|
PLATE DIS FIB 2.7/3.5*129 7H L
|
Facility
|
IP
|
$4,351.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.71 |
| Max. Negotiated Rate |
$4,177.56 |
| Rate for Payer: Aetna Commercial |
$3,350.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.26
|
| Rate for Payer: Cash Price |
$2,175.81
|
| Rate for Payer: Cigna Commercial |
$3,611.84
|
| Rate for Payer: First Health Commercial |
$4,134.04
|
| Rate for Payer: Humana Commercial |
$3,698.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,349.00
|
| Rate for Payer: PHCS Commercial |
$4,177.56
|
| Rate for Payer: United Healthcare All Payer |
$3,829.43
|
|
|
PLATE DIS FIB 2.7/3.5*129 7H L
|
Facility
|
OP
|
$4,351.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.71 |
| Max. Negotiated Rate |
$4,177.56 |
| Rate for Payer: Aetna Commercial |
$3,350.75
|
| Rate for Payer: Anthem Medicaid |
$1,496.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,394.26
|
| Rate for Payer: Cash Price |
$2,175.81
|
| Rate for Payer: Cigna Commercial |
$3,611.84
|
| Rate for Payer: First Health Commercial |
$4,134.04
|
| Rate for Payer: Humana Commercial |
$3,698.88
|
| Rate for Payer: Humana KY Medicaid |
$1,496.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,511.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,568.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,211.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,305.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,526.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,829.43
|
| Rate for Payer: Ohio Health Group HMO |
$3,263.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$870.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$565.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,349.00
|
| Rate for Payer: PHCS Commercial |
$4,177.56
|
| Rate for Payer: United Healthcare All Payer |
$3,829.43
|
|
|
PLATE DIS FIB 2.7/3.5*129 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: 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*129 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: 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: 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: 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*151 9H L
|
Facility
|
OP
|
$4,802.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.36 |
| Max. Negotiated Rate |
$4,610.63 |
| Rate for Payer: Aetna Commercial |
$3,698.11
|
| Rate for Payer: Anthem Medicaid |
$1,651.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,746.14
|
| Rate for Payer: Cash Price |
$2,401.37
|
| Rate for Payer: Cigna Commercial |
$3,986.27
|
| Rate for Payer: First Health Commercial |
$4,562.60
|
| Rate for Payer: Humana Commercial |
$4,082.33
|
| Rate for Payer: Humana KY Medicaid |
$1,651.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,668.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,938.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,544.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,684.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,226.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,602.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.85
|
| Rate for Payer: PHCS Commercial |
$4,610.63
|
| Rate for Payer: United Healthcare All Payer |
$4,226.41
|
|
|
PLATE DIS FIB 2.7/3.5*151 9H L
|
Facility
|
IP
|
$4,802.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.36 |
| Max. Negotiated Rate |
$4,610.63 |
| Rate for Payer: Aetna Commercial |
$3,698.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,746.14
|
| Rate for Payer: Cash Price |
$2,401.37
|
| Rate for Payer: Cigna Commercial |
$3,986.27
|
| Rate for Payer: First Health Commercial |
$4,562.60
|
| Rate for Payer: Humana Commercial |
$4,082.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,938.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,544.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,226.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,602.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.85
|
| Rate for Payer: PHCS Commercial |
$4,610.63
|
| Rate for Payer: United Healthcare All Payer |
$4,226.41
|
|
|
PLATE DIS FIB 2.7/3.5*151 9H R
|
Facility
|
IP
|
$4,802.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.36 |
| Max. Negotiated Rate |
$4,610.63 |
| Rate for Payer: Aetna Commercial |
$3,698.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,746.14
|
| Rate for Payer: Cash Price |
$2,401.37
|
| Rate for Payer: Cigna Commercial |
$3,986.27
|
| Rate for Payer: First Health Commercial |
$4,562.60
|
| Rate for Payer: Humana Commercial |
$4,082.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,938.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,544.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,226.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,602.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.85
