|
PLATE LK HUM PLD 5H 80MM R
|
Facility
|
IP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE LK HUM PLD 7H 107MM L
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LK HUM PLD 7H 107MM L
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LK HUM PLD 7H 107MM R
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LK HUM PLD 7H 107MM R
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LK HUM PLD 9H 132MM L
|
Facility
|
OP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem Medicaid |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Humana KY Medicaid |
$2,664.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,691.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LK HUM PLD 9H 132MM L
|
Facility
|
IP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LK HUM PLD 9H 132MM R
|
Facility
|
OP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem Medicaid |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Humana KY Medicaid |
$2,664.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,691.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LK HUM PLD 9H 132MM R
|
Facility
|
IP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LK LAT DIST FIB 3.5 9H R
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LK LAT DIST FIB 3.5 9H R
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LK LAT DST FIB 3.5 11H L
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LK LAT DST FIB 3.5 11H L
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LK LAT DST FIB 3.5 11H R
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LK LAT DST FIB 3.5 11H R
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LK MD CLAV SUP 6H 73M L
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 6H 73M L
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 6H 73M R
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 6H 73M R
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 7H 85M L
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 7H 85M L
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 7H 85M R
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 7H 85M R
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK MD CLAV SUP 8H 97M R
|
Facility
|
IP
|
$4,546.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.82 |
| Max. Negotiated Rate |
$4,364.22 |
| Rate for Payer: Aetna Commercial |
$3,500.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.93
|
| Rate for Payer: Cash Price |
$2,273.03
|
| Rate for Payer: Cigna Commercial |
$3,773.23
|
| Rate for Payer: First Health Commercial |
$4,318.76
|
| Rate for Payer: Humana Commercial |
$3,864.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,955.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,136.78
|
| Rate for Payer: PHCS Commercial |
$4,364.22
|
| Rate for Payer: United Healthcare All Payer |
$4,000.53
|
|
|
PLATE LK MD CLAV SUP 8H 97M R
|
Facility
|
OP
|
$4,546.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.82 |
| Max. Negotiated Rate |
$4,364.22 |
| Rate for Payer: Aetna Commercial |
$3,500.47
|
| Rate for Payer: Anthem Medicaid |
$1,563.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,545.93
|
| Rate for Payer: Cash Price |
$2,273.03
|
| Rate for Payer: Cigna Commercial |
$3,773.23
|
| Rate for Payer: First Health Commercial |
$4,318.76
|
| Rate for Payer: Humana Commercial |
$3,864.15
|
| Rate for Payer: Humana KY Medicaid |
$1,563.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,579.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,727.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,354.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,363.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,594.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,000.53
|
| Rate for Payer: Ohio Health Group HMO |
$3,409.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,636.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,955.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,136.78
|
| Rate for Payer: PHCS Commercial |
$4,364.22
|
| Rate for Payer: United Healthcare All Payer |
$4,000.53
|
|
