|
PLATE DIS FIB 2.7/3.5*155 9H L
|
Facility
|
IP
|
$4,338.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.55 |
| Max. Negotiated Rate |
$4,164.96 |
| Rate for Payer: Aetna Commercial |
$3,340.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,384.03
|
| Rate for Payer: Cash Price |
$2,169.25
|
| Rate for Payer: Cigna Commercial |
$3,600.95
|
| Rate for Payer: First Health Commercial |
$4,121.57
|
| Rate for Payer: Humana Commercial |
$3,687.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.57
|
| Rate for Payer: PHCS Commercial |
$4,164.96
|
| Rate for Payer: United Healthcare All Payer |
$3,817.88
|
|
|
PLATE DIS FIB 2.7/3.5*155 9H L
|
Facility
|
OP
|
$4,338.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.55 |
| Max. Negotiated Rate |
$4,164.96 |
| Rate for Payer: Aetna Commercial |
$3,340.64
|
| Rate for Payer: Anthem Medicaid |
$1,492.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,384.03
|
| Rate for Payer: Cash Price |
$2,169.25
|
| Rate for Payer: Cigna Commercial |
$3,600.95
|
| Rate for Payer: First Health Commercial |
$4,121.57
|
| Rate for Payer: Humana Commercial |
$3,687.72
|
| Rate for Payer: Humana KY Medicaid |
$1,492.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,521.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.57
|
| Rate for Payer: PHCS Commercial |
$4,164.96
|
| Rate for Payer: United Healthcare All Payer |
$3,817.88
|
|
|
PLATE DIS FIB 2.7/3.5*155 9H R
|
Facility
|
OP
|
$4,338.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.55 |
| Max. Negotiated Rate |
$4,164.96 |
| Rate for Payer: Aetna Commercial |
$3,340.64
|
| Rate for Payer: Anthem Medicaid |
$1,492.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,384.03
|
| Rate for Payer: Cash Price |
$2,169.25
|
| Rate for Payer: Cigna Commercial |
$3,600.95
|
| Rate for Payer: First Health Commercial |
$4,121.57
|
| Rate for Payer: Humana Commercial |
$3,687.72
|
| Rate for Payer: Humana KY Medicaid |
$1,492.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,507.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,521.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.57
|
| Rate for Payer: PHCS Commercial |
$4,164.96
|
| Rate for Payer: United Healthcare All Payer |
$3,817.88
|
|
|
PLATE DIS FIB 2.7/3.5*155 9H R
|
Facility
|
IP
|
$4,338.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,301.55 |
| Max. Negotiated Rate |
$4,164.96 |
| Rate for Payer: Aetna Commercial |
$3,340.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,384.03
|
| Rate for Payer: Cash Price |
$2,169.25
|
| Rate for Payer: Cigna Commercial |
$3,600.95
|
| Rate for Payer: First Health Commercial |
$4,121.57
|
| Rate for Payer: Humana Commercial |
$3,687.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,557.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,201.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,817.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,470.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,774.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,993.57
|
| Rate for Payer: PHCS Commercial |
$4,164.96
|
| Rate for Payer: United Healthcare All Payer |
$3,817.88
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HL
|
Facility
|
IP
|
$4,371.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.49 |
| Max. Negotiated Rate |
$4,196.78 |
| Rate for Payer: Aetna Commercial |
$3,366.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.89
|
| Rate for Payer: Cash Price |
$2,185.82
|
| Rate for Payer: Cigna Commercial |
$3,628.47
|
| Rate for Payer: First Health Commercial |
$4,153.07
|
| Rate for Payer: Humana Commercial |
$3,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.44
|
| Rate for Payer: PHCS Commercial |
$4,196.78
|
| Rate for Payer: United Healthcare All Payer |
$3,847.05
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HL
|
Facility
|
OP
|
$4,371.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.49 |
| Max. Negotiated Rate |
$4,196.78 |
| Rate for Payer: Aetna Commercial |
$3,366.17
|
| Rate for Payer: Anthem Medicaid |
$1,503.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.89
|
| Rate for Payer: Cash Price |
$2,185.82
|
| Rate for Payer: Cigna Commercial |
$3,628.47
|
| Rate for Payer: First Health Commercial |
$4,153.07
|
| Rate for Payer: Humana Commercial |
$3,715.90
|
| Rate for Payer: Humana KY Medicaid |
$1,503.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.44
|
| Rate for Payer: PHCS Commercial |
$4,196.78
|
| Rate for Payer: United Healthcare All Payer |
$3,847.05
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HR
|
Facility
|
OP
|
$4,371.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.45 |
| Max. Negotiated Rate |
$4,196.64 |
| Rate for Payer: Aetna Commercial |
$3,366.05
|
| Rate for Payer: Anthem Medicaid |
$1,503.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.77
|
| Rate for Payer: Cash Price |
$2,185.75
|
| Rate for Payer: Cigna Commercial |
$3,628.34
|
| Rate for Payer: First Health Commercial |
$4,152.93
|
| Rate for Payer: Humana Commercial |
$3,715.78
|
| Rate for Payer: Humana KY Medicaid |
$1,503.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,846.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.34
|
| Rate for Payer: PHCS Commercial |
$4,196.64
|
| Rate for Payer: United Healthcare All Payer |
$3,846.92
|
|
|
PLATE DIS FIB 2.7/3.5*177 11HR
|
Facility
|
IP
|
