| Rate for Payer: United Healthcare All Payer |
$1,820.47
|
|
|
PLATE BROAD 4.5*141 7H
|
Facility
|
OP
|
$2,068.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.93 |
| Max. Negotiated Rate |
$1,985.97 |
| Rate for Payer: Humana Commercial |
$1,758.41
|
| Rate for Payer: Humana KY Medicaid |
$711.43
|
| Rate for Payer: Kentucky WC Medicaid |
$718.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.30
|
| Rate for Payer: PHCS Commercial |
$1,985.97
|
| Rate for Payer: United Healthcare All Payer |
$1,820.47
|
| Rate for Payer: Aetna Commercial |
$1,592.91
|
| Rate for Payer: Anthem Medicaid |
$711.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.60
|
| Rate for Payer: Cash Price |
$1,034.36
|
| Rate for Payer: Cigna Commercial |
$1,717.04
|
| Rate for Payer: First Health Commercial |
$1,965.28
|
|
|
PLATE BROAD 4.5*159 8H
|
Facility
|
OP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem Medicaid |
$1,063.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Humana KY Medicaid |
$1,063.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
|
