|
PLATE BONE CBL RDY 8H 246MM
|
Facility
|
OP
|
$7,934.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.44 |
| Max. Negotiated Rate |
$7,617.41 |
| Rate for Payer: Aetna Commercial |
$6,109.80
|
| Rate for Payer: Anthem Medicaid |
$2,728.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.14
|
| Rate for Payer: Cash Price |
$3,967.40
|
| Rate for Payer: Cigna Commercial |
$6,585.88
|
| Rate for Payer: First Health Commercial |
$7,538.06
|
| Rate for Payer: Humana Commercial |
$6,744.58
|
| Rate for Payer: Humana KY Medicaid |
$2,728.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,756.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,783.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,951.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,903.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.01
|
| Rate for Payer: PHCS Commercial |
$7,617.41
|
| Rate for Payer: United Healthcare All Payer |
$6,982.62
|
|
|
PLATE BONE CBL RDY 8H 246MM
|
Facility
|
IP
|
$7,934.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,380.44 |
| Max. Negotiated Rate |
$7,617.41 |
| Rate for Payer: Aetna Commercial |
$6,109.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,189.14
|
| Rate for Payer: Cash Price |
$3,967.40
|
| Rate for Payer: Cigna Commercial |
$6,585.88
|
| Rate for Payer: First Health Commercial |
$7,538.06
|
| Rate for Payer: Humana Commercial |
$6,744.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,506.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,855.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,380.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,982.62
|
| Rate for Payer: Ohio Health Group HMO |
$5,951.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,347.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,903.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,475.01
|
| Rate for Payer: PHCS Commercial |
$7,617.41
|
| Rate for Payer: United Healthcare All Payer |
$6,982.62
|
|
|
PLATE BOW 4MM
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE BOW 4MM
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE BRD LCKG COMP 4.5MM 6H
|
Facility
|
IP
|
$3,770.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.00 |
| Max. Negotiated Rate |
$3,619.20 |
| Rate for Payer: Aetna Commercial |
$2,902.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,940.60
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$3,129.10
|
| Rate for Payer: First Health Commercial |
$3,581.50
|
| Rate for Payer: Humana Commercial |
$3,204.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,091.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,782.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,131.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,317.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,827.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,279.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,601.30
|
| Rate for Payer: PHCS Commercial |
$3,619.20
|
| Rate for Payer: United Healthcare All Payer |
$3,317.60
|
|
|
PLATE BRD LCKG COMP 4.5MM 6H
|
Facility
|
OP
|
$3,770.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.00 |
| Max. Negotiated Rate |
$3,619.20 |
| Rate for Payer: Aetna Commercial |
$2,902.90
|
| Rate for Payer: Anthem Medicaid |
$1,296.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,940.60
|
| Rate for Payer: Cash Price |
$1,885.00
|
| Rate for Payer: Cigna Commercial |
$3,129.10
|
| Rate for Payer: First Health Commercial |
$3,581.50
|
| Rate for Payer: Humana Commercial |
$3,204.50
|
| Rate for Payer: Humana KY Medicaid |
$1,296.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,309.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,091.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,782.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,131.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,322.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,317.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,827.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,016.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,279.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,601.30
|
| Rate for Payer: PHCS Commercial |
$3,619.20
|
| Rate for Payer: United Healthcare All Payer |
$3,317.60
|
|
|
PLATE BRD LCKG COMP 4.5MM 7H
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE BRD LCKG COMP 4.5MM 7H
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE BRD LCKG COMP 4.5MM 8H
|
Facility
|
IP
|
$3,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.00 |
| Max. Negotiated Rate |
$3,820.80 |
| Rate for Payer: Aetna Commercial |
$3,064.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,104.40
|
| Rate for Payer: Cash Price |
$1,990.00
|
| Rate for Payer: Cigna Commercial |
$3,303.40
|
| Rate for Payer: First Health Commercial |
$3,781.00
|
| Rate for Payer: Humana Commercial |
$3,383.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,263.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,937.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,502.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,985.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,462.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,746.20
|
| Rate for Payer: PHCS Commercial |
$3,820.80
|
| Rate for Payer: United Healthcare All Payer |
$3,502.40
|
|
|
PLATE BRD LCKG COMP 4.5MM 8H
|
Facility
|
OP
|
$3,980.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.00 |
| Max. Negotiated Rate |
$3,820.80 |
| Rate for Payer: Aetna Commercial |
$3,064.60
|
| Rate for Payer: Anthem Medicaid |
$1,368.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,104.40
|
| Rate for Payer: Cash Price |
$1,990.00
|
| Rate for Payer: Cigna Commercial |
$3,303.40
|
| Rate for Payer: First Health Commercial |
$3,781.00
|
| Rate for Payer: Humana Commercial |
$3,383.00
|
| Rate for Payer: Humana KY Medicaid |
$1,368.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,382.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,263.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,937.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,502.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,985.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,184.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,462.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,746.20
