|
PLATE DHS 145*6H 110MM
|
Facility
|
IP
|
$3,305.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$991.50 |
| Max. Negotiated Rate |
$3,172.80 |
| Rate for Payer: Aetna Commercial |
$2,544.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,577.90
|
| Rate for Payer: Cash Price |
$1,652.50
|
| Rate for Payer: Cigna Commercial |
$2,743.15
|
| Rate for Payer: First Health Commercial |
$3,139.75
|
| Rate for Payer: Humana Commercial |
$2,809.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,710.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,439.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$991.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,908.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,478.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,644.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,875.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.45
|
| Rate for Payer: PHCS Commercial |
$3,172.80
|
| Rate for Payer: United Healthcare All Payer |
$2,908.40
|
|
|
PLATE DI RY 1&2 RT LG
|
Facility
|
IP
|
$9,022.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,706.75 |
| Max. Negotiated Rate |
$8,661.60 |
| Rate for Payer: Aetna Commercial |
$6,947.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,037.55
|
| Rate for Payer: Cash Price |
$4,511.25
|
| Rate for Payer: Cigna Commercial |
$7,488.68
|
| Rate for Payer: First Health Commercial |
$8,571.38
|
| Rate for Payer: Humana Commercial |
$7,669.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,398.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,658.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,706.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,939.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,766.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,849.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,225.52
|
| Rate for Payer: PHCS Commercial |
$8,661.60
|
| Rate for Payer: United Healthcare All Payer |
$7,939.80
|
|
|
PLATE DI RY 1&2 RT LG
|
Facility
|
OP
|
$9,022.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,706.75 |
| Max. Negotiated Rate |
$8,661.60 |
| Rate for Payer: Aetna Commercial |
$6,947.32
|
| Rate for Payer: Anthem Medicaid |
$3,102.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,037.55
|
| Rate for Payer: Cash Price |
$4,511.25
|
| Rate for Payer: Cigna Commercial |
$7,488.68
|
| Rate for Payer: First Health Commercial |
$8,571.38
|
| Rate for Payer: Humana Commercial |
$7,669.12
|
| Rate for Payer: Humana KY Medicaid |
$3,102.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,134.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,398.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,658.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,706.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,165.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,939.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,766.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,218.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,849.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,225.52
|
| Rate for Payer: PHCS Commercial |
$8,661.60
|
| Rate for Payer: United Healthcare All Payer |
$7,939.80
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H L
|
Facility
|
OP
|
$4,238.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.69 |
| Max. Negotiated Rate |
$4,069.42 |
| Rate for Payer: Aetna Commercial |
$3,264.01
|
| Rate for Payer: Anthem Medicaid |
$1,457.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,306.40
|
| Rate for Payer: Cash Price |
$2,119.49
|
| Rate for Payer: Cigna Commercial |
$3,518.35
|
| Rate for Payer: First Health Commercial |
$4,027.03
|
| Rate for Payer: Humana Commercial |
$3,603.13
|
| Rate for Payer: Humana KY Medicaid |
$1,457.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,472.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,475.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,128.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,487.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,730.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,179.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,391.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,687.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,924.90
|
| Rate for Payer: PHCS Commercial |
$4,069.42
|
| Rate for Payer: United Healthcare All Payer |
$3,730.30
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H L
|
Facility
|
IP
|
$4,238.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.69 |
| Max. Negotiated Rate |
$4,069.42 |
| Rate for Payer: Aetna Commercial |
$3,264.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,306.40
|
| Rate for Payer: Cash Price |
$2,119.49
|
| Rate for Payer: Cigna Commercial |
$3,518.35
|
| Rate for Payer: First Health Commercial |
$4,027.03
|
| Rate for Payer: Humana Commercial |
$3,603.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,475.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,128.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,730.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,179.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,391.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,687.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,924.90
|
| Rate for Payer: PHCS Commercial |
$4,069.42
|
| Rate for Payer: United Healthcare All Payer |
$3,730.30
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H R
