|
PLATE DIS FIB 2.7/3.5* 77 3H L
|
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 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 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: 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
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H L
|
Facility
|
OP
|
$4,655.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.17 |
| Max. Negotiated Rate |
$4,468.94 |
| Rate for Payer: Aetna Commercial |
$3,584.47
|
| Rate for Payer: Anthem Medicaid |
$1,600.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,631.02
|
| Rate for Payer: Cash Price |
$2,327.57
|
| Rate for Payer: Cigna Commercial |
$3,863.77
|
| Rate for Payer: First Health Commercial |
$4,422.39
|
| Rate for Payer: Humana Commercial |
$3,956.88
|
| Rate for Payer: Humana KY Medicaid |
$1,600.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,633.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.10
|
| Rate for Payer: PHCS Commercial |
$4,468.94
|
| Rate for Payer: United Healthcare All Payer |
$4,096.53
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H L
|
Facility
|
IP
|
$4,655.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.17 |
| Max. Negotiated Rate |
$4,468.94 |
| Rate for Payer: Aetna Commercial |
$3,584.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,631.02
|
| Rate for Payer: Cash Price |
$2,327.57
|
| Rate for Payer: Cigna Commercial |
$3,863.77
|
| Rate for Payer: First Health Commercial |
$4,422.39
|
| Rate for Payer: Humana Commercial |
$3,956.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.10
|
| Rate for Payer: PHCS Commercial |
$4,468.94
|
| Rate for Payer: United Healthcare All Payer |
$4,096.53
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H R
|
Facility
|
OP
|
$4,655.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.17 |
| Max. Negotiated Rate |
$4,468.94 |
| Rate for Payer: Aetna Commercial |
$3,584.47
|
| Rate for Payer: Anthem Medicaid |
$1,600.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,631.02
|
| Rate for Payer: Cash Price |
$2,327.57
|
| Rate for Payer: Cigna Commercial |
$3,863.77
|
| Rate for Payer: First Health Commercial |
$4,422.39
|
| Rate for Payer: Humana Commercial |
$3,956.88
|
| Rate for Payer: Humana KY Medicaid |
$1,600.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,633.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.10
|
| Rate for Payer: PHCS Commercial |
$4,468.94
|
| Rate for Payer: United Healthcare All Payer |
$4,096.53
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H R
|
Facility
|
IP
|
$4,655.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.17 |
| Max. Negotiated Rate |
$4,468.94 |
| Rate for Payer: Aetna Commercial |
$3,584.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,631.02
|
| Rate for Payer: Cash Price |
$2,327.57
|
| Rate for Payer: Cigna Commercial |
$3,863.77
|
| Rate for Payer: First Health Commercial |
$4,422.39
|
| Rate for Payer: Humana Commercial |
$3,956.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,817.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,435.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,396.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,096.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,491.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.10
|
| Rate for Payer: PHCS Commercial |
$4,468.94
|
| Rate for Payer: United Healthcare All Payer |
$4,096.53
|
|
|
PLATE DIS FIB 2.7/3.5* 90 4H L
|
Facility
|
OP
|
$4,258.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.64 |
| Max. Negotiated Rate |
$4,088.42 |
| Rate for Payer: Anthem Medicaid |
$1,464.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.84
|
| Rate for Payer: Cash Price |
$2,129.39
|
| Rate for Payer: Cigna Commercial |
$3,534.78
|
| Rate for Payer: First Health Commercial |
$4,045.83
|
| Rate for Payer: Humana Commercial |
$3,619.95
|
| Rate for Payer: Humana KY Medicaid |
$1,464.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.19
|
| Rate for Payer: Aetna Commercial |
$3,279.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.22
|
| Rate for Payer: PHCS Commercial |
$4,088.42
|
| Rate for Payer: United Healthcare All Payer |
$3,747.72
|
|
|
PLATE DIS FIB 2.7/3.5* 90 4H L
|
Facility
|
IP
|
$4,258.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.64 |
| Max. Negotiated Rate |
$4,088.42 |
| Rate for Payer: Aetna Commercial |
$3,279.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.84
|
| Rate for Payer: Cash Price |
$2,129.39
|
| Rate for Payer: Cigna Commercial |
$3,534.78
|
| Rate for Payer: First Health Commercial |
$4,045.83
|
| Rate for Payer: Humana Commercial |
$3,619.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.22
|
| Rate for Payer: PHCS Commercial |
$4,088.42
|
| Rate for Payer: United Healthcare All Payer |
$3,747.72
|
|
|
PLATE DIS FIB 2.7/3.5* 90 4H R
|
Facility
|
IP
|
$4,258.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.64 |
| Max. Negotiated Rate |
$4,088.42 |
| Rate for Payer: Aetna Commercial |
$3,279.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.84
|
| Rate for Payer: Cash Price |
$2,129.39
|
| Rate for Payer: Cigna Commercial |
$3,534.78
|
| Rate for Payer: First Health Commercial |
$4,045.83
|
| Rate for Payer: Humana Commercial |
$3,619.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.22
|
| Rate for Payer: PHCS Commercial |
$4,088.42
|
| Rate for Payer: United Healthcare All Payer |
$3,747.72
|
|
|
PLATE DIS FIB 2.7/3.5* 90 4H R
|
Facility
|
OP
|
$4,258.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.64 |
