|
PLATE 1/3 TUB 3H 38 71829433
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.40 |
| Max. Negotiated Rate |
$1,082.88 |
| Rate for Payer: Aetna Commercial |
$868.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.84
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.24
|
| Rate for Payer: First Health Commercial |
$1,071.60
|
| Rate for Payer: Humana Commercial |
$958.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.64
|
| Rate for Payer: Ohio Health Group HMO |
$846.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$778.32
|
| Rate for Payer: PHCS Commercial |
$1,082.88
|
| Rate for Payer: United Healthcare All Payer |
$992.64
|
|
|
PLATE 1/3 TUB 3H 38 71829433
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$338.40 |
| Max. Negotiated Rate |
$1,082.88 |
| Rate for Payer: Aetna Commercial |
$868.56
|
| Rate for Payer: Anthem Medicaid |
$387.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$879.84
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cigna Commercial |
$936.24
|
| Rate for Payer: First Health Commercial |
$1,071.60
|
| Rate for Payer: Humana Commercial |
$958.80
|
| Rate for Payer: Humana KY Medicaid |
$387.92
|
| Rate for Payer: Kentucky WC Medicaid |
$391.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$924.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$992.64
|
| Rate for Payer: Ohio Health Group HMO |
$846.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$778.32
|
| Rate for Payer: PHCS Commercial |
$1,082.88
|
| Rate for Payer: United Healthcare All Payer |
$992.64
|
|
|
PLATE 1/3 TUB 4H 50 71829434
|
Facility
|
OP
|
$1,173.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.98 |
| Max. Negotiated Rate |
$1,126.32 |
| Rate for Payer: Aetna Commercial |
$903.40
|
| Rate for Payer: Anthem Medicaid |
$403.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.13
|
| Rate for Payer: Cash Price |
$586.62
|
| Rate for Payer: Cigna Commercial |
$973.80
|
| Rate for Payer: First Health Commercial |
$1,114.59
|
| Rate for Payer: Humana Commercial |
$997.26
|
| Rate for Payer: Humana KY Medicaid |
$403.48
|
| Rate for Payer: Kentucky WC Medicaid |
$407.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.46
|
| Rate for Payer: Ohio Health Group HMO |
$879.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.54
|
| Rate for Payer: PHCS Commercial |
$1,126.32
|
| Rate for Payer: United Healthcare All Payer |
$1,032.46
|
|
|
PLATE 1/3 TUB 4H 50 71829434
|
Facility
|
IP
|
$1,173.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.98 |
| Max. Negotiated Rate |
$1,126.32 |
| Rate for Payer: Aetna Commercial |
$903.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.13
|
| Rate for Payer: Cash Price |
$586.62
|
| Rate for Payer: Cigna Commercial |
$973.80
|
| Rate for Payer: First Health Commercial |
$1,114.59
|
| Rate for Payer: Humana Commercial |
$997.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.46
|
| Rate for Payer: Ohio Health Group HMO |
$879.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.54
|
| Rate for Payer: PHCS Commercial |
$1,126.32
|
| Rate for Payer: United Healthcare All Payer |
$1,032.46
|
|
|
PLATE 1/3 TUB 5H 62 71829435
|
Facility
|
OP
|
$1,173.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.98 |
| Max. Negotiated Rate |
$1,126.32 |
| Rate for Payer: Aetna Commercial |
$903.40
|
| Rate for Payer: Anthem Medicaid |
$403.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.13
|
| Rate for Payer: Cash Price |
$586.62
|
| Rate for Payer: Cigna Commercial |
$973.80
|
| Rate for Payer: First Health Commercial |
$1,114.59
|
| Rate for Payer: Humana Commercial |
$997.26
|
| Rate for Payer: Humana KY Medicaid |
$403.48
|
| Rate for Payer: Kentucky WC Medicaid |
$407.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.46
|
| Rate for Payer: Ohio Health Group HMO |
$879.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.54
|
| Rate for Payer: PHCS Commercial |
$1,126.32
|
| Rate for Payer: United Healthcare All Payer |
$1,032.46
|
|
|
PLATE 1/3 TUB 5H 62 71829435
|
