|
PLATE POSTEROLATERAL FIB 4H L
|
Facility
|
OP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem Medicaid |
$1,648.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Humana KY Medicaid |
$1,648.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
|
PLATE POSTEROLATERAL FIB 4H R
|
Facility
|
OP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem Medicaid |
$1,648.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Humana KY Medicaid |
$1,648.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
|
PLATE POSTEROLATERAL FIB 4H R
|
Facility
|
IP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
|
PLATE POSTEROLATERAL FIB 5H L
|
Facility
|
IP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE POSTEROLATERAL FIB 5H L
|
Facility
|
OP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Anthem Medicaid |
$1,664.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Humana KY Medicaid |
$1,664.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,697.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE POSTEROLATERAL FIB 5H R
|
Facility
|
OP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Anthem Medicaid |
$1,664.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Humana KY Medicaid |
$1,664.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,697.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE POSTEROLATERAL FIB 5H R
|
Facility
|
IP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE POSTEROLATERAL FIB 6H L
|
Facility
|
IP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
|
|
PLATE POSTEROLATERAL FIB 6H L
|
Facility
|
OP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem Medicaid |
$1,679.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Humana KY Medicaid |
$1,679.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,696.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,713.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
|
|
PLATE POSTEROLATERAL FIB 6H R
|
Facility
|
OP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem Medicaid |
$1,679.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Humana KY Medicaid |
$1,679.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,696.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,713.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
|
|
PLATE POSTEROLATERAL FIB 6H R
|
Facility
|
IP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
|
|
PLATE POSTEROLATERAL FIB 7H L
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE POSTEROLATERAL FIB 7H L
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE POSTEROLATERAL FIB 7H R
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE POSTEROLATERAL FIB 7H R
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE POSTEROLTRL DIS TIB 3H L
|
Facility
|
IP
|
$4,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.26 |
| Max. Negotiated Rate |
$4,033.92 |
| Rate for Payer: Aetna Commercial |
$3,235.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,277.56
|
| Rate for Payer: Cash Price |
$2,101.00
|
| Rate for Payer: Cigna Commercial |
$3,487.66
|
| Rate for Payer: First Health Commercial |
$3,991.90
|
| Rate for Payer: Humana Commercial |
$3,571.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,445.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,697.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.62
|
| Rate for Payer: PHCS Commercial |
$4,033.92
|
| Rate for Payer: United Healthcare All Payer |
$3,697.76
|
|
|
PLATE POSTEROLTRL DIS TIB 3H L
|
Facility
|
OP
|
$4,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.26 |
| Max. Negotiated Rate |
$4,033.92 |
| Rate for Payer: Anthem Medicaid |
$1,445.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,277.56
|
| Rate for Payer: Cash Price |
$2,101.00
|
| Rate for Payer: Cigna Commercial |
$3,487.66
|
| Rate for Payer: First Health Commercial |
$3,991.90
|
| Rate for Payer: Humana Commercial |
$3,571.70
|
| Rate for Payer: Humana KY Medicaid |
$1,445.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,445.64
|
| Rate for Payer: Aetna Commercial |
$3,235.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,474.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,697.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.62
|
| Rate for Payer: PHCS Commercial |
$4,033.92
|
| Rate for Payer: United Healthcare All Payer |
$3,697.76
|
|
|
PLATE POSTEROLTRL DIS TIB 3H R
|
Facility
|
OP
|
$4,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.26 |
| Max. Negotiated Rate |
$4,033.92 |
| Rate for Payer: Aetna Commercial |
$3,235.54
|
| Rate for Payer: Anthem Medicaid |
$1,445.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,277.56
|
| Rate for Payer: Cash Price |
$2,101.00
|
| Rate for Payer: Cigna Commercial |
$3,487.66
|
| Rate for Payer: First Health Commercial |
$3,991.90
|
| Rate for Payer: Humana Commercial |
$3,571.70
|
| Rate for Payer: Humana KY Medicaid |
$1,445.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,445.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,474.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,697.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.62
|
| Rate for Payer: PHCS Commercial |
$4,033.92
|
| Rate for Payer: United Healthcare All Payer |
$3,697.76
|
|
|
PLATE POSTEROLTRL DIS TIB 3H R
|
Facility
|
IP
|
$4,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.26 |
| Max. Negotiated Rate |
$4,033.92 |
| Rate for Payer: Aetna Commercial |
$3,235.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,277.56
|
| Rate for Payer: Cash Price |
$2,101.00
|
| Rate for Payer: Cigna Commercial |
$3,487.66
|
| Rate for Payer: First Health Commercial |
$3,991.90
|
| Rate for Payer: Humana Commercial |
$3,571.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,445.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,697.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.62
|
| Rate for Payer: PHCS Commercial |
$4,033.92
|
