|
PLATE LAT DIS HM LK 9H 128M L
|
Facility
|
OP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem Medicaid |
$2,595.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Humana KY Medicaid |
$2,595.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,647.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
|
PLATE LAT DIS HM LK 9H 128M R
|
Facility
|
IP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
|
PLATE LAT DIS HM LK 9H 128M R
|
Facility
|
OP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Humana KY Medicaid |
$2,595.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,647.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem Medicaid |
$2,595.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
|
|
PLATE LAT DIST HM LK 5H 77M L
|
Facility
|
OP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem Medicaid |
$2,335.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Humana KY Medicaid |
$2,335.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,382.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE LAT DIST HM LK 5H 77M L
|
Facility
|
IP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE LAT DIST HM LK 7H 102M L
|
Facility
|
OP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem Medicaid |
$2,472.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Humana KY Medicaid |
$2,472.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DIST HM LK 7H 102M L
|
Facility
|
IP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DIST HM LK 9H 128M L
|
Facility
|
OP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem Medicaid |
$2,595.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Humana KY Medicaid |
$2,595.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,647.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
|
PLATE LAT DIST HM LK 9H 128M L
|
Facility
|
IP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
|
PLATE LAT DIST HUM LK 5 77MM R
|
Facility
|
IP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE LAT DIST HUM LK 5 77MM R
|
Facility
|
OP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem Medicaid |
$2,335.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Humana KY Medicaid |
$2,335.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,382.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE LAT DST HM LK 11H 153M L
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE LAT DST HM LK 11H 153M L
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE LAT DST HUM LK 7 102M R
|
Facility
|
IP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DST HUM LK 7 102M R
|
Facility
|
OP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem Medicaid |
$2,472.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Humana KY Medicaid |
$2,472.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DST HUM LK 9 128M R
|
Facility
|
IP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
|
PLATE LAT DST HUM LK 9 128M R
|
Facility
|
OP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem Medicaid |
$2,595.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Humana KY Medicaid |
$2,595.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,647.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
|
PLATE LATERAL ANT CLAVICLE 6H
|
Facility
|
IP
|
$7,183.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.87 |
| Max. Negotiated Rate |
$6,896.30 |
| Rate for Payer: Aetna Commercial |
$5,531.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.25
|
| Rate for Payer: Cash Price |
$3,591.82
|
| Rate for Payer: Cigna Commercial |
$5,962.43
|
| Rate for Payer: First Health Commercial |
$6,824.47
|
| Rate for Payer: Humana Commercial |
$6,106.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.93
|
| Rate for Payer: PHCS Commercial |
$6,896.30
|
| Rate for Payer: United Healthcare All Payer |
$6,321.61
|
|
|
PLATE LATERAL ANT CLAVICLE 6H
|
Facility
|
OP
|
$7,183.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.87 |
| Max. Negotiated Rate |
$6,896.30 |
| Rate for Payer: Aetna Commercial |
$5,531.41
|
| Rate for Payer: Anthem Medicaid |
$2,470.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.25
|
| Rate for Payer: Cash Price |
$3,591.82
|
| Rate for Payer: Cigna Commercial |
$5,962.43
|
| Rate for Payer: First Health Commercial |
$6,824.47
|
| Rate for Payer: Humana Commercial |
$6,106.10
|
| Rate for Payer: Humana KY Medicaid |
$2,470.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,495.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,520.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.93
|
| Rate for Payer: PHCS Commercial |
$6,896.30
|
| Rate for Payer: United Healthcare All Payer |
$6,321.61
|
|
|
PLATE LATERAL ANT CLAVICLE 8H
|
Facility
|
IP
|
$5,567.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.71 |
| Max. Negotiated Rate |
$5,344.32 |
| Rate for Payer: Aetna Commercial |
$4,286.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.26
|
| Rate for Payer: Cash Price |
$2,783.50
|
| Rate for Payer: Cigna Commercial |
$4,620.61
|
| Rate for Payer: First Health Commercial |
$5,288.65
|
| Rate for Payer: Humana Commercial |
$4,731.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,564.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,898.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.77
|
| Rate for Payer: PHCS Commercial |
$5,344.32
|
| Rate for Payer: United Healthcare All Payer |
$4,898.96
|
|
|
PLATE LATERAL ANT CLAVICLE 8H
|
Facility
|
OP
|
$5,567.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.71 |
| Max. Negotiated Rate |
$5,344.32 |
| Rate for Payer: Anthem Medicaid |
$1,914.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,342.26
|
| Rate for Payer: Cash Price |
$2,783.50
|
| Rate for Payer: Cigna Commercial |
$4,620.61
|
| Rate for Payer: First Health Commercial |
$5,288.65
|
| Rate for Payer: Humana Commercial |
$4,731.95
|
| Rate for Payer: Humana KY Medicaid |
$1,914.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,933.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,564.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,108.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,670.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,952.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,898.96
|
| Rate for Payer: Ohio Health Group HMO |
$4,175.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,113.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$723.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,725.77
|
| Rate for Payer: PHCS Commercial |
$5,344.32
|
| Rate for Payer: United Healthcare All Payer |
$4,898.96
|
| Rate for Payer: Aetna Commercial |
$4,286.59
|
|
|
PLATE LATERAL FIBULA 4H L
|
Facility
|
OP
|
$4,748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.24 |
| Max. Negotiated Rate |
$4,558.08 |
| Rate for Payer: Aetna Commercial |
$3,655.96
|
| Rate for Payer: Anthem Medicaid |
$1,632.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,703.44
|
| Rate for Payer: Cash Price |
$2,374.00
|
| Rate for Payer: Cigna Commercial |
$3,940.84
|
| Rate for Payer: First Health Commercial |
$4,510.60
|
| Rate for Payer: Humana Commercial |
$4,035.80
|
| Rate for Payer: Humana KY Medicaid |
$1,632.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,893.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,178.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.88
|
| Rate for Payer: PHCS Commercial |
$4,558.08
|
| Rate for Payer: United Healthcare All Payer |
$4,178.24
|
|
|
PLATE LATERAL FIBULA 4H L
|
Facility
|
IP
|
$4,748.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.24 |
| Max. Negotiated Rate |
$4,558.08 |
| Rate for Payer: Aetna Commercial |
$3,655.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,703.44
|
| Rate for Payer: Cash Price |
$2,374.00
|
| Rate for Payer: Cigna Commercial |
$3,940.84
|
| Rate for Payer: First Health Commercial |
$4,510.60
|
| Rate for Payer: Humana Commercial |
$4,035.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,893.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,178.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,471.88
|
| Rate for Payer: PHCS Commercial |
$4,558.08
|
| Rate for Payer: United Healthcare All Payer |
$4,178.24
|
|
|
PLATE LATERAL FIBULA 4H R
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE LATERAL FIBULA 4H R
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