Facility
|
IP
|
$1,173.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$351.98 |
| Max. Negotiated Rate |
$1,126.32 |
| Rate for Payer: Aetna Commercial |
$903.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.13
|
| Rate for Payer: Cash Price |
$586.62
|
| Rate for Payer: Cigna Commercial |
$973.80
|
| Rate for Payer: First Health Commercial |
$1,114.59
|
| Rate for Payer: Humana Commercial |
$997.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$865.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$351.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.46
|
| Rate for Payer: Ohio Health Group HMO |
$879.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$938.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,020.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.54
|
| Rate for Payer: PHCS Commercial |
$1,126.32
|
| Rate for Payer: United Healthcare All Payer |
$1,032.46
|
|
|
PLATE 1/3 TUB 6H 74 71829436
|
Facility
|
IP
|
$1,184.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.43 |
| Max. Negotiated Rate |
$1,137.36 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.11
|
| Rate for Payer: Cash Price |
$592.38
|
| Rate for Payer: Cigna Commercial |
$983.34
|
| Rate for Payer: First Health Commercial |
$1,125.51
|
| Rate for Payer: Humana Commercial |
$1,007.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.58
|
| Rate for Payer: Ohio Health Group HMO |
$888.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.48
|
| Rate for Payer: PHCS Commercial |
$1,137.36
|
| Rate for Payer: United Healthcare All Payer |
$1,042.58
|
|
|
PLATE 1/3 TUB 6H 74 71829436
|
Facility
|
OP
|
$1,184.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.43 |
| Max. Negotiated Rate |
$1,137.36 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Anthem Medicaid |
$407.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.11
|
| Rate for Payer: Cash Price |
$592.38
|
| Rate for Payer: Cigna Commercial |
$983.34
|
| Rate for Payer: First Health Commercial |
$1,125.51
|
| Rate for Payer: Humana Commercial |
$1,007.04
|
| Rate for Payer: Humana KY Medicaid |
$407.44
|
| Rate for Payer: Kentucky WC Medicaid |
$411.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.58
|
| Rate for Payer: Ohio Health Group HMO |
$888.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.48
|
| Rate for Payer: PHCS Commercial |
$1,137.36
|
| Rate for Payer: United Healthcare All Payer |
$1,042.58
|
|
|
PLATE 1/3 TUB 7H 86 71829437
|
Facility
|
IP
|
$1,184.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.43 |
| Max. Negotiated Rate |
$1,137.36 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.11
|
| Rate for Payer: Cash Price |
$592.38
|
| Rate for Payer: Cigna Commercial |
$983.34
|
| Rate for Payer: First Health Commercial |
$1,125.51
|
| Rate for Payer: Humana Commercial |
$1,007.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.58
|
| Rate for Payer: Ohio Health Group HMO |
$888.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.48
|
| Rate for Payer: PHCS Commercial |
$1,137.36
|
| Rate for Payer: United Healthcare All Payer |
$1,042.58
|
|
|
PLATE 1/3 TUB 7H 86 71829437
|
Facility
|
OP
|
$1,184.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$355.43 |
| Max. Negotiated Rate |
$1,137.36 |
| Rate for Payer: Aetna Commercial |
$912.26
|
| Rate for Payer: Anthem Medicaid |
$407.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$924.11
|
| Rate for Payer: Cash Price |
$592.38
|
| Rate for Payer: Cigna Commercial |
$983.34
|
| Rate for Payer: First Health Commercial |
$1,125.51
|
| Rate for Payer: Humana Commercial |
$1,007.04
|
| Rate for Payer: Humana KY Medicaid |
$407.44
|
| Rate for Payer: Kentucky WC Medicaid |
$411.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$971.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$874.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$355.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,042.58
|
| Rate for Payer: Ohio Health Group HMO |