|
| Rate for Payer: PHCS Commercial |
$4,610.63
|
| Rate for Payer: United Healthcare All Payer |
$4,226.41
|
|
|
PLATE DIS FIB 2.7/3.5*151 9H R
|
Facility
|
OP
|
$4,802.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.36 |
| Max. Negotiated Rate |
$4,610.63 |
| Rate for Payer: Aetna Commercial |
$3,698.11
|
| Rate for Payer: Anthem Medicaid |
$1,651.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,746.14
|
| Rate for Payer: Cash Price |
$2,401.37
|
| Rate for Payer: Cigna Commercial |
$3,986.27
|
| Rate for Payer: First Health Commercial |
$4,562.60
|
| Rate for Payer: Humana Commercial |
$4,082.33
|
| Rate for Payer: Humana KY Medicaid |
$1,651.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,668.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,938.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,544.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,440.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,684.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,226.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,602.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,488.85
|
| Rate for Payer: PHCS Commercial |
$4,610.63
|
| Rate for Payer: United Healthcare All Payer |
$4,226.41
|
|
|
PLATE DIS FIB 2.7/3.5*155 9H L
|
Facility
|
IP
|
$4,382.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.74 |
| Max. Negotiated Rate |
$4,207.30 |
| Rate for Payer: Aetna Commercial |
$3,374.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.43
|
| Rate for Payer: Cash Price |
$2,191.30
|
| Rate for Payer: Cigna Commercial |
$3,637.56
|
| Rate for Payer: First Health Commercial |
$4,163.47
|
| Rate for Payer: Humana Commercial |
$3,725.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.61
|
| Rate for Payer: PHCS Commercial |
$4,207.30
|
| Rate for Payer: United Healthcare All Payer |
$3,856.69
|
|
|
PLATE DIS FIB 2.7/3.5*155 9H L
|
Facility
|
OP
|
$4,382.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.74 |
| Max. Negotiated Rate |
$4,207.30 |
| Rate for Payer: Aetna Commercial |
$3,374.60
|
| Rate for Payer: Anthem Medicaid |
$1,507.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.43
|
| Rate for Payer: Cash Price |
$2,191.30
|
| Rate for Payer: Cigna Commercial |
$3,637.56
|
| Rate for Payer: First Health Commercial |
$4,163.47
|
| Rate for Payer: Humana Commercial |
$3,725.21
|
| Rate for Payer: Humana KY Medicaid |
$1,507.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.61
|
| Rate for Payer: PHCS Commercial |
$4,207.30
|
| Rate for Payer: United Healthcare All Payer |
$3,856.69
|
|
|
PLATE DIS FIB 2.7/3.5*155 9H R
|
Facility
|
IP
|
$4,382.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.74 |
| Max. Negotiated Rate |
$4,207.30 |
| Rate for Payer: Aetna Commercial |
$3,374.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.43
|
| Rate for Payer: Cash Price |
$2,191.30
|
| Rate for Payer: Cigna Commercial |
$3,637.56
|
| Rate for Payer: First Health Commercial |
$4,163.47
|
| Rate for Payer: Humana Commercial |
$3,725.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.61
|
| Rate for Payer: PHCS Commercial |
$4,207.30
|
| Rate for Payer: United Healthcare All Payer |
$3,856.69
|
|
|
PLATE DIS FIB 2.7/3.5*155 9H R
|
Facility
|
OP
|
$4,382.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$569.74 |
| Max. Negotiated Rate |
$4,207.30 |
| Rate for Payer: Aetna Commercial |
$3,374.60
|
| Rate for Payer: Anthem Medicaid |
$1,507.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,418.43
|
| Rate for Payer: Cash Price |
$2,191.30
|
| Rate for Payer: Cigna Commercial |
$3,637.56
|
| Rate for Payer: First Health Commercial |
$4,163.47
|
| Rate for Payer: Humana Commercial |
$3,725.21
|
| Rate for Payer: Humana KY Medicaid |
$1,507.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,522.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,593.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,234.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,314.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,537.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,856.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,286.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$876.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$569.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,358.61
|
| Rate for Payer: PHCS Commercial |
$4,207.30
|
| Rate for Payer: United Healthcare All Payer |
$3,856.69
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HL
|
Facility
|
IP
|
$4,413.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.76 |
| Max. Negotiated Rate |
$4,237.00 |
| Rate for Payer: Aetna Commercial |
$3,398.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.56
|
| Rate for Payer: Cash Price |
$2,206.77
|
| Rate for Payer: Cigna Commercial |
$3,663.24
|
| Rate for Payer: First Health Commercial |