| Max. Negotiated Rate |
$4,088.42 |
| Rate for Payer: Aetna Commercial |
$3,279.25
|
| Rate for Payer: Anthem Medicaid |
$1,464.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.84
|
| Rate for Payer: Cash Price |
$2,129.39
|
| Rate for Payer: Cigna Commercial |
$3,534.78
|
| Rate for Payer: First Health Commercial |
$4,045.83
|
| Rate for Payer: Humana Commercial |
$3,619.95
|
| Rate for Payer: Humana KY Medicaid |
$1,464.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.22
|
| Rate for Payer: PHCS Commercial |
$4,088.42
|
| Rate for Payer: United Healthcare All Payer |
$3,747.72
|
|
|
PLATE DIS FIB 2.7/3.5*99 5H 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*99 5H 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*99 5H R
|
Facility
|
IP
|
$4,584.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.01 |
| Max. Negotiated Rate |
$4,401.34 |
| Rate for Payer: Aetna Commercial |
$3,530.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,576.09
|
| Rate for Payer: Cash Price |
$2,292.36
|
| Rate for Payer: Cigna Commercial |
$3,805.33
|
| Rate for Payer: First Health Commercial |
$4,355.49
|
| Rate for Payer: Humana Commercial |
$3,897.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,759.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,383.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,034.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,438.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$596.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.27
|
| Rate for Payer: PHCS Commercial |
$4,401.34
|
| Rate for Payer: United Healthcare All Payer |
$4,034.56
|
|
|
PLATE DIS FIB 2.7/3.5*99 5H R
|
Facility
|
OP
|
$4,584.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$596.01 |
| Max. Negotiated Rate |
$4,401.34 |
| Rate for Payer: Aetna Commercial |
$3,530.24
|
| Rate for Payer: Anthem Medicaid |
$1,576.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,576.09
|
| Rate for Payer: Cash Price |
$2,292.36
|
| Rate for Payer: Cigna Commercial |
$3,805.33
|
| Rate for Payer: First Health Commercial |
$4,355.49
|
| Rate for Payer: Humana Commercial |
$3,897.02
|
| Rate for Payer: Humana KY Medicaid |
$1,576.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,592.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,759.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,383.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,375.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,608.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,034.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,438.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$916.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$596.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,421.27
|
| Rate for Payer: PHCS Commercial |
$4,401.34
|
| Rate for Payer: United Healthcare All Payer |
$4,034.56
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57L
|
Facility
|
OP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Anthem Medicaid |
$1,847.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,847.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,866.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,884.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57L
|
Facility
|
IP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57R
|
Facility
|
IP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57R
|
Facility
|
OP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Anthem Medicaid |
$1,847.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,847.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,866.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,884.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57L
|
Facility
|
IP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57L
|
Facility
|
OP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Anthem Medicaid |
$1,847.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,847.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,866.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,884.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57R
|
Facility
|
IP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57R
|
Facility
|
OP
|
$5,372.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.41 |
| Max. Negotiated Rate |
$5,157.47 |
| Rate for Payer: Aetna Commercial |
$4,136.72
|
| Rate for Payer: Anthem Medicaid |
$1,847.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,190.44
|
| Rate for Payer: Cash Price |
$2,686.18
|
| Rate for Payer: Cigna Commercial |
$4,459.06
|
| Rate for Payer: First Health Commercial |
$5,103.74
|
| Rate for Payer: Humana Commercial |
$4,566.51
|
| Rate for Payer: Humana KY Medicaid |
$1,847.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,866.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,405.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,964.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,611.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,884.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,727.68
|
| Rate for Payer: Ohio Health Group HMO |
$4,029.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,074.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$698.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,665.43
|
| Rate for Payer: PHCS Commercial |
$5,157.47
|
| Rate for Payer: United Healthcare All Payer |
$4,727.68
|
|
|
PLATE DISTAL FEM LAT L 3H 122M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE DISTAL FEM LAT L 3H 122M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
