|
PLATE PERC CALC MD 2.7M 58M L
|
Facility
|
IP
|
$6,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.89 |
| Max. Negotiated Rate |
$6,615.81 |
| Rate for Payer: Aetna Commercial |
$5,306.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,375.35
|
| Rate for Payer: Cash Price |
$3,445.73
|
| Rate for Payer: Cigna Commercial |
$5,719.92
|
| Rate for Payer: First Health Commercial |
$6,546.90
|
| Rate for Payer: Humana Commercial |
$5,857.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,651.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,085.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,067.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,064.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,168.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.36
|
| Rate for Payer: PHCS Commercial |
$6,615.81
|
| Rate for Payer: United Healthcare All Payer |
$6,064.49
|
|
|
PLATE PERC CALC MD 2.7M 58M R
|
Facility
|
OP
|
$6,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.89 |
| Max. Negotiated Rate |
$6,615.81 |
| Rate for Payer: Aetna Commercial |
$5,306.43
|
| Rate for Payer: Anthem Medicaid |
$2,369.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,375.35
|
| Rate for Payer: Cash Price |
$3,445.73
|
| Rate for Payer: Cigna Commercial |
$5,719.92
|
| Rate for Payer: First Health Commercial |
$6,546.90
|
| Rate for Payer: Humana Commercial |
$5,857.75
|
| Rate for Payer: Humana KY Medicaid |
$2,369.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,394.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,651.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,085.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,067.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,417.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,064.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,168.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.36
|
| Rate for Payer: PHCS Commercial |
$6,615.81
|
| Rate for Payer: United Healthcare All Payer |
$6,064.49
|
|
|
PLATE PERC CALC MD 2.7M 58M R
|
Facility
|
IP
|
$6,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.89 |
| Max. Negotiated Rate |
$6,615.81 |
| Rate for Payer: Aetna Commercial |
$5,306.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,375.35
|
| Rate for Payer: Cash Price |
$3,445.73
|
| Rate for Payer: Cigna Commercial |
$5,719.92
|
| Rate for Payer: First Health Commercial |
$6,546.90
|
| Rate for Payer: Humana Commercial |
$5,857.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,651.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,085.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,067.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,064.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,168.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.36
|
| Rate for Payer: PHCS Commercial |
$6,615.81
|
| Rate for Payer: United Healthcare All Payer |
$6,064.49
|
|
|
PLATE PINCH 4H STR
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PLATE PINCH 4H STR
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PLATE PINCH 6H STR
|
Facility
|
OP
|
$9,552.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.82 |
| Max. Negotiated Rate |
$9,170.40 |
| Rate for Payer: Anthem Medicaid |
$3,285.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.95
|
| Rate for Payer: Cash Price |
$4,776.25
|
| Rate for Payer: Cigna Commercial |
$7,928.58
|
| Rate for Payer: First Health Commercial |
$9,074.88
|
| Rate for Payer: Humana Commercial |
$8,119.62
|
| Rate for Payer: Humana KY Medicaid |
$3,285.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,318.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,833.05
|
| Rate for Payer: Aetna Commercial |
$7,355.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,351.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,406.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,910.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,241.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,961.28
|
| Rate for Payer: PHCS Commercial |
$9,170.40
|
| Rate for Payer: United Healthcare All Payer |
$8,406.20
|
|
|
PLATE PINCH 6H STR
|
Facility
|
IP
|
$9,552.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,241.82 |
| Max. Negotiated Rate |
$9,170.40 |
| Rate for Payer: Aetna Commercial |
$7,355.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,450.95
|
| Rate for Payer: Cash Price |
$4,776.25
|
| Rate for Payer: Cigna Commercial |
$7,928.58
|
| Rate for Payer: First Health Commercial |
$9,074.88
|
| Rate for Payer: Humana Commercial |
$8,119.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,833.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,049.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,865.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,406.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,164.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,910.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,241.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,961.28
|
| Rate for Payer: PHCS Commercial |
$9,170.40
|
| Rate for Payer: United Healthcare All Payer |
$8,406.20
|
|
|
PLATE P-L-D HUM LK 11 157MM L
|
Facility
|
OP
|
$7,803.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.47 |
| Max. Negotiated Rate |
$7,491.46 |
| Rate for Payer: Aetna Commercial |
$6,008.77
|
| Rate for Payer: Anthem Medicaid |
$2,683.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,086.81
|
| Rate for Payer: Cash Price |
$3,901.80
|
| Rate for Payer: Cigna Commercial |
$6,476.99
|
| Rate for Payer: First Health Commercial |
$7,413.42
|
| Rate for Payer: Humana Commercial |
$6,633.06
|
| Rate for Payer: Humana KY Medicaid |
$2,683.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,710.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,398.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,759.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,341.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,737.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,867.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,852.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,419.12
|
| Rate for Payer: PHCS Commercial |
$7,491.46
|