$4,192.86
|
| Rate for Payer: Humana Commercial |
$3,751.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.20
|
| Rate for Payer: PHCS Commercial |
$4,237.00
|
| Rate for Payer: United Healthcare All Payer |
$3,883.92
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HL
|
Facility
|
OP
|
$4,413.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.76 |
| Max. Negotiated Rate |
$4,237.00 |
| Rate for Payer: Anthem Medicaid |
$1,517.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.56
|
| Rate for Payer: Cash Price |
$2,206.77
|
| Rate for Payer: Cigna Commercial |
$3,663.24
|
| Rate for Payer: First Health Commercial |
$4,192.86
|
| Rate for Payer: Humana Commercial |
$3,751.51
|
| Rate for Payer: Humana KY Medicaid |
$1,517.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.10
|
| Rate for Payer: Aetna Commercial |
$3,398.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.20
|
| Rate for Payer: PHCS Commercial |
$4,237.00
|
| Rate for Payer: United Healthcare All Payer |
$3,883.92
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HR
|
Facility
|
IP
|
$4,413.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.74 |
| Max. Negotiated Rate |
$4,236.86 |
| Rate for Payer: Aetna Commercial |
$3,398.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.45
|
| Rate for Payer: Cash Price |
$2,206.70
|
| Rate for Payer: Cigna Commercial |
$3,663.12
|
| Rate for Payer: First Health Commercial |
$4,192.73
|
| Rate for Payer: Humana Commercial |
$3,751.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,618.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.15
|
| Rate for Payer: PHCS Commercial |
$4,236.86
|
| Rate for Payer: United Healthcare All Payer |
$3,883.79
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HR
|
Facility
|
OP
|
$4,413.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.74 |
| Max. Negotiated Rate |
$4,236.86 |
| Rate for Payer: Aetna Commercial |
$3,398.32
|
| Rate for Payer: Anthem Medicaid |
$1,517.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.45
|
| Rate for Payer: Cash Price |
$2,206.70
|
| Rate for Payer: Cigna Commercial |
$3,663.12
|
| Rate for Payer: First Health Commercial |
$4,192.73
|
| Rate for Payer: Humana Commercial |
$3,751.39
|
| Rate for Payer: Humana KY Medicaid |
$1,517.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,618.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.15
|
| Rate for Payer: PHCS Commercial |
$4,236.86
|
| Rate for Payer: United Healthcare All Payer |
$3,883.79
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HL
|
Facility
|
OP
|
$4,413.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.76 |
| Max. Negotiated Rate |
$4,237.00 |
| Rate for Payer: Aetna Commercial |
$3,398.43
|
| Rate for Payer: Anthem Medicaid |
$1,517.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.56
|
| Rate for Payer: Cash Price |
$2,206.77
|
| Rate for Payer: Cigna Commercial |
$3,663.24
|
| Rate for Payer: First Health Commercial |
$4,192.86
|
| Rate for Payer: Humana Commercial |
$3,751.51
|
| Rate for Payer: Humana KY Medicaid |
$1,517.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.20
|
| Rate for Payer: PHCS Commercial |
$4,237.00
|
| Rate for Payer: United Healthcare All Payer |
$3,883.92
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HL
|
Facility
|
IP
|
$4,413.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.76 |
| Max. Negotiated Rate |
$4,237.00 |
| Rate for Payer: Aetna Commercial |
$3,398.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.56
|
| Rate for Payer: Cash Price |
$2,206.77
|
| Rate for Payer: Cigna Commercial |
$3,663.24
|
| Rate for Payer: First Health Commercial |
$4,192.86
|
| Rate for Payer: Humana Commercial |
$3,751.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.20
|
| Rate for Payer: PHCS Commercial |
$4,237.00
|
| Rate for Payer: United Healthcare All Payer |
$3,883.92
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HR
|
Facility
|
OP
|
$4,413.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.76 |
| Max. Negotiated Rate |
$4,237.00 |
| Rate for Payer: Aetna Commercial |
$3,398.43
|
| Rate for Payer: Anthem Medicaid |
$1,517.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.56
|
| Rate for Payer: Cash Price |
$2,206.77
|
| Rate for Payer: Cigna Commercial |
$3,663.24
|
| Rate for Payer: First Health Commercial |
$4,192.86
|
| Rate for Payer: Humana Commercial |
$3,751.51
|
| Rate for Payer: Humana KY Medicaid |
$1,517.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.20
|
| Rate for Payer: PHCS Commercial |
$4,237.00
|
| Rate for Payer: United Healthcare All Payer |
$3,883.92
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HR
|
Facility
|
IP
|
$4,413.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.76 |
| Max. Negotiated Rate |
$4,237.00 |
| Rate for Payer: Aetna Commercial |
$3,398.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.56