$4,371.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.45 |
| Max. Negotiated Rate |
$4,196.64 |
| Rate for Payer: Aetna Commercial |
$3,366.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.77
|
| Rate for Payer: Cash Price |
$2,185.75
|
| Rate for Payer: Cigna Commercial |
$3,628.34
|
| Rate for Payer: First Health Commercial |
$4,152.93
|
| Rate for Payer: Humana Commercial |
$3,715.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,846.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.34
|
| Rate for Payer: PHCS Commercial |
$4,196.64
|
| Rate for Payer: United Healthcare All Payer |
$3,846.92
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HL
|
Facility
|
IP
|
$4,371.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.49 |
| Max. Negotiated Rate |
$4,196.78 |
| Rate for Payer: Aetna Commercial |
$3,366.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.89
|
| Rate for Payer: Cash Price |
$2,185.82
|
| Rate for Payer: Cigna Commercial |
$3,628.47
|
| Rate for Payer: First Health Commercial |
$4,153.07
|
| Rate for Payer: Humana Commercial |
$3,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.44
|
| Rate for Payer: PHCS Commercial |
$4,196.78
|
| Rate for Payer: United Healthcare All Payer |
$3,847.05
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HL
|
Facility
|
OP
|
$4,371.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.49 |
| Max. Negotiated Rate |
$4,196.78 |
| Rate for Payer: Aetna Commercial |
$3,366.17
|
| Rate for Payer: Anthem Medicaid |
$1,503.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.89
|
| Rate for Payer: Cash Price |
$2,185.82
|
| Rate for Payer: Cigna Commercial |
$3,628.47
|
| Rate for Payer: First Health Commercial |
$4,153.07
|
| Rate for Payer: Humana Commercial |
$3,715.90
|
| Rate for Payer: Humana KY Medicaid |
$1,503.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.44
|
| Rate for Payer: PHCS Commercial |
$4,196.78
|
| Rate for Payer: United Healthcare All Payer |
$3,847.05
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HR
|
Facility
|
IP
|
$4,371.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.49 |
| Max. Negotiated Rate |
$4,196.78 |
| Rate for Payer: Aetna Commercial |
$3,366.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.89
|
| Rate for Payer: Cash Price |
$2,185.82
|
| Rate for Payer: Cigna Commercial |
$3,628.47
|
| Rate for Payer: First Health Commercial |
$4,153.07
|
| Rate for Payer: Humana Commercial |
$3,715.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.44
|
| Rate for Payer: PHCS Commercial |
$4,196.78
|
| Rate for Payer: United Healthcare All Payer |
$3,847.05
|
|
|
PLATE DIS FIB 2.7/3.5*181 11HR
|
Facility
|
OP
|
$4,371.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.49 |
| Max. Negotiated Rate |
$4,196.78 |
| Rate for Payer: Aetna Commercial |
$3,366.17
|
| Rate for Payer: Anthem Medicaid |
$1,503.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,409.89
|
| Rate for Payer: Cash Price |
$2,185.82
|
| Rate for Payer: Cigna Commercial |
$3,628.47
|
| Rate for Payer: First Health Commercial |
$4,153.07
|
| Rate for Payer: Humana Commercial |
$3,715.90
|
| Rate for Payer: Humana KY Medicaid |
$1,503.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,584.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,278.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,497.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,803.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,016.44
|
| Rate for Payer: PHCS Commercial |
$4,196.78
|
| Rate for Payer: United Healthcare All Payer |
$3,847.05
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H L
|
Facility
|
IP
|
$4,372.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.77 |
| Max. Negotiated Rate |
$4,197.65 |
| Rate for Payer: Aetna Commercial |
$3,366.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,410.59
|
| Rate for Payer: Cash Price |
$2,186.28
|
| Rate for Payer: Cigna Commercial |
$3,629.22
|
| Rate for Payer: First Health Commercial |
$4,153.92
|
| Rate for Payer: Humana Commercial |
$3,716.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,585.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,279.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,498.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,804.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.06
|
| Rate for Payer: PHCS Commercial |
$4,197.65
|
| Rate for Payer: United Healthcare All Payer |
$3,847.84
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H L
|
Facility
|
OP
|
$4,372.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,311.77 |
| Max. Negotiated Rate |
$4,197.65 |
| Rate for Payer: Aetna Commercial |
$3,366.86
|
| Rate for Payer: Anthem Medicaid |
$1,503.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,410.59
|
| Rate for Payer: Cash Price |
$2,186.28
|
| Rate for Payer: Cigna Commercial |
$3,629.22
|
| Rate for Payer: First Health Commercial |
$4,153.92
|
| Rate for Payer: Humana Commercial |
$3,716.67
|
| Rate for Payer: Humana KY Medicaid |
$1,503.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,519.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,585.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,226.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,847.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,279.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,498.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,804.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,017.06