| Rate for Payer: United Healthcare All Payer |
$6,867.17
|
|
|
PLATE P-L-D HUM LK 11 157MM L
|
Facility
|
IP
|
$7,803.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.47 |
| Max. Negotiated Rate |
$7,491.46 |
| Rate for Payer: Aetna Commercial |
$6,008.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,086.81
|
| Rate for Payer: Cash Price |
$3,901.80
|
| Rate for Payer: Cigna Commercial |
$6,476.99
|
| Rate for Payer: First Health Commercial |
$7,413.42
|
| Rate for Payer: Humana Commercial |
$6,633.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,398.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,759.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,341.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,867.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,852.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,560.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,419.12
|
| Rate for Payer: PHCS Commercial |
$7,491.46
|
| Rate for Payer: United Healthcare All Payer |
$6,867.17
|
|
|
PLATE P-L-D HUM LK 11 157MM R
|
Facility
|
OP
|
$7,621.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.74 |
| Max. Negotiated Rate |
$7,316.26 |
| Rate for Payer: Aetna Commercial |
$5,868.25
|
| Rate for Payer: Anthem Medicaid |
$2,620.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,944.46
|
| Rate for Payer: Cash Price |
$3,810.55
|
| Rate for Payer: Cigna Commercial |
$6,325.51
|
| Rate for Payer: First Health Commercial |
$7,240.04
|
| Rate for Payer: Humana Commercial |
$6,477.94
|
| Rate for Payer: Humana KY Medicaid |
$2,620.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,647.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,249.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,624.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,673.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,706.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,715.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,362.54
|
| Rate for Payer: PHCS Commercial |
$7,316.26
|
| Rate for Payer: United Healthcare All Payer |
$6,706.57
|
|
|
PLATE P-L-D HUM LK 11 157MM R
|
Facility
|
IP
|
$7,621.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$990.74 |
| Max. Negotiated Rate |
$7,316.26 |
| Rate for Payer: Aetna Commercial |
$5,868.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,944.46
|
| Rate for Payer: Cash Price |
$3,810.55
|
| Rate for Payer: Cigna Commercial |
$6,325.51
|
| Rate for Payer: First Health Commercial |
$7,240.04
|
| Rate for Payer: Humana Commercial |
$6,477.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,249.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,624.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,286.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,706.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,715.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,524.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$990.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,362.54
|
| Rate for Payer: PHCS Commercial |
$7,316.26
|
| Rate for Payer: United Healthcare All Payer |
$6,706.57
|
|
|
PLATE P-L-D HUM LK 15 207MM 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 P-L-D HUM LK 15 207MM 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 P-L-D HUM LK 15 207MM 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 P-L-D HUM LK 15 207MM 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 P-L-D HUM LK 5 80MM L
|
Facility
|
IP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE P-L-D HUM LK 5 80MM L
|
Facility
|
OP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Anthem Medicaid |
$2,335.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Humana KY Medicaid |
$2,335.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,382.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE P-L-D HUM LK 5 80MM R
|
Facility
|
IP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE P-L-D HUM LK 5 80MM R
|
Facility
|
OP
|
$6,790.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.79 |
| Max. Negotiated Rate |
$6,519.10 |
| Rate for Payer: Aetna Commercial |
$5,228.86
|
| Rate for Payer: Anthem Medicaid |
$2,335.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,296.77
|
| Rate for Payer: Cash Price |
$3,395.36
|
| Rate for Payer: Cigna Commercial |
$5,636.31
|
| Rate for Payer: First Health Commercial |
$6,451.19
|
| Rate for Payer: Humana Commercial |
$5,772.12
|
| Rate for Payer: Humana KY Medicaid |
$2,335.33
|
| Rate for Payer: Kentucky WC Medicaid |
$2,359.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,568.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,011.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,037.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,382.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,975.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,093.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,358.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.13
|
| Rate for Payer: PHCS Commercial |
$6,519.10
|
| Rate for Payer: United Healthcare All Payer |
$5,975.84
|
|
|
PLATE P-L-D HUM LK 7 107MM R
|
Facility
|
OP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem Medicaid |
$2,472.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Humana KY Medicaid |
$2,472.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE P-L-D HUM LK 7 107MM R
|
Facility
|
IP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE P-L-D HUM LK 7 80MM L
|
Facility
|
OP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem Medicaid |
$2,472.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Humana KY Medicaid |
$2,472.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE P-L-D HUM LK 7 80MM L
|
Facility
|
IP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE P-L-D HUM LK 9 132MM L
|
Facility
|
OP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem Medicaid |
$2,595.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Humana KY Medicaid |
$2,595.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,621.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,647.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
|
PLATE P-L-D HUM LK 9 132MM L
|
Facility
|
IP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
