|
PLATE MED DIST HUM LK 5 79MM L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE MED DIST HUM LK 5 79MM R
|
Facility
|
IP
|
$6,682.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.75 |
| Max. Negotiated Rate |
$6,415.38 |
| Rate for Payer: Aetna Commercial |
$5,145.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,212.50
|
| Rate for Payer: Cash Price |
$3,341.34
|
| Rate for Payer: Cigna Commercial |
$5,546.63
|
| Rate for Payer: First Health Commercial |
$6,348.56
|
| Rate for Payer: Humana Commercial |
$5,680.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,479.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,931.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,004.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,880.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,012.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,336.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,071.63
|
| Rate for Payer: PHCS Commercial |
$6,415.38
|
| Rate for Payer: United Healthcare All Payer |
$5,880.77
|
|
|
PLATE MED DIST HUM LK 5 79MM R
|
Facility
|
OP
|
$6,682.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.75 |
| Max. Negotiated Rate |
$6,415.38 |
| Rate for Payer: Aetna Commercial |
$5,145.67
|
| Rate for Payer: Anthem Medicaid |
$2,298.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,212.50
|
| Rate for Payer: Cash Price |
$3,341.34
|
| Rate for Payer: Cigna Commercial |
$5,546.63
|
| Rate for Payer: First Health Commercial |
$6,348.56
|
| Rate for Payer: Humana Commercial |
$5,680.29
|
| Rate for Payer: Humana KY Medicaid |
$2,298.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,321.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,479.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,931.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,004.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,344.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,880.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,012.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,336.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,071.63
|
| Rate for Payer: PHCS Commercial |
$6,415.38
|
| Rate for Payer: United Healthcare All Payer |
$5,880.77
|
|
|
PLATE MED DIST HUM LK 7 103M L
|
Facility
|
IP
|
$7,128.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.69 |
| Max. Negotiated Rate |
$6,843.22 |
| Rate for Payer: Aetna Commercial |
$5,488.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,560.11
|
| Rate for Payer: Cash Price |
$3,564.18
|
| Rate for Payer: Cigna Commercial |
$5,916.53
|
| Rate for Payer: First Health Commercial |
$6,771.93
|
| Rate for Payer: Humana Commercial |
$6,059.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,845.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,346.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.79
|
| Rate for Payer: PHCS Commercial |
$6,843.22
|
| Rate for Payer: United Healthcare All Payer |
$6,272.95
|
|
|
PLATE MED DIST HUM LK 7 103M L
|
Facility
|
OP
|
$7,128.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.69 |
| Max. Negotiated Rate |
$6,843.22 |
| Rate for Payer: Aetna Commercial |
$5,488.83
|
| Rate for Payer: Anthem Medicaid |
$2,451.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,560.11
|
| Rate for Payer: Cash Price |
$3,564.18
|
| Rate for Payer: Cigna Commercial |
$5,916.53
|
| Rate for Payer: First Health Commercial |
$6,771.93
|
| Rate for Payer: Humana Commercial |
$6,059.10
|
| Rate for Payer: Humana KY Medicaid |
$2,451.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,476.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,845.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,500.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,346.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.79
|
| Rate for Payer: PHCS Commercial |
$6,843.22
|
| Rate for Payer: United Healthcare All Payer |
$6,272.95
|
|
|
PLATE MED DIST HUM LK 7 103M R
|
Facility
|
IP
|
$7,128.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.69 |
| Max. Negotiated Rate |
$6,843.22 |
| Rate for Payer: Aetna Commercial |
$5,488.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,560.11
|
| Rate for Payer: Cash Price |
$3,564.18
|
| Rate for Payer: Cigna Commercial |
$5,916.53
|
| Rate for Payer: First Health Commercial |
$6,771.93
|
| Rate for Payer: Humana Commercial |
$6,059.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,845.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,346.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.79
|
| Rate for Payer: PHCS Commercial |
$6,843.22
|
| Rate for Payer: United Healthcare All Payer |
$6,272.95
|
|
|
PLATE MED DIST HUM LK 7 103M R
|
Facility
|
OP
|
$7,128.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.69 |
| Max. Negotiated Rate |
$6,843.22 |
| Rate for Payer: Anthem Medicaid |
$2,451.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,560.11
|
| Rate for Payer: Cash Price |
$3,564.18
|
| Rate for Payer: Cigna Commercial |
$5,916.53
|
| Rate for Payer: First Health Commercial |
$6,771.93
|
| Rate for Payer: Humana Commercial |
$6,059.10
|
| Rate for Payer: Humana KY Medicaid |
$2,451.44
|
| Rate for Payer: Kentucky WC Medicaid |
$2,476.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,845.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,260.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,138.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,500.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,272.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,346.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,425.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$926.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,209.79
|
