|
PLATE ADULT BLD 95 70/156 9H
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 70/204 12H
|
Facility
|
IP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 70/204 12H
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 70/235 14H
|
Facility
|
IP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 70/235 14H
|
Facility
|
OP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem Medicaid |
$2,629.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Humana KY Medicaid |
$2,629.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 70/267 16H
|
Facility
|
IP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 70/267 16H
|
Facility
|
OP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem Medicaid |
$2,629.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Humana KY Medicaid |
$2,629.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 70/299 18H
|
Facility
|
IP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 70/299 18H
|
Facility
|
OP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem Medicaid |
$2,629.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Humana KY Medicaid |
$2,629.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 70/92 5H
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 70/92 5H
|
Facility
|
IP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/124 7H
|
Facility
|
IP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/124 7H
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/156 9H
|
Facility
|
IP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/156 9H
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/204 12H
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/204 12H
|
Facility
|
IP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/235 14H
|
Facility
|
IP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 80/235 14H
|
Facility
|
OP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem Medicaid |
$2,629.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Humana KY Medicaid |
$2,629.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 80/267 16H
|
Facility
|
IP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 80/267 16H
|
Facility
|
OP
|
$7,646.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.99 |
| Max. Negotiated Rate |
$7,340.76 |
| Rate for Payer: Aetna Commercial |
$5,887.91
|
| Rate for Payer: Anthem Medicaid |
$2,629.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.37
|
| Rate for Payer: Cash Price |
$3,823.32
|
| Rate for Payer: Cigna Commercial |
$6,346.70
|
| Rate for Payer: First Health Commercial |
$7,264.30
|
| Rate for Payer: Humana Commercial |
$6,499.64
|
| Rate for Payer: Humana KY Medicaid |
$2,629.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,734.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,117.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,276.17
|
| Rate for Payer: PHCS Commercial |
$7,340.76
|
| Rate for Payer: United Healthcare All Payer |
$6,729.03
|
|
|
PLATE ADULT BLD 95 80/92 5H
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADULT BLD 95 80/92 5H
|
Facility
|
IP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE ADVMT 5H L 2MM 100D LT
|
Facility
|
IP
|
$2,101.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.39 |
| Max. Negotiated Rate |
$2,017.26 |
| Rate for Payer: Aetna Commercial |
$1,618.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.02
|
| Rate for Payer: Cash Price |
$1,050.65
|
| Rate for Payer: Cigna Commercial |
$1,744.09
|
| Rate for Payer: First Health Commercial |
$1,996.24
|
| Rate for Payer: Humana Commercial |
$1,786.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,849.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,828.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.90
|
| Rate for Payer: PHCS Commercial |
$2,017.26
|
| Rate for Payer: United Healthcare All Payer |
$1,849.15
|
|
|
PLATE ADVMT 5H L 2MM 100D LT
|
Facility
|
OP
|
$2,101.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.39 |
| Max. Negotiated Rate |
$2,017.26 |
| Rate for Payer: Aetna Commercial |
$1,618.01
|
| Rate for Payer: Anthem Medicaid |
$722.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.02
|
| Rate for Payer: Cash Price |
$1,050.65
|
| Rate for Payer: Cigna Commercial |
$1,744.09
|
| Rate for Payer: First Health Commercial |
$1,996.24
|
| Rate for Payer: Humana Commercial |
$1,786.11
|
| Rate for Payer: Humana KY Medicaid |
$722.64
|
| Rate for Payer: Kentucky WC Medicaid |
$730.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,723.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,849.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,681.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,828.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.90
|
| Rate for Payer: PHCS Commercial |
$2,017.26
|
| Rate for Payer: United Healthcare All Payer |
$1,849.15
|
|