| Rate for Payer: United Healthcare All Payer |
$3,697.76
|
|
|
PLATE POSTEROLTRL DIS TIB 4H L
|
Facility
|
IP
|
$4,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.09 |
| Max. Negotiated Rate |
$4,121.28 |
| Rate for Payer: Aetna Commercial |
$3,305.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,348.54
|
| Rate for Payer: Cash Price |
$2,146.50
|
| Rate for Payer: Cigna Commercial |
$3,563.19
|
| Rate for Payer: First Health Commercial |
$4,078.35
|
| Rate for Payer: Humana Commercial |
$3,649.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,520.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,168.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,777.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$858.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,330.83
|
| Rate for Payer: PHCS Commercial |
$4,121.28
|
| Rate for Payer: United Healthcare All Payer |
$3,777.84
|
|
|
PLATE POSTEROLTRL DIS TIB 4H L
|
Facility
|
OP
|
$4,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.09 |
| Max. Negotiated Rate |
$4,121.28 |
| Rate for Payer: Aetna Commercial |
$3,305.61
|
| Rate for Payer: Anthem Medicaid |
$1,476.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,348.54
|
| Rate for Payer: Cash Price |
$2,146.50
|
| Rate for Payer: Cigna Commercial |
$3,563.19
|
| Rate for Payer: First Health Commercial |
$4,078.35
|
| Rate for Payer: Humana Commercial |
$3,649.05
|
| Rate for Payer: Humana KY Medicaid |
$1,476.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,491.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,520.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,168.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,505.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,777.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$858.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,330.83
|
| Rate for Payer: PHCS Commercial |
$4,121.28
|
| Rate for Payer: United Healthcare All Payer |
$3,777.84
|
|
|
PLATE POSTEROLTRL DIS TIB 4H R
|
Facility
|
OP
|
$4,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.09 |
| Max. Negotiated Rate |
$4,121.28 |
| Rate for Payer: Aetna Commercial |
$3,305.61
|
| Rate for Payer: Anthem Medicaid |
$1,476.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,348.54
|
| Rate for Payer: Cash Price |
$2,146.50
|
| Rate for Payer: Cigna Commercial |
$3,563.19
|
| Rate for Payer: First Health Commercial |
$4,078.35
|
| Rate for Payer: Humana Commercial |
$3,649.05
|
| Rate for Payer: Humana KY Medicaid |
$1,476.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,491.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,520.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,168.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,505.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,777.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$858.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,330.83
|
| Rate for Payer: PHCS Commercial |
$4,121.28
|
| Rate for Payer: United Healthcare All Payer |
$3,777.84
|
|
|
PLATE POSTEROLTRL DIS TIB 4H R
|
Facility
|
IP
|
$4,293.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.09 |
| Max. Negotiated Rate |
$4,121.28 |
| Rate for Payer: Aetna Commercial |
$3,305.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,348.54
|
| Rate for Payer: Cash Price |
$2,146.50
|
| Rate for Payer: Cigna Commercial |
$3,563.19
|
| Rate for Payer: First Health Commercial |
$4,078.35
|
| Rate for Payer: Humana Commercial |
$3,649.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,520.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,168.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,777.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,219.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$858.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,330.83
|
| Rate for Payer: PHCS Commercial |
$4,121.28
|
| Rate for Payer: United Healthcare All Payer |
$3,777.84
|
|
|
PLATE POSTEROMEDL DIS TIB 3H L
|
Facility
|
OP
|
$4,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.26 |
| Max. Negotiated Rate |
$4,033.92 |
| Rate for Payer: Aetna Commercial |
$3,235.54
|
| Rate for Payer: Anthem Medicaid |
$1,445.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,277.56
|
| Rate for Payer: Cash Price |
$2,101.00
|
| Rate for Payer: Cigna Commercial |
$3,487.66
|
| Rate for Payer: First Health Commercial |
$3,991.90
|
| Rate for Payer: Humana Commercial |
$3,571.70
|
| Rate for Payer: Humana KY Medicaid |
$1,445.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,459.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,445.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,474.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,697.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.62
|
| Rate for Payer: PHCS Commercial |
$4,033.92
|
| Rate for Payer: United Healthcare All Payer |
$3,697.76
|
|
|
PLATE POSTEROMEDL DIS TIB 3H L
|
Facility
|
IP
|
$4,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.26 |
| Max. Negotiated Rate |
$4,033.92 |
| Rate for Payer: Aetna Commercial |
$3,235.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,277.56
|
| Rate for Payer: Cash Price |
$2,101.00
|
| Rate for Payer: Cigna Commercial |
$3,487.66
|
| Rate for Payer: First Health Commercial |
$3,991.90
|
| Rate for Payer: Humana Commercial |
$3,571.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,445.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,101.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,260.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,697.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$840.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$546.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,302.62
|
| Rate for Payer: PHCS Commercial |
$4,033.92
|
| Rate for Payer: United Healthcare All Payer |
$3,697.76
|
|