| Rate for Payer: PHCS Commercial |
$6,843.22
|
| Rate for Payer: United Healthcare All Payer |
$6,272.95
|
| Rate for Payer: Aetna Commercial |
$5,488.83
|
|
|
PLATE MED DIST HUM LK 9 127M R
|
Facility
|
IP
|
$7,452.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.82 |
| Max. Negotiated Rate |
$7,154.37 |
| Rate for Payer: Aetna Commercial |
$5,738.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,812.93
|
| Rate for Payer: Cash Price |
$3,726.24
|
| Rate for Payer: Cigna Commercial |
$6,185.55
|
| Rate for Payer: First Health Commercial |
$7,079.85
|
| Rate for Payer: Humana Commercial |
$6,334.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,111.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,499.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,235.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,558.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,589.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,310.27
|
| Rate for Payer: PHCS Commercial |
$7,154.37
|
| Rate for Payer: United Healthcare All Payer |
$6,558.17
|
|
|
PLATE MED DIST HUM LK 9 127M R
|
Facility
|
OP
|
$7,452.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.82 |
| Max. Negotiated Rate |
$7,154.37 |
| Rate for Payer: Aetna Commercial |
$5,738.40
|
| Rate for Payer: Anthem Medicaid |
$2,562.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,812.93
|
| Rate for Payer: Cash Price |
$3,726.24
|
| Rate for Payer: Cigna Commercial |
$6,185.55
|
| Rate for Payer: First Health Commercial |
$7,079.85
|
| Rate for Payer: Humana Commercial |
$6,334.60
|
| Rate for Payer: Humana KY Medicaid |
$2,562.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,588.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,111.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,499.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,235.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,614.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,558.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,589.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,310.27
|
| Rate for Payer: PHCS Commercial |
$7,154.37
|
| Rate for Payer: United Healthcare All Payer |
$6,558.17
|
|
|
PLATE MED DST HUM LK 11 151M L
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE MED DST HUM LK 11 151M L
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE MED DST HUM LK 11 151M R
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE MED DST HUM LK 11 151M R
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE MED DST HUM LK 13 174M L
|
Facility
|
IP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE MED DST HUM LK 13 174M L
|
Facility
|
OP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem Medicaid |
$2,730.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Humana KY Medicaid |
$2,730.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE MED DST HUM LK 13 174M R
|
Facility
|
IP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE MED DST HUM LK 13 174M R
|
Facility
|
OP
|
$7,938.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,032.02 |
| Max. Negotiated Rate |
$7,621.10 |
| Rate for Payer: Aetna Commercial |
$6,112.76
|
| Rate for Payer: Anthem Medicaid |
$2,730.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,192.15
|
| Rate for Payer: Cash Price |
$3,969.33
|
| Rate for Payer: Cigna Commercial |
$6,589.08
|
| Rate for Payer: First Health Commercial |
$7,541.72
|
| Rate for Payer: Humana Commercial |
$6,747.85
|
| Rate for Payer: Humana KY Medicaid |
$2,730.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,757.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,509.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,858.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,381.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,784.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,986.01
|
| Rate for Payer: Ohio Health Group HMO |
$5,953.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,587.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,032.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,460.98
|
| Rate for Payer: PHCS Commercial |
$7,621.10
|
| Rate for Payer: United Healthcare All Payer |
$6,986.01
|
|
|
PLATE MED DST HUM LK 9 127M L
|
Facility
|
OP
|
$7,452.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.82 |
| Max. Negotiated Rate |
$7,154.37 |
| Rate for Payer: Aetna Commercial |
$5,738.40
|
| Rate for Payer: Anthem Medicaid |
$2,562.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,812.93
|
| Rate for Payer: Cash Price |
$3,726.24
|
| Rate for Payer: Cigna Commercial |
$6,185.55
|
| Rate for Payer: First Health Commercial |
$7,079.85
|
| Rate for Payer: Humana Commercial |
$6,334.60
|
| Rate for Payer: Humana KY Medicaid |
$2,562.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,588.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,111.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,499.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,235.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,614.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,558.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,589.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,310.27
|
| Rate for Payer: PHCS Commercial |
$7,154.37
|
| Rate for Payer: United Healthcare All Payer |
$6,558.17
|
|
|
PLATE MED DST HUM LK 9 127M L
|
Facility
|
IP
|
$7,452.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$968.82 |
| Max. Negotiated Rate |
$7,154.37 |
| Rate for Payer: Aetna Commercial |
$5,738.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,812.93
|
| Rate for Payer: Cash Price |
$3,726.24
|
| Rate for Payer: Cigna Commercial |
$6,185.55
|
| Rate for Payer: First Health Commercial |
$7,079.85
|
| Rate for Payer: Humana Commercial |