$888.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$947.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,030.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$817.48
|
| Rate for Payer: PHCS Commercial |
$1,137.36
|
| Rate for Payer: United Healthcare All Payer |
$1,042.58
|
|
|
PLATE 1/3 TUB 8H 98 71829438
|
Facility
|
IP
|
$1,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.88
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.24
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
PLATE 1/3 TUB 8H 98 71829438
|
Facility
|
OP
|
$1,196.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.80 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$920.92
|
| Rate for Payer: Anthem Medicaid |
$411.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.88
|
| Rate for Payer: Cash Price |
$598.00
|
| Rate for Payer: Cigna Commercial |
$992.68
|
| Rate for Payer: First Health Commercial |
$1,136.20
|
| Rate for Payer: Humana Commercial |
$1,016.60
|
| Rate for Payer: Humana KY Medicaid |
$411.30
|
| Rate for Payer: Kentucky WC Medicaid |
$415.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$980.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$882.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,052.48
|
| Rate for Payer: Ohio Health Group HMO |
$897.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,040.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$825.24
|
| Rate for Payer: PHCS Commercial |
$1,148.16
|
| Rate for Payer: United Healthcare All Payer |
$1,052.48
|
|
|
PLATE 1/3 TUB LCK 3.5M 5H 62M
|
Facility
|
IP
|
$2,031.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.56 |
| Max. Negotiated Rate |
$1,950.60 |
| Rate for Payer: Aetna Commercial |
$1,564.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.87
|
| Rate for Payer: Cash Price |
$1,015.94
|
| Rate for Payer: Cigna Commercial |
$1,686.46
|
| Rate for Payer: First Health Commercial |
$1,930.29
|
| Rate for Payer: Humana Commercial |
$1,727.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,767.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.00
|
| Rate for Payer: PHCS Commercial |
$1,950.60
|
| Rate for Payer: United Healthcare All Payer |
$1,788.05
|
|
|
PLATE 1/3 TUB LCK 3.5M 5H 62M
|
Facility
|
OP
|
$2,031.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.56 |
| Max. Negotiated Rate |
$1,950.60 |
| Rate for Payer: Aetna Commercial |
$1,564.55
|
| Rate for Payer: Anthem Medicaid |
$698.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.87
|
| Rate for Payer: Cash Price |
$1,015.94
|
| Rate for Payer: Cigna Commercial |
$1,686.46
|
| Rate for Payer: First Health Commercial |
$1,930.29
|
| Rate for Payer: Humana Commercial |
$1,727.10
|
| Rate for Payer: Humana KY Medicaid |
$698.76
|
| Rate for Payer: Kentucky WC Medicaid |
$705.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,767.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.00
|
| Rate for Payer: PHCS Commercial |
$1,950.60
|
| Rate for Payer: United Healthcare All Payer |
$1,788.05
|
|
|
PLATE 1/3 TUB LCK 3.5M 6H 74M
|
Facility
|
IP
|
$2,127.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.29 |
| Max. Negotiated Rate |
$2,042.53 |
| Rate for Payer: Aetna Commercial |
$1,638.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.56
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cigna Commercial |
$1,765.94
|
| Rate for Payer: First Health Commercial |
$2,021.26
|
| Rate for Payer: Humana Commercial |
$1,808.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.07
|
| Rate for Payer: PHCS Commercial |
$2,042.53
|
| Rate for Payer: United Healthcare All Payer |
$1,872.32
|
|
|
PLATE 1/3 TUB LCK 3.5M 6H 74M
|
Facility
|
OP
|
$2,127.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.29 |
| Max. Negotiated Rate |
$2,042.53 |
| Rate for Payer: Aetna Commercial |
$1,638.28
|
| Rate for Payer: Anthem Medicaid |
$731.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.56
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cigna Commercial |
$1,765.94
|
| Rate for Payer: First Health Commercial |