|
| Rate for Payer: PHCS Commercial |
$4,197.65
|
| Rate for Payer: United Healthcare All Payer |
$3,847.84
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H R
|
Facility
|
IP
|
$4,172.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.79 |
| Max. Negotiated Rate |
$4,005.73 |
| Rate for Payer: Aetna Commercial |
$3,212.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.66
|
| Rate for Payer: Cash Price |
$2,086.32
|
| Rate for Payer: Cigna Commercial |
$3,463.29
|
| Rate for Payer: First Health Commercial |
$3,964.01
|
| Rate for Payer: Humana Commercial |
$3,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,251.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,671.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,338.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.12
|
| Rate for Payer: PHCS Commercial |
$4,005.73
|
| Rate for Payer: United Healthcare All Payer |
$3,671.92
|
|
|
PLATE DIS FIB 2.7/3.5*73 3H R
|
Facility
|
OP
|
$4,172.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.79 |
| Max. Negotiated Rate |
$4,005.73 |
| Rate for Payer: Aetna Commercial |
$3,212.93
|
| Rate for Payer: Anthem Medicaid |
$1,434.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.66
|
| Rate for Payer: Cash Price |
$2,086.32
|
| Rate for Payer: Cigna Commercial |
$3,463.29
|
| Rate for Payer: First Health Commercial |
$3,964.01
|
| Rate for Payer: Humana Commercial |
$3,546.74
|
| Rate for Payer: Humana KY Medicaid |
$1,434.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,449.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,251.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,463.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,671.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,338.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.12
|
| Rate for Payer: PHCS Commercial |
$4,005.73
|
| Rate for Payer: United Healthcare All Payer |
$3,671.92
|
|
|
PLATE DIS FIB 2.7/3.5* 77 3H L
|
Facility
|
IP
|
$4,172.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.79 |
| Max. Negotiated Rate |
$4,005.73 |
| Rate for Payer: Aetna Commercial |
$3,212.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.66
|
| Rate for Payer: Cash Price |
$2,086.32
|
| Rate for Payer: Cigna Commercial |
$3,463.29
|
| Rate for Payer: First Health Commercial |
$3,964.01
|
| Rate for Payer: Humana Commercial |
$3,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,251.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,671.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,338.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.12
|
| Rate for Payer: PHCS Commercial |
$4,005.73
|
| Rate for Payer: United Healthcare All Payer |
$3,671.92
|
|
|
PLATE DIS FIB 2.7/3.5* 77 3H L
|
Facility
|
OP
|
$4,172.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.79 |
| Max. Negotiated Rate |
$4,005.73 |
| Rate for Payer: Aetna Commercial |
$3,212.93
|
| Rate for Payer: Anthem Medicaid |
$1,434.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.66
|
| Rate for Payer: Cash Price |
$2,086.32
|
| Rate for Payer: Cigna Commercial |
$3,463.29
|
| Rate for Payer: First Health Commercial |
$3,964.01
|
| Rate for Payer: Humana Commercial |
$3,546.74
|
| Rate for Payer: Humana KY Medicaid |
$1,434.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,449.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,251.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,463.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,671.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,338.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.12
|
| Rate for Payer: PHCS Commercial |
$4,005.73
|
| Rate for Payer: United Healthcare All Payer |
$3,671.92
|
|
|
PLATE DIS FIB 2.7/3.5* 77 3H R
|
Facility
|
IP
|
$4,172.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.79 |
| Max. Negotiated Rate |
$4,005.73 |
| Rate for Payer: Aetna Commercial |
$3,212.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.66
|
| Rate for Payer: Cash Price |
$2,086.32
|
| Rate for Payer: Cigna Commercial |
$3,463.29
|
| Rate for Payer: First Health Commercial |
$3,964.01
|
| Rate for Payer: Humana Commercial |
$3,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,251.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,671.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,338.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.12
|
| Rate for Payer: PHCS Commercial |
$4,005.73
|
| Rate for Payer: United Healthcare All Payer |
$3,671.92
|
|
|
PLATE DIS FIB 2.7/3.5* 77 3H R
|
Facility
|
OP
|
$4,172.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,251.79 |
| Max. Negotiated Rate |
$4,005.73 |
| Rate for Payer: Aetna Commercial |
$3,212.93
|
| Rate for Payer: Anthem Medicaid |
$1,434.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,254.66
|
| Rate for Payer: Cash Price |
$2,086.32
|
| Rate for Payer: Cigna Commercial |
$3,463.29
|
| Rate for Payer: First Health Commercial |
$3,964.01
|
| Rate for Payer: Humana Commercial |
$3,546.74
|
| Rate for Payer: Humana KY Medicaid |