|
Facility
|
IP
|
$4,238.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.69 |
| Max. Negotiated Rate |
$4,069.42 |
| Rate for Payer: Aetna Commercial |
$3,264.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,306.40
|
| Rate for Payer: Cash Price |
$2,119.49
|
| Rate for Payer: Cigna Commercial |
$3,518.35
|
| Rate for Payer: First Health Commercial |
$4,027.03
|
| Rate for Payer: Humana Commercial |
$3,603.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,475.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,128.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,730.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,179.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,391.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,687.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,924.90
|
| Rate for Payer: PHCS Commercial |
$4,069.42
|
| Rate for Payer: United Healthcare All Payer |
$3,730.30
|
|
|
PLATE DIS FIB 2.7/3.5*103 5H R
|
Facility
|
OP
|
$4,238.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,271.69 |
| Max. Negotiated Rate |
$4,069.42 |
| Rate for Payer: Aetna Commercial |
$3,264.01
|
| Rate for Payer: Anthem Medicaid |
$1,457.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,306.40
|
| Rate for Payer: Cash Price |
$2,119.49
|
| Rate for Payer: Cigna Commercial |
$3,518.35
|
| Rate for Payer: First Health Commercial |
$4,027.03
|
| Rate for Payer: Humana Commercial |
$3,603.13
|
| Rate for Payer: Humana KY Medicaid |
$1,457.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,472.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,475.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,128.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,271.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,487.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,730.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,179.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,391.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,687.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,924.90
|
| Rate for Payer: PHCS Commercial |
$4,069.42
|
| Rate for Payer: United Healthcare All Payer |
$3,730.30
|
|
|
PLATE DIS FIB 2.7/3.5*112 6H R
|
Facility
|
OP
|
$4,481.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.38 |
| Max. Negotiated Rate |
$4,302.01 |
| Rate for Payer: Aetna Commercial |
$3,450.57
|
| Rate for Payer: Aetna Commercial |
$3,626.42
|
| Rate for Payer: Anthem Medicaid |
$1,541.11
|
| Rate for Payer: Anthem Medicaid |
$1,619.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.52
|
| Rate for Payer: Cash Price |
$2,240.63
|
| Rate for Payer: Cash Price |
$2,354.82
|
| Rate for Payer: Cigna Commercial |
$3,909.00
|
| Rate for Payer: Cigna Commercial |
$3,719.45
|
| Rate for Payer: First Health Commercial |
$4,474.16
|
| Rate for Payer: First Health Commercial |
$4,257.20
|
| Rate for Payer: Humana Commercial |
$3,809.07
|
| Rate for Payer: Humana Commercial |
$4,003.19
|
| Rate for Payer: Humana KY Medicaid |
$1,541.11
|
| Rate for Payer: Humana KY Medicaid |
$1,619.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,556.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,360.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,585.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,767.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,898.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,097.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,092.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,249.65
|
| Rate for Payer: PHCS Commercial |
$4,521.25
|
| Rate for Payer: PHCS Commercial |
$4,302.01
|
| Rate for Payer: United Healthcare All Payer |
$4,144.48
|
| Rate for Payer: United Healthcare All Payer |
$3,943.51
|
|
|
PLATE DIS FIB 2.7/3.5*112 6H R
|
Facility
|
IP
|
$4,481.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,344.38 |
| Max. Negotiated Rate |
$4,302.01 |
| Rate for Payer: Aetna Commercial |
$3,450.57
|
| Rate for Payer: Aetna Commercial |
$3,626.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.52
|
| Rate for Payer: Cash Price |
$2,240.63
|
| Rate for Payer: Cash Price |
$2,354.82
|
| Rate for Payer: Cigna Commercial |
$3,719.45
|
| Rate for Payer: Cigna Commercial |
$3,909.00
|
| Rate for Payer: First Health Commercial |
$4,474.16
|
| Rate for Payer: First Health Commercial |
$4,257.20
|
| Rate for Payer: Humana Commercial |
$4,003.19
|
| Rate for Payer: Humana Commercial |
$3,809.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,360.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,585.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,767.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,898.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,097.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,249.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,092.07
|
| Rate for Payer: PHCS Commercial |
$4,302.01
|
| Rate for Payer: PHCS Commercial |
$4,521.25
|
| Rate for Payer: United Healthcare All Payer |
$3,943.51
|
| Rate for Payer: United Healthcare All Payer |
$4,144.48
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H L
|
Facility
|
IP
|
$4,272.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.65 |
| Max. Negotiated Rate |
$4,101.27 |
| Rate for Payer: Aetna Commercial |
$3,289.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.28
|
| Rate for Payer: Cash Price |
$2,136.08
|
| Rate for Payer: Cigna Commercial |
$3,545.89