$2,021.26
|
| Rate for Payer: Humana Commercial |
$1,808.49
|
| Rate for Payer: Humana KY Medicaid |
$731.70
|
| Rate for Payer: Kentucky WC Medicaid |
$739.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.07
|
| Rate for Payer: PHCS Commercial |
$2,042.53
|
| Rate for Payer: United Healthcare All Payer |
$1,872.32
|
|
|
PLATE 1/3 TUB LCK 3.5M 7H 86M
|
Facility
|
OP
|
$2,216.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.97 |
| Max. Negotiated Rate |
$2,127.90 |
| Rate for Payer: Aetna Commercial |
$1,706.75
|
| Rate for Payer: Anthem Medicaid |
$762.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,728.92
|
| Rate for Payer: Cash Price |
$1,108.28
|
| Rate for Payer: Cigna Commercial |
$1,839.74
|
| Rate for Payer: First Health Commercial |
$2,105.73
|
| Rate for Payer: Humana Commercial |
$1,884.08
|
| Rate for Payer: Humana KY Medicaid |
$762.27
|
| Rate for Payer: Kentucky WC Medicaid |
$770.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,635.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$777.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,950.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,662.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,928.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.43
|
| Rate for Payer: PHCS Commercial |
$2,127.90
|
| Rate for Payer: United Healthcare All Payer |
$1,950.57
|
|
|
PLATE 1/3 TUB LCK 3.5M 7H 86M
|
Facility
|
IP
|
$2,216.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.97 |
| Max. Negotiated Rate |
$2,127.90 |
| Rate for Payer: Aetna Commercial |
$1,706.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,728.92
|
| Rate for Payer: Cash Price |
$1,108.28
|
| Rate for Payer: Cigna Commercial |
$1,839.74
|
| Rate for Payer: First Health Commercial |
$2,105.73
|
| Rate for Payer: Humana Commercial |
$1,884.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,635.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,950.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,662.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,928.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.43
|
| Rate for Payer: PHCS Commercial |
$2,127.90
|
| Rate for Payer: United Healthcare All Payer |
$1,950.57
|
|
|
PLATE 14H 3.5*189MM SM FRAG
|
Facility
|
OP
|
$3,775.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.54 |
| Max. Negotiated Rate |
$3,624.13 |
| Rate for Payer: Aetna Commercial |
$2,906.86
|
| Rate for Payer: Anthem Medicaid |
$1,298.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.61
|
| Rate for Payer: Cash Price |
$1,887.57
|
| Rate for Payer: Cigna Commercial |
$3,133.37
|
| Rate for Payer: First Health Commercial |
$3,586.38
|
| Rate for Payer: Humana Commercial |
$3,208.87
|
| Rate for Payer: Humana KY Medicaid |
$1,298.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,604.85
|
| Rate for Payer: PHCS Commercial |
$3,624.13
|
| Rate for Payer: United Healthcare All Payer |
$3,322.12
|
|
|
PLATE 14H 3.5*189MM SM FRAG
|
Facility
|
IP
|
$3,775.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.54 |
| Max. Negotiated Rate |
$3,624.13 |
| Rate for Payer: Aetna Commercial |
$2,906.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.61
|
| Rate for Payer: Cash Price |
$1,887.57
|
| Rate for Payer: Cigna Commercial |
$3,133.37
|
| Rate for Payer: First Health Commercial |
$3,586.38
|
| Rate for Payer: Humana Commercial |
$3,208.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,284.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,604.85
|
| Rate for Payer: PHCS Commercial |
$3,624.13
|
| Rate for Payer: United Healthcare All Payer |
$3,322.12
|
|
|
PLATE 1.5MM 7 HOLE LEFT SMALL
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 1.5MM 7 HOLE LEFT SMALL
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 1.5MM 7 HOLE RIGHT SMALL
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 1.5MM 7 HOLE RIGHT SMALL
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 1ST TARSOMETATARSAL 4H
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