$1,434.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,449.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,421.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,079.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,251.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,463.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,671.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,129.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,338.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,630.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.12
|
| Rate for Payer: PHCS Commercial |
$4,005.73
|
| Rate for Payer: United Healthcare All Payer |
$3,671.92
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H L
|
Facility
|
OP
|
$4,630.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.15 |
| Max. Negotiated Rate |
$4,445.29 |
| Rate for Payer: Aetna Commercial |
$3,565.49
|
| Rate for Payer: Anthem Medicaid |
$1,592.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,611.80
|
| Rate for Payer: Cash Price |
$2,315.26
|
| Rate for Payer: Cigna Commercial |
$3,843.32
|
| Rate for Payer: First Health Commercial |
$4,398.98
|
| Rate for Payer: Humana Commercial |
$3,935.93
|
| Rate for Payer: Humana KY Medicaid |
$1,592.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,608.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,797.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,417.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,074.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,472.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,704.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,028.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,195.05
|
| Rate for Payer: PHCS Commercial |
$4,445.29
|
| Rate for Payer: United Healthcare All Payer |
$4,074.85
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H L
|
Facility
|
IP
|
$4,630.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.15 |
| Max. Negotiated Rate |
$4,445.29 |
| Rate for Payer: Aetna Commercial |
$3,565.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,611.80
|
| Rate for Payer: Cash Price |
$2,315.26
|
| Rate for Payer: Cigna Commercial |
$3,843.32
|
| Rate for Payer: First Health Commercial |
$4,398.98
|
| Rate for Payer: Humana Commercial |
$3,935.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,797.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,417.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,074.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,472.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,704.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,028.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,195.05
|
| Rate for Payer: PHCS Commercial |
$4,445.29
|
| Rate for Payer: United Healthcare All Payer |
$4,074.85
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H R
|
Facility
|
OP
|
$4,630.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.15 |
| Max. Negotiated Rate |
$4,445.29 |
| Rate for Payer: Aetna Commercial |
$3,565.49
|
| Rate for Payer: Anthem Medicaid |
$1,592.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,611.80
|
| Rate for Payer: Cash Price |
$2,315.26
|
| Rate for Payer: Cigna Commercial |
$3,843.32
|
| Rate for Payer: First Health Commercial |
$4,398.98
|
| Rate for Payer: Humana Commercial |
$3,935.93
|
| Rate for Payer: Humana KY Medicaid |
$1,592.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,608.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,797.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,417.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,074.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,472.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,704.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,028.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,195.05
|
| Rate for Payer: PHCS Commercial |
$4,445.29
|
| Rate for Payer: United Healthcare All Payer |
$4,074.85
|
|
|
PLATE DIS FIB 2.7/3.5*86 4H R
|
Facility
|
IP
|
$4,630.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.15 |
| Max. Negotiated Rate |
$4,445.29 |
| Rate for Payer: Aetna Commercial |
$3,565.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,611.80
|
| Rate for Payer: Cash Price |
$2,315.26
|
| Rate for Payer: Cigna Commercial |
$3,843.32
|
| Rate for Payer: First Health Commercial |
$4,398.98
|
| Rate for Payer: Humana Commercial |
$3,935.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,797.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,417.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,074.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,472.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,704.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,028.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,195.05
|
| Rate for Payer: PHCS Commercial |
$4,445.29
|
| Rate for Payer: United Healthcare All Payer |
$4,074.85
|
|
|
PLATE DIS FIB 2.7/3.5* 90 4H L
|
Facility
|
IP
|
$4,205.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.75 |
| Max. Negotiated Rate |
$4,037.59 |
| Rate for Payer: Aetna Commercial |
$3,238.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.54
|
| Rate for Payer: Cash Price |
$2,102.91
|
| Rate for Payer: Cigna Commercial |
$3,490.83
|
| Rate for Payer: First Health Commercial |
$3,995.53
|
| Rate for Payer: Humana Commercial |
$3,574.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.02
|
| Rate for Payer: PHCS Commercial |
$4,037.59
|
| Rate for Payer: United Healthcare All Payer |
$3,701.12
|
|