|
| Rate for Payer: First Health Commercial |
$4,058.55
|
| Rate for Payer: Humana Commercial |
$3,631.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,204.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,417.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,716.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,947.79
|
| Rate for Payer: PHCS Commercial |
$4,101.27
|
| Rate for Payer: United Healthcare All Payer |
$3,759.50
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H L
|
Facility
|
OP
|
$4,272.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.65 |
| Max. Negotiated Rate |
$4,101.27 |
| Rate for Payer: Aetna Commercial |
$3,289.56
|
| Rate for Payer: Anthem Medicaid |
$1,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.28
|
| Rate for Payer: Cash Price |
$2,136.08
|
| Rate for Payer: Cigna Commercial |
$3,545.89
|
| Rate for Payer: First Health Commercial |
$4,058.55
|
| Rate for Payer: Humana Commercial |
$3,631.34
|
| Rate for Payer: Humana KY Medicaid |
$1,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,498.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,204.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,417.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,716.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,947.79
|
| Rate for Payer: PHCS Commercial |
$4,101.27
|
| Rate for Payer: United Healthcare All Payer |
$3,759.50
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H R
|
Facility
|
IP
|
$4,272.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.65 |
| Max. Negotiated Rate |
$4,101.27 |
| Rate for Payer: Aetna Commercial |
$3,289.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.28
|
| Rate for Payer: Cash Price |
$2,136.08
|
| Rate for Payer: Cigna Commercial |
$3,545.89
|
| Rate for Payer: First Health Commercial |
$4,058.55
|
| Rate for Payer: Humana Commercial |
$3,631.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,204.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,417.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,716.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,947.79
|
| Rate for Payer: PHCS Commercial |
$4,101.27
|
| Rate for Payer: United Healthcare All Payer |
$3,759.50
|
|
|
PLATE DIS FIB 2.7/3.5*116 6H R
|
Facility
|
OP
|
$4,272.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,281.65 |
| Max. Negotiated Rate |
$4,101.27 |
| Rate for Payer: Aetna Commercial |
$3,289.56
|
| Rate for Payer: Anthem Medicaid |
$1,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,332.28
|
| Rate for Payer: Cash Price |
$2,136.08
|
| Rate for Payer: Cigna Commercial |
$3,545.89
|
| Rate for Payer: First Health Commercial |
$4,058.55
|
| Rate for Payer: Humana Commercial |
$3,631.34
|
| Rate for Payer: Humana KY Medicaid |
$1,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,484.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,503.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,152.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,281.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,498.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,759.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,204.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,417.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,716.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,947.79
|
| Rate for Payer: PHCS Commercial |
$4,101.27
|
| Rate for Payer: United Healthcare All Payer |
$3,759.50
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H L
|
Facility
|
OP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem Medicaid |
$1,633.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Humana KY Medicaid |
$1,633.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H L
|
Facility
|
IP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H R
|
Facility
|
IP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*125 7H R
|
Facility
|
OP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem Medicaid |
$1,633.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Humana KY Medicaid |
$1,633.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*129 7H L
|
Facility
|
IP
|
$4,305.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.59 |
| Max. Negotiated Rate |
$4,133.10 |
| Rate for Payer: Aetna Commercial |
$3,315.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,358.14
|
| Rate for Payer: Cash Price |
$2,152.66
|
| Rate for Payer: Cigna Commercial |
$3,573.41
|
| Rate for Payer: First Health Commercial |
$4,090.04
|
| Rate for Payer: Humana Commercial |
$3,659.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,530.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,177.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,788.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,444.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,745.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,970.66
|
| Rate for Payer: PHCS Commercial |
$4,133.10
|
| Rate for Payer: United Healthcare All Payer |
$3,788.67
|
|
|
PLATE DIS FIB 2.7/3.5*129 7H L
|
Facility
|
OP
|
$4,305.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,291.59 |
| Max. Negotiated Rate |
$4,133.10 |
| Rate for Payer: Aetna Commercial |
$3,315.09
|
| Rate for Payer: Anthem Medicaid |
$1,480.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,358.14
|
| Rate for Payer: Cash Price |
$2,152.66
|
| Rate for Payer: Cigna Commercial |
$3,573.41
|
| Rate for Payer: First Health Commercial |
$4,090.04
|
