|
PLATE DHS 135*4H 78MM
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 140*5H 94MM
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 140*5H 94MM
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 140* 6H 110MM
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 140* 6H 110MM
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 145*5H 94MM
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 145*5H 94MM
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 145*6H 110MM
|
Facility
|
IP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DHS 145*6H 110MM
|
Facility
|
OP
|
$3,418.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.34 |
| Max. Negotiated Rate |
$3,281.28 |
| Rate for Payer: Aetna Commercial |
$2,631.86
|
| Rate for Payer: Anthem Medicaid |
$1,175.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,666.04
|
| Rate for Payer: Cash Price |
$1,709.00
|
| Rate for Payer: Cigna Commercial |
$2,836.94
|
| Rate for Payer: First Health Commercial |
$3,247.10
|
| Rate for Payer: Humana Commercial |
$2,905.30
|
| Rate for Payer: Humana KY Medicaid |
$1,175.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,187.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,802.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,522.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,025.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,007.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,563.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$683.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.58
|
| Rate for Payer: PHCS Commercial |
$3,281.28
|
| Rate for Payer: United Healthcare All Payer |
$3,007.84
|
|
|
PLATE DI RY 1&2 RT LG
|
Facility
|
IP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
PLATE DI RY 1&2 RT LG
|
Facility
|
OP
|
$8,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.92 |
| Max. Negotiated Rate |
$8,469.60 |
| Rate for Payer: Aetna Commercial |
$6,793.32
|
| Rate for Payer: Anthem Medicaid |
$3,034.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,881.55
|
| Rate for Payer: Cash Price |
$4,411.25
|
| Rate for Payer: Cigna Commercial |
$7,322.68
|
| Rate for Payer: First Health Commercial |
$8,381.38
|
| Rate for Payer: Humana Commercial |
$7,499.12
|
| Rate for Payer: Humana KY Medicaid |
$3,034.06
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,234.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,511.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.98
|
| Rate for Payer: PHCS Commercial |
$8,469.60
|
| Rate for Payer: United Healthcare All Payer |
$7,763.80
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H L
|
Facility
|
OP
|
$4,289.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.66 |
| Max. Negotiated Rate |
$4,118.12 |
| Rate for Payer: Aetna Commercial |
$3,303.08
|
| Rate for Payer: Anthem Medicaid |
$1,475.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,345.97
|
| Rate for Payer: Cash Price |
$2,144.86
|
| Rate for Payer: Cigna Commercial |
$3,560.46
|
| Rate for Payer: First Health Commercial |
$4,075.22
|
| Rate for Payer: Humana Commercial |
$3,646.25
|
| Rate for Payer: Humana KY Medicaid |
$1,475.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,490.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,517.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,165.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,774.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,217.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$857.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.81
|
| Rate for Payer: PHCS Commercial |
$4,118.12
|
| Rate for Payer: United Healthcare All Payer |
$3,774.94
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H L
|
Facility
|
IP
|
$4,289.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.66 |
| Max. Negotiated Rate |
$4,118.12 |
| Rate for Payer: Aetna Commercial |
$3,303.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,345.97
|
| Rate for Payer: Cash Price |
$2,144.86
|
| Rate for Payer: Cigna Commercial |
$3,560.46
|
| Rate for Payer: First Health Commercial |
$4,075.22
|
| Rate for Payer: Humana Commercial |
$3,646.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,517.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,165.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,774.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,217.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$857.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.81
|
| Rate for Payer: PHCS Commercial |
$4,118.12
|
| Rate for Payer: United Healthcare All Payer |
$3,774.94
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H R
|
Facility
|
IP
|
$4,289.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.66 |
| Max. Negotiated Rate |
$4,118.12 |
| Rate for Payer: Aetna Commercial |
$3,303.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,345.97
|
| Rate for Payer: Cash Price |
$2,144.86
|
| Rate for Payer: Cigna Commercial |
$3,560.46
|
| Rate for Payer: First Health Commercial |
$4,075.22
|
| Rate for Payer: Humana Commercial |
$3,646.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,517.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,165.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,774.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,217.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$857.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.81
|
| Rate for Payer: PHCS Commercial |
$4,118.12
|
| Rate for Payer: United Healthcare All Payer |
$3,774.94
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H R
|
Facility
|
OP
|
$4,289.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.66 |
| Max. Negotiated Rate |
$4,118.12 |
| Rate for Payer: Aetna Commercial |
$3,303.08
|
| Rate for Payer: Anthem Medicaid |
$1,475.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,345.97
|
| Rate for Payer: Cash Price |
$2,144.86
|
| Rate for Payer: Cigna Commercial |
$3,560.46
|
| Rate for Payer: First Health Commercial |
$4,075.22
|
| Rate for Payer: Humana Commercial |
$3,646.25
|
| Rate for Payer: Humana KY Medicaid |
