|
PLATE LK HUM PLD 5H 80MM 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 LK HUM PLD 5H 80MM 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: 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
|
| Rate for Payer: Aetna Commercial |
$5,228.86
|
|
|
PLATE LK HUM PLD 5H 80MM 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 LK HUM PLD 7H 107MM 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 LK HUM PLD 7H 107MM 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 LK HUM PLD 7H 107MM 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 LK HUM PLD 7H 107MM 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 LK HUM PLD 9H 132MM 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 LK HUM PLD 9H 132MM 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 LK HUM PLD 9H 132MM 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 LK HUM PLD 9H 132MM 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 LK LAT DIST FIB 3.5 9H R
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LK LAT DIST FIB 3.5 9H R
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LK LAT DST FIB 3.5 11H L
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LK LAT DST FIB 3.5 11H L
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LK LAT DST FIB 3.5 11H R
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LK LAT DST FIB 3.5 11H R
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
|
|
PLATE LK MD CLAV SUP 6H 73M L
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK MD CLAV SUP 6H 73M L
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK MD CLAV SUP 6H 73M R
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK MD CLAV SUP 6H 73M R
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK MD CLAV SUP 7H 85M L
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK MD CLAV SUP 7H 85M L
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK MD CLAV SUP 7H 85M R
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE LK MD CLAV SUP 7H 85M R
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
|