$6,334.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,111.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,499.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,235.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,558.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,589.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$968.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,310.27
|
| Rate for Payer: PHCS Commercial |
$7,154.37
|
| Rate for Payer: United Healthcare All Payer |
$6,558.17
|
|
|
PLATE MEDIAL ANT CLAVICLE 6H
|
Facility
|
OP
|
$7,183.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.87 |
| Max. Negotiated Rate |
$6,896.30 |
| Rate for Payer: Aetna Commercial |
$5,531.41
|
| Rate for Payer: Anthem Medicaid |
$2,470.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.25
|
| Rate for Payer: Cash Price |
$3,591.82
|
| Rate for Payer: Cigna Commercial |
$5,962.43
|
| Rate for Payer: First Health Commercial |
$6,824.47
|
| Rate for Payer: Humana Commercial |
$6,106.10
|
| Rate for Payer: Humana KY Medicaid |
$2,470.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,495.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,520.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.93
|
| Rate for Payer: PHCS Commercial |
$6,896.30
|
| Rate for Payer: United Healthcare All Payer |
$6,321.61
|
|
|
PLATE MEDIAL ANT CLAVICLE 6H
|
Facility
|
IP
|
$7,183.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.87 |
| Max. Negotiated Rate |
$6,896.30 |
| Rate for Payer: Humana Commercial |
$6,106.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.93
|
| Rate for Payer: PHCS Commercial |
$6,896.30
|
| Rate for Payer: United Healthcare All Payer |
$6,321.61
|
| Rate for Payer: Aetna Commercial |
$5,531.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.25
|
| Rate for Payer: Cash Price |
$3,591.82
|
| Rate for Payer: Cigna Commercial |
$5,962.43
|
| Rate for Payer: First Health Commercial |
$6,824.47
|
|
|
PLATE MEDIAL ANT CLAVICLE 8H
|
Facility
|
OP
|
$7,183.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.87 |
| Max. Negotiated Rate |
$6,896.30 |
| Rate for Payer: Aetna Commercial |
$5,531.41
|
| Rate for Payer: Anthem Medicaid |
$2,470.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.25
|
| Rate for Payer: Cash Price |
$3,591.82
|
| Rate for Payer: Cigna Commercial |
$5,962.43
|
| Rate for Payer: First Health Commercial |
$6,824.47
|
| Rate for Payer: Humana Commercial |
$6,106.10
|
| Rate for Payer: Humana KY Medicaid |
$2,470.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,495.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,520.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.93
|
| Rate for Payer: PHCS Commercial |
$6,896.30
|
| Rate for Payer: United Healthcare All Payer |
$6,321.61
|
|
|
PLATE MEDIAL ANT CLAVICLE 8H
|
Facility
|
IP
|
$7,183.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.87 |
| Max. Negotiated Rate |
$6,896.30 |
| Rate for Payer: Aetna Commercial |
$5,531.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,603.25
|
| Rate for Payer: Cash Price |
$3,591.82
|
| Rate for Payer: Cigna Commercial |
$5,962.43
|
| Rate for Payer: First Health Commercial |
$6,824.47
|
| Rate for Payer: Humana Commercial |
$6,106.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,890.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,301.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,155.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,321.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.93
|
| Rate for Payer: PHCS Commercial |
$6,896.30
|
| Rate for Payer: United Healthcare All Payer |
$6,321.61
|
|
|
PLATE MEDIAL ANTI-GLIDE 4H
|
Facility
|
OP
|
$3,656.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.28 |
| Max. Negotiated Rate |
$3,509.76 |
| Rate for Payer: Aetna Commercial |
$2,815.12
|
| Rate for Payer: Anthem Medicaid |
$1,257.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,851.68
|
| Rate for Payer: Cash Price |
$1,828.00
|
| Rate for Payer: Cigna Commercial |
$3,034.48
|
| Rate for Payer: First Health Commercial |
$3,473.20
|
| Rate for Payer: Humana Commercial |
$3,107.60
|
| Rate for Payer: Humana KY Medicaid |
$1,257.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,270.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,997.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,698.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,282.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,217.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,742.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,133.36
|
| Rate for Payer: PHCS Commercial |
$3,509.76
|
| Rate for Payer: United Healthcare All Payer |
$3,217.28
|
|
|
PLATE MEDIAL ANTI-GLIDE 4H
|
Facility
|
IP
|
$3,656.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$475.28 |
| Max. Negotiated Rate |
$3,509.76 |
| Rate for Payer: Aetna Commercial |
$2,815.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,851.68
|
| Rate for Payer: Cash Price |
$1,828.00
|
| Rate for Payer: Cigna Commercial |
$3,034.48
|
| Rate for Payer: First Health Commercial |
$3,473.20
|
| Rate for Payer: Humana Commercial |
$3,107.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,997.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,698.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,096.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,217.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,742.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$731.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$475.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,133.36
|
| Rate for Payer: PHCS Commercial |
$3,509.76
|
| Rate for Payer: United Healthcare All Payer |
$3,217.28
|
|