| Rate for Payer: Humana Commercial |
$3,659.51
|
| Rate for Payer: Humana KY Medicaid |
$1,480.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,530.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,177.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,510.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,788.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,444.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,745.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,970.66
|
| Rate for Payer: PHCS Commercial |
$4,133.10
|
| Rate for Payer: United Healthcare All Payer |
$3,788.67
|
|
|
PLATE DIS FIB 2.7/3.5*129 7H R
|
Facility
|
OP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem Medicaid |
$1,633.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Humana KY Medicaid |
$1,633.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*129 7H R
|
Facility
|
IP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*151 9H L
|
Facility
|
OP
|
$4,788.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.60 |
| Max. Negotiated Rate |
$4,597.10 |
| Rate for Payer: Aetna Commercial |
$3,687.26
|
| Rate for Payer: Anthem Medicaid |
$1,646.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,735.15
|
| Rate for Payer: Cash Price |
$2,394.32
|
| Rate for Payer: Cigna Commercial |
$3,974.58
|
| Rate for Payer: First Health Commercial |
$4,549.22
|
| Rate for Payer: Humana Commercial |
$4,070.35
|
| Rate for Payer: Humana KY Medicaid |
$1,646.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,663.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,926.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,534.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,436.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,679.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,214.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,591.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,830.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,166.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,304.17
|
| Rate for Payer: PHCS Commercial |
$4,597.10
|
| Rate for Payer: United Healthcare All Payer |
$4,214.01
|
|
|
PLATE DIS FIB 2.7/3.5*151 9H L
|
Facility
|
IP
|
$4,788.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.60 |
| Max. Negotiated Rate |
$4,597.10 |
| Rate for Payer: Aetna Commercial |
$3,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,735.15
|
| Rate for Payer: Cash Price |
$2,394.32
|
| Rate for Payer: Cigna Commercial |
$3,974.58
|
| Rate for Payer: First Health Commercial |
$4,549.22
|
| Rate for Payer: Humana Commercial |
$4,070.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,926.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,534.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,436.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,214.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,591.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,830.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,166.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,304.17
|
| Rate for Payer: PHCS Commercial |
$4,597.10
|
| Rate for Payer: United Healthcare All Payer |
$4,214.01
|
|
|
PLATE DIS FIB 2.7/3.5*151 9H R
|
Facility
|
OP
|
$4,788.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.60 |
| Max. Negotiated Rate |
$4,597.10 |
| Rate for Payer: Aetna Commercial |
$3,687.26
|
| Rate for Payer: Anthem Medicaid |
$1,646.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,735.15
|
| Rate for Payer: Cash Price |
$2,394.32
|
| Rate for Payer: Cigna Commercial |
$3,974.58
|
| Rate for Payer: First Health Commercial |
$4,549.22
|
| Rate for Payer: Humana Commercial |
$4,070.35
|
| Rate for Payer: Humana KY Medicaid |
$1,646.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,663.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,926.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,534.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,436.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,679.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,214.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,591.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,830.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,166.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,304.17
|
| Rate for Payer: PHCS Commercial |
$4,597.10
|
| Rate for Payer: United Healthcare All Payer |
$4,214.01
|
|
|
PLATE DIS FIB 2.7/3.5*151 9H R
|
Facility
|
IP
|
$4,788.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,436.60 |
| Max. Negotiated Rate |
$4,597.10 |
| Rate for Payer: Aetna Commercial |
$3,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,735.15
|
| Rate for Payer: Cash Price |
$2,394.32
|
| Rate for Payer: Cigna Commercial |
$3,974.58
|
| Rate for Payer: First Health Commercial |
$4,549.22
|
| Rate for Payer: Humana Commercial |
$4,070.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,926.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,534.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,436.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,214.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,591.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,830.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,166.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,304.17
|
| Rate for Payer: PHCS Commercial |
$4,597.10
|
| Rate for Payer: United Healthcare All Payer |
$4,214.01
|
|