$1,475.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,490.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,517.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,165.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,286.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,504.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,774.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,217.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$857.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,329.81
|
| Rate for Payer: PHCS Commercial |
$4,118.12
|
| Rate for Payer: United Healthcare All Payer |
$3,774.94
|
|
|
PLATE DIS FIB 2.7/3.5*112 6H R
|
Facility
|
IP
|
$4,515.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$4,335.21 |
| Rate for Payer: Aetna Commercial |
$3,477.20
|
| Rate for Payer: Aetna Commercial |
$3,641.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,522.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,688.62
|
| Rate for Payer: Cash Price |
$2,257.92
|
| Rate for Payer: Cash Price |
$2,364.50
|
| Rate for Payer: Cigna Commercial |
$3,748.15
|
| Rate for Payer: Cigna Commercial |
$3,925.07
|
| Rate for Payer: First Health Commercial |
$4,492.55
|
| Rate for Payer: First Health Commercial |
$4,290.05
|
| Rate for Payer: Humana Commercial |
$4,019.65
|
| Rate for Payer: Humana Commercial |
$3,838.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,702.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,877.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,332.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,418.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,973.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,161.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,386.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,546.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$903.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.91
|
| Rate for Payer: PHCS Commercial |
$4,335.21
|
| Rate for Payer: PHCS Commercial |
$4,539.84
|
| Rate for Payer: United Healthcare All Payer |
$3,973.94
|
| Rate for Payer: United Healthcare All Payer |
$4,161.52
|
|
|
PLATE DIS FIB 2.7/3.5*112 6H R
|
Facility
|
OP
|
$4,515.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$4,335.21 |
| Rate for Payer: Aetna Commercial |
$3,477.20
|
| Rate for Payer: Aetna Commercial |
$3,641.33
|
| Rate for Payer: Anthem Medicaid |
$1,553.00
|
| Rate for Payer: Anthem Medicaid |
$1,626.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,522.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,688.62
|
| Rate for Payer: Cash Price |
$2,257.92
|
| Rate for Payer: Cash Price |
$2,364.50
|
| Rate for Payer: Cigna Commercial |
$3,925.07
|
| Rate for Payer: Cigna Commercial |
$3,748.15
|
| Rate for Payer: First Health Commercial |
$4,492.55
|
| Rate for Payer: First Health Commercial |
$4,290.05
|
| Rate for Payer: Humana Commercial |
$3,838.46
|
| Rate for Payer: Humana Commercial |
$4,019.65
|
| Rate for Payer: Humana KY Medicaid |
$1,553.00
|
| Rate for Payer: Humana KY Medicaid |
$1,626.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,642.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,568.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,702.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,877.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,332.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,418.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,354.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,584.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,658.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,973.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,161.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,386.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,546.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$903.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$945.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$587.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$614.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,399.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.99
|
| Rate for Payer: PHCS Commercial |
$4,539.84
|
| Rate for Payer: PHCS Commercial |
$4,335.21
|
| Rate for Payer: United Healthcare All Payer |
$4,161.52
|
| Rate for Payer: United Healthcare All Payer |
$3,973.94
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H L
|
Facility
|
IP
|
$4,320.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.69 |
| Max. Negotiated Rate |
$4,147.86 |
| Rate for Payer: Aetna Commercial |
$3,326.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,370.14
|
| Rate for Payer: Cash Price |
$2,160.34
|
| Rate for Payer: Cigna Commercial |
$3,586.17
|
| Rate for Payer: First Health Commercial |
$4,104.66
|
| Rate for Payer: Humana Commercial |
$3,672.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,542.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,188.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,802.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,240.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.41
|
| Rate for Payer: PHCS Commercial |
$4,147.86
|
| Rate for Payer: United Healthcare All Payer |
$3,802.21
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H L
|
Facility
|
OP
|
$4,320.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.69 |
| Max. Negotiated Rate |
$4,147.86 |
| Rate for Payer: Aetna Commercial |
$3,326.93
|
| Rate for Payer: Anthem Medicaid |
$1,485.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,370.14
|
| Rate for Payer: Cash Price |
$2,160.34
|
| Rate for Payer: Cigna Commercial |
$3,586.17
|
| Rate for Payer: First Health Commercial |
$4,104.66
|
| Rate for Payer: Humana Commercial |
$3,672.59
|
| Rate for Payer: Humana KY Medicaid |
$1,485.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,501.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,542.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,188.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,515.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,802.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,240.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.41
