|
PLATE BROAD 4.5*159 8H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE BROAD 4.5*177 9H
|
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
|
|
|
PLATE BROAD 4.5*177 9H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE BROAD 4.5*195 10H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE BROAD 4.5*195 10H
|
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
|
|
|
PLATE BROAD 4.5*213 11H
|
Facility
|
OP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem Medicaid |
$1,088.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Humana KY Medicaid |
$1,088.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*213 11H
|
Facility
|
IP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*231 12H
|
Facility
|
IP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*231 12H
|
Facility
|
OP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem Medicaid |
$1,088.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Humana KY Medicaid |
$1,088.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*267 14H
|
Facility
|
OP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem Medicaid |
$1,088.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Humana KY Medicaid |
$1,088.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*267 14H
|
Facility
|
IP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*303 16H
|
Facility
|
IP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*303 16H
|
Facility
|
OP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem Medicaid |
$1,088.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Humana KY Medicaid |
$1,088.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5*339 18H
|
Facility
|
IP
|
$3,462.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.14 |
| Max. Negotiated Rate |
$3,324.12 |
| Rate for Payer: Aetna Commercial |
$2,666.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.84
|
| Rate for Payer: Cash Price |
$1,731.31
|
| Rate for Payer: Cigna Commercial |
$2,873.97
|
| Rate for Payer: First Health Commercial |
$3,289.49
|
| Rate for Payer: Humana Commercial |
$2,943.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.41
|
| Rate for Payer: PHCS Commercial |
$3,324.12
|
| Rate for Payer: United Healthcare All Payer |
$3,047.11
|
|
|
PLATE BROAD 4.5*339 18H
|
Facility
|
OP
|
$3,462.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.14 |
| Max. Negotiated Rate |
$3,324.12 |
| Rate for Payer: Aetna Commercial |
$2,666.22
|
| Rate for Payer: Anthem Medicaid |
$1,190.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.84
|
| Rate for Payer: Cash Price |
$1,731.31
|
| Rate for Payer: Cigna Commercial |
$2,873.97
|
| Rate for Payer: First Health Commercial |
$3,289.49
|
| Rate for Payer: Humana Commercial |
$2,943.23
|
| Rate for Payer: Humana KY Medicaid |
$1,190.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.41
|
| Rate for Payer: PHCS Commercial |
$3,324.12
|
| Rate for Payer: United Healthcare All Payer |
$3,047.11
|
|
|
PLATE BROAD 4.5*375 20H
|
Facility
|
OP
|
$3,922.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.91 |
| Max. Negotiated Rate |
$3,765.46 |
| Rate for Payer: Anthem Medicaid |
$1,348.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,059.43
|
| Rate for Payer: Cash Price |
$1,961.17
|
| Rate for Payer: Cigna Commercial |
$3,255.55
|
| Rate for Payer: First Health Commercial |
$3,726.23
|
| Rate for Payer: Humana Commercial |
$3,334.00
|
| Rate for Payer: Humana KY Medicaid |
$1,348.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,362.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,216.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,894.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,375.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,451.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,941.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.93
|
| Rate for Payer: PHCS Commercial |
$3,765.46
|
| Rate for Payer: United Healthcare All Payer |
$3,451.67
|
| Rate for Payer: Aetna Commercial |
$3,020.21
|
|
|
PLATE BROAD 4.5*375 20H
|
Facility
|
IP
|
$3,922.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.91 |
| Max. Negotiated Rate |
$3,765.46 |
| Rate for Payer: Aetna Commercial |
$3,020.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,059.43
|
| Rate for Payer: Cash Price |
$1,961.17
|
| Rate for Payer: Cigna Commercial |
$3,255.55
|
| Rate for Payer: First Health Commercial |
$3,726.23
|
| Rate for Payer: Humana Commercial |
$3,334.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,216.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,894.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,176.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,451.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,941.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$784.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$509.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,215.93
|
| Rate for Payer: PHCS Commercial |
$3,765.46
|
| Rate for Payer: United Healthcare All Payer |
$3,451.67
|
|
|
PLATE BROAD 4.5MM 10H 195MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE BROAD 4.5MM 10H 195MM
|
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
|
|
|
PLATE BROAD 4.5MM 11H 213MM
|
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
|
|
|
PLATE BROAD 4.5MM 11H 213MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE BROAD 4.5MM 12H 231MM
|
Facility
|
OP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem Medicaid |
$1,088.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Humana KY Medicaid |
$1,088.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5MM 12H 231MM
|
Facility
|
IP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5MM 14H 267MM
|
Facility
|
IP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
|
PLATE BROAD 4.5MM 14H 267MM
|
Facility
|
OP
|
$3,164.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.42 |
| Max. Negotiated Rate |
$3,038.19 |
| Rate for Payer: Aetna Commercial |
$2,436.88
|
| Rate for Payer: Anthem Medicaid |
$1,088.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,468.53
|
| Rate for Payer: Cash Price |
$1,582.39
|
| Rate for Payer: Cigna Commercial |
$2,626.77
|
| Rate for Payer: First Health Commercial |
$3,006.54
|
| Rate for Payer: Humana Commercial |
$2,690.06
|
| Rate for Payer: Humana KY Medicaid |
$1,088.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,099.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,595.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,335.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$949.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,110.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,785.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,373.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$411.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$981.08
|
| Rate for Payer: PHCS Commercial |
$3,038.19
|
| Rate for Payer: United Healthcare All Payer |
$2,785.01
|
|