|
| Rate for Payer: Cash Price |
$2,206.77
|
| Rate for Payer: Cigna Commercial |
$3,663.24
|
| Rate for Payer: First Health Commercial |
$4,192.86
|
| Rate for Payer: Humana Commercial |
$3,751.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,883.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.20
|
| Rate for Payer: PHCS Commercial |
$4,237.00
|
| Rate for Payer: United Healthcare All Payer |
$3,883.92
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H L
|
Facility
|
OP
|
$4,414.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.87 |
| Max. Negotiated Rate |
$4,237.80 |
| Rate for Payer: Aetna Commercial |
$3,399.07
|
| Rate for Payer: Anthem Medicaid |
$1,518.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,443.22
|
| Rate for Payer: Cash Price |
$2,207.19
|
| Rate for Payer: Cigna Commercial |
$3,663.94
|
| Rate for Payer: First Health Commercial |
$4,193.66
|
| Rate for Payer: Humana Commercial |
$3,752.22
|
| Rate for Payer: Humana KY Medicaid |
$1,518.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.46
|
| Rate for Payer: PHCS Commercial |
$4,237.80
|
| Rate for Payer: United Healthcare All Payer |
$3,884.65
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H L
|
Facility
|
IP
|
$4,414.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.87 |
| Max. Negotiated Rate |
$4,237.80 |
| Rate for Payer: Aetna Commercial |
$3,399.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,443.22
|
| Rate for Payer: Cash Price |
$2,207.19
|
| Rate for Payer: Cigna Commercial |
$3,663.94
|
| Rate for Payer: First Health Commercial |
$4,193.66
|
| Rate for Payer: Humana Commercial |
$3,752.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,368.46
|
| Rate for Payer: PHCS Commercial |
$4,237.80
|
| Rate for Payer: United Healthcare All Payer |
$3,884.65
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H R
|
Facility
|
OP
|
$4,227.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.61 |
| Max. Negotiated Rate |
$4,058.69 |
| Rate for Payer: Anthem Medicaid |
$1,453.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,297.68
|
| Rate for Payer: Cash Price |
$2,113.90
|
| Rate for Payer: Cigna Commercial |
$3,509.07
|
| Rate for Payer: First Health Commercial |
$4,016.41
|
| Rate for Payer: Humana Commercial |
$3,593.63
|
| Rate for Payer: Humana KY Medicaid |
$1,453.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,468.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,466.80
|
| Rate for Payer: Aetna Commercial |
$3,255.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,120.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,720.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,170.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.62
|
| Rate for Payer: PHCS Commercial |
$4,058.69
|
| Rate for Payer: United Healthcare All Payer |
$3,720.46
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H R
|
Facility
|
IP
|
$4,227.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.61 |
| Max. Negotiated Rate |
$4,058.69 |
| Rate for Payer: Aetna Commercial |
$3,255.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,297.68
|
| Rate for Payer: Cash Price |
$2,113.90
|
| Rate for Payer: Cigna Commercial |
$3,509.07
|
| Rate for Payer: First Health Commercial |
$4,016.41
|
| Rate for Payer: Humana Commercial |
$3,593.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,466.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,120.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,720.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,170.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.62
|
| Rate for Payer: PHCS Commercial |
$4,058.69
|
| Rate for Payer: United Healthcare All Payer |
$3,720.46
|
|
|
PLATE DIS FIB 2.7/3.5* 77 3H L
|
Facility
|
OP
|
$4,227.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.61 |
| Max. Negotiated Rate |
$4,058.69 |
| Rate for Payer: Aetna Commercial |
$3,255.41
|
| Rate for Payer: Anthem Medicaid |
$1,453.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,297.68
|
| Rate for Payer: Cash Price |
$2,113.90
|
| Rate for Payer: Cigna Commercial |
$3,509.07
|
| Rate for Payer: First Health Commercial |
$4,016.41
|
| Rate for Payer: Humana Commercial |
$3,593.63
|
| Rate for Payer: Humana KY Medicaid |
$1,453.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,468.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,466.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,120.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,720.46
|
| Rate for Payer: Ohio Health Group HMO |
$3,170.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$845.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$549.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,310.62
|
| Rate for Payer: PHCS Commercial |
$4,058.69
|
| Rate for Payer: United Healthcare All Payer |
$3,720.46
|
|