|
| Rate for Payer: PHCS Commercial |
$4,147.86
|
| Rate for Payer: United Healthcare All Payer |
$3,802.21
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H R
|
Facility
|
OP
|
$4,320.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.69 |
| Max. Negotiated Rate |
$4,147.86 |
| Rate for Payer: Aetna Commercial |
$3,326.93
|
| Rate for Payer: Anthem Medicaid |
$1,485.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,370.14
|
| Rate for Payer: Cash Price |
$2,160.34
|
| Rate for Payer: Cigna Commercial |
$3,586.17
|
| Rate for Payer: First Health Commercial |
$4,104.66
|
| Rate for Payer: Humana Commercial |
$3,672.59
|
| Rate for Payer: Humana KY Medicaid |
$1,485.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,501.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,542.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,188.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,515.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,802.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,240.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.41
|
| Rate for Payer: PHCS Commercial |
$4,147.86
|
| Rate for Payer: United Healthcare All Payer |
$3,802.21
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H R
|
Facility
|
IP
|
$4,320.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.69 |
| Max. Negotiated Rate |
$4,147.86 |
| Rate for Payer: Aetna Commercial |
$3,326.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,370.14
|
| Rate for Payer: Cash Price |
$2,160.34
|
| Rate for Payer: Cigna Commercial |
$3,586.17
|
| Rate for Payer: First Health Commercial |
$4,104.66
|
| Rate for Payer: Humana Commercial |
$3,672.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,542.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,188.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,296.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,802.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,240.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$864.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,339.41
|
| Rate for Payer: PHCS Commercial |
$4,147.86
|
| Rate for Payer: United Healthcare All Payer |
$3,802.21
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H L
|
Facility
|
OP
|
$4,765.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.56 |
| Max. Negotiated Rate |
$4,575.22 |
| Rate for Payer: Aetna Commercial |
$3,669.70
|
| Rate for Payer: Anthem Medicaid |
$1,638.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,717.36
|
| Rate for Payer: Cash Price |
$2,382.93
|
| Rate for Payer: Cigna Commercial |
$3,955.66
|
| Rate for Payer: First Health Commercial |
$4,527.56
|
| Rate for Payer: Humana Commercial |
$4,050.97
|
| Rate for Payer: Humana KY Medicaid |
$1,638.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,517.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,193.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,574.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.41
|
| Rate for Payer: PHCS Commercial |
$4,575.22
|
| Rate for Payer: United Healthcare All Payer |
$4,193.95
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H L
|
Facility
|
IP
|
$4,765.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.56 |
| Max. Negotiated Rate |
$4,575.22 |
| Rate for Payer: Aetna Commercial |
$3,669.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,717.36
|
| Rate for Payer: Cash Price |
$2,382.93
|
| Rate for Payer: Cigna Commercial |
$3,955.66
|
| Rate for Payer: First Health Commercial |
$4,527.56
|
| Rate for Payer: Humana Commercial |
$4,050.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,517.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,193.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,574.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.41
|
| Rate for Payer: PHCS Commercial |
$4,575.22
|
| Rate for Payer: United Healthcare All Payer |
$4,193.95
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H R
|
Facility
|
IP
|
$4,765.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.56 |
| Max. Negotiated Rate |
$4,575.22 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,717.36
|
| Rate for Payer: Cash Price |
$2,382.93
|
| Rate for Payer: Cigna Commercial |
$3,955.66
|
| Rate for Payer: First Health Commercial |
$4,527.56
|
| Rate for Payer: Humana Commercial |
$4,050.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,908.00
|
| Rate for Payer: Aetna Commercial |
$3,669.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,517.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,193.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,574.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.41
|
| Rate for Payer: PHCS Commercial |
$4,575.22
|
| Rate for Payer: United Healthcare All Payer |
$4,193.95
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H R
|
Facility
|
OP
|
$4,765.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.56 |
| Max. Negotiated Rate |
$4,575.22 |
| Rate for Payer: Aetna Commercial |
$3,669.70
|
| Rate for Payer: Anthem Medicaid |
$1,638.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,717.36
|
| Rate for Payer: Cash Price |
$2,382.93
|
| Rate for Payer: Cigna Commercial |
$3,955.66
|
| Rate for Payer: First Health Commercial |
$4,527.56
|
| Rate for Payer: Humana Commercial |
$4,050.97
|
| Rate for Payer: Humana KY Medicaid |
$1,638.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,655.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,908.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,517.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,429.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,671.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,193.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,574.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$619.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,477.41
|
| Rate for Payer: PHCS Commercial |
$4,575.22
|
| Rate for Payer: United Healthcare All Payer |
$4,193.95
|
|