|
| Rate for Payer: PHCS Commercial |
$3,820.80
|
| Rate for Payer: United Healthcare All Payer |
$3,502.40
|
|
|
PLATE BRD LCKG COMP 4.5MM 9H
|
Facility
|
OP
|
$4,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.00 |
| Max. Negotiated Rate |
$3,964.80 |
| Rate for Payer: Aetna Commercial |
$3,180.10
|
| Rate for Payer: Anthem Medicaid |
$1,420.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,221.40
|
| Rate for Payer: Cash Price |
$2,065.00
|
| Rate for Payer: Cigna Commercial |
$3,427.90
|
| Rate for Payer: First Health Commercial |
$3,923.50
|
| Rate for Payer: Humana Commercial |
$3,510.50
|
| Rate for Payer: Humana KY Medicaid |
$1,420.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,434.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,386.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,448.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,634.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,097.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,593.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,849.70
|
| Rate for Payer: PHCS Commercial |
$3,964.80
|
| Rate for Payer: United Healthcare All Payer |
$3,634.40
|
|
|
PLATE BRD LCKG COMP 4.5MM 9H
|
Facility
|
IP
|
$4,130.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.00 |
| Max. Negotiated Rate |
$3,964.80 |
| Rate for Payer: Aetna Commercial |
$3,180.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,221.40
|
| Rate for Payer: Cash Price |
$2,065.00
|
| Rate for Payer: Cigna Commercial |
$3,427.90
|
| Rate for Payer: First Health Commercial |
$3,923.50
|
| Rate for Payer: Humana Commercial |
$3,510.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,386.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,634.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,097.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,304.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,593.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,849.70
|
| Rate for Payer: PHCS Commercial |
$3,964.80
|
| Rate for Payer: United Healthcare All Payer |
$3,634.40
|
|
|
PLATE BROAD 4.5*123 6H
|
Facility
|
IP
|
$3,776.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$3,624.96 |
| Rate for Payer: Aetna Commercial |
$2,907.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,945.28
|
| Rate for Payer: Cash Price |
$1,888.00
|
| Rate for Payer: Cigna Commercial |
$3,134.08
|
| Rate for Payer: First Health Commercial |
$3,587.20
|
| Rate for Payer: Humana Commercial |
$3,209.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,096.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,832.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.44
|
| Rate for Payer: PHCS Commercial |
$3,624.96
|
| Rate for Payer: United Healthcare All Payer |
$3,322.88
|
|
|
PLATE BROAD 4.5*123 6H
|
Facility
|
OP
|
$3,776.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.80 |
| Max. Negotiated Rate |
$3,624.96 |
| Rate for Payer: Aetna Commercial |
$2,907.52
|
| Rate for Payer: Anthem Medicaid |
$1,298.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,945.28
|
| Rate for Payer: Cash Price |
$1,888.00
|
| Rate for Payer: Cigna Commercial |
$3,134.08
|
| Rate for Payer: First Health Commercial |
$3,587.20
|
| Rate for Payer: Humana Commercial |
$3,209.60
|
| Rate for Payer: Humana KY Medicaid |
$1,298.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,096.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,786.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.88
|
| Rate for Payer: Ohio Health Group HMO |
$2,832.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,020.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,285.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,605.44
|
| Rate for Payer: PHCS Commercial |
$3,624.96
|
| Rate for Payer: United Healthcare All Payer |
$3,322.88
|
|
|
PLATE BROAD 4.5*141 7H
|
Facility
|
OP
|
$2,080.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$1,997.12 |
| Rate for Payer: Aetna Commercial |
$1,601.85
|
| Rate for Payer: Anthem Medicaid |
$715.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,622.66
|
| Rate for Payer: Cash Price |
$1,040.16
|
| Rate for Payer: Cigna Commercial |
$1,726.67
|
| Rate for Payer: First Health Commercial |
$1,976.31
|
| Rate for Payer: Humana Commercial |
$1,768.28
|
| Rate for Payer: Humana KY Medicaid |
$715.43
|
| Rate for Payer: Kentucky WC Medicaid |
$722.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,705.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,830.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.43
|
| Rate for Payer: PHCS Commercial |
$1,997.12
|
| Rate for Payer: United Healthcare All Payer |
$1,830.69
|
|
|
PLATE BROAD 4.5*141 7H
|
Facility
|
IP
|
$2,080.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$1,997.12 |
| Rate for Payer: Aetna Commercial |
$1,601.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,622.66
|
| Rate for Payer: Cash Price |
$1,040.16
|
| Rate for Payer: Cigna Commercial |
$1,726.67
|
| Rate for Payer: First Health Commercial |
$1,976.31
|
| Rate for Payer: Humana Commercial |
$1,768.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,705.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,830.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.43
|
| Rate for Payer: PHCS Commercial |
$1,997.12
|
| Rate for Payer: United Healthcare All Payer |
$1,830.69
|
|
|
PLATE BROAD 4.5*159 8H
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5*159 8H
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5*177 9H
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5*177 9H
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5*195 10H
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5*195 10H
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5*213 11H
|
Facility
|
OP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem Medicaid |
$1,043.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Humana KY Medicaid |
$1,043.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5*213 11H
|
Facility
|
IP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5*231 12H
|
Facility
|
IP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
