|
PLATE STRAIGHT AR-9943C-07
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE STRAIGHT AR-9943C-07
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE STRAIGHT AR-9943C-08
|
Facility
|
OP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem Medicaid |
$1,418.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Humana KY Medicaid |
$1,418.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
PLATE STRAIGHT AR-9943C-08
|
Facility
|
IP
|
$4,125.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.25 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Aetna Commercial |
$3,176.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
| Rate for Payer: Cash Price |
$2,062.50
|
| Rate for Payer: Cigna Commercial |
$3,423.75
|
| Rate for Payer: First Health Commercial |
$3,918.75
|
| Rate for Payer: Humana Commercial |
$3,506.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
| Rate for Payer: PHCS Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
|
PLATE STRAIGHT AR-9943C-10
|
Facility
|
IP
|
$4,282.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.72 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Aetna Commercial |
$3,297.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.35
|
| Rate for Payer: Cash Price |
$2,141.25
|
| Rate for Payer: Cigna Commercial |
$3,554.48
|
| Rate for Payer: First Health Commercial |
$4,068.38
|
| Rate for Payer: Humana Commercial |
$3,640.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.58
|
| Rate for Payer: PHCS Commercial |
$4,111.20
|
| Rate for Payer: United Healthcare All Payer |
$3,768.60
|
|
|
PLATE STRAIGHT AR-9943C-10
|
Facility
|
OP
|
$4,282.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.72 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Aetna Commercial |
$3,297.52
|
| Rate for Payer: Anthem Medicaid |
$1,472.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.35
|
| Rate for Payer: Cash Price |
$2,141.25
|
| Rate for Payer: Cigna Commercial |
$3,554.48
|
| Rate for Payer: First Health Commercial |
$4,068.38
|
| Rate for Payer: Humana Commercial |
$3,640.12
|
| Rate for Payer: Humana KY Medicaid |
$1,472.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,502.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.58
|
| Rate for Payer: PHCS Commercial |
$4,111.20
|
| Rate for Payer: United Healthcare All Payer |
$3,768.60
|
|
|
PLATE STRAIGHT AR-9943C-12
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE STRAIGHT AR-9943C-12
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE STRAIGHT FRAGMENT
|
Facility
|
IP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
PLATE STRAIGHT FRAGMENT
|
Facility
|
OP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
PLATE STR NAR 7H*90MM 4LCKING
|
Facility
|
IP
|
$3,367.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.82 |
| Max. Negotiated Rate |
$3,233.16 |
| Rate for Payer: Aetna Commercial |
$2,593.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
| Rate for Payer: Cash Price |
$1,683.94
|
| Rate for Payer: Cigna Commercial |
$2,795.34
|
| Rate for Payer: First Health Commercial |
$3,199.49
|
| Rate for Payer: Humana Commercial |
$2,862.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
| Rate for Payer: PHCS Commercial |
$3,233.16
|
| Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
|
PLATE STR NAR 7H*90MM 4LCKING
|
Facility
|
OP
|
$3,367.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.82 |
| Max. Negotiated Rate |
$3,233.16 |
| Rate for Payer: Aetna Commercial |
$2,593.27
|
| Rate for Payer: Anthem Medicaid |
$1,158.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,626.95
|
| Rate for Payer: Cash Price |
$1,683.94
|
| Rate for Payer: Cigna Commercial |
$2,795.34
|
| Rate for Payer: First Health Commercial |
$3,199.49
|
| Rate for Payer: Humana Commercial |
$2,862.70
|
| Rate for Payer: Humana KY Medicaid |
$1,158.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,761.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,963.73
|
| Rate for Payer: Ohio Health Group HMO |
$2,525.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.04
|
| Rate for Payer: PHCS Commercial |
$3,233.16
|
| Rate for Payer: United Healthcare All Payer |
$2,963.73
|
|
|
PLATE STRNL LSS STR 2.3MM 14HO
|
Facility
|
IP
|
$8,452.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.88 |
| Max. Negotiated Rate |
$8,114.82 |
| Rate for Payer: Aetna Commercial |
$6,508.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.29
|
| Rate for Payer: Cash Price |
$4,226.47
|
| Rate for Payer: Cigna Commercial |
$7,015.94
|
| Rate for Payer: First Health Commercial |
$8,030.29
|
| Rate for Payer: Humana Commercial |
$7,185.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.41
|
| Rate for Payer: PHCS Commercial |
$8,114.82
|
| Rate for Payer: United Healthcare All Payer |
$7,438.59
|
|
|
PLATE STRNL LSS STR 2.3MM 14HO
|
Facility
|
OP
|
$8,452.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.88 |
| Max. Negotiated Rate |
$8,114.82 |
| Rate for Payer: Aetna Commercial |
$6,508.76
|
| Rate for Payer: Anthem Medicaid |
$2,906.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,593.29
|
| Rate for Payer: Cash Price |
$4,226.47
|
| Rate for Payer: Cigna Commercial |
$7,015.94
|
| Rate for Payer: First Health Commercial |
$8,030.29
|
| Rate for Payer: Humana Commercial |
$7,185.00
|
| Rate for Payer: Humana KY Medicaid |
$2,906.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,936.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,931.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,238.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,965.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,438.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,339.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.41
|
| Rate for Payer: PHCS Commercial |
$8,114.82
|
| Rate for Payer: United Healthcare All Payer |
$7,438.59
|
|
|
PLATE SUPERIOR DEC 6H BR L
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE SUPERIOR DEC 6H BR L
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
| Rate for Payer: Aetna Commercial |
$5,191.34
|
|
|
PLATE SUPERIOR DEC 6H BR R
|
Facility
|
IP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
PLATE SUPERIOR DEC 6H BR R
|
Facility
|
OP
|
$11,508.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,496.15 |
| Max. Negotiated Rate |
$11,048.50 |
| Rate for Payer: Aetna Commercial |
$8,861.81
|
| Rate for Payer: Anthem Medicaid |
$3,957.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,976.90
|
| Rate for Payer: Cash Price |
$5,754.42
|
| Rate for Payer: Cigna Commercial |
$9,552.35
|
| Rate for Payer: First Health Commercial |
$10,933.41
|
| Rate for Payer: Humana Commercial |
$9,782.52
|
| Rate for Payer: Humana KY Medicaid |
$3,957.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,998.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,437.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,493.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,452.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,037.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,127.79
|
| Rate for Payer: Ohio Health Group HMO |
$8,631.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,301.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,496.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,567.74
|
| Rate for Payer: PHCS Commercial |
$11,048.50
|
| Rate for Payer: United Healthcare All Payer |
$10,127.79
|
|
|
PLATE SUPERIOR DEC 8H BR L
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE SUPERIOR DEC 8H BR L
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE SUPERIOR DECR 8H BR R
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE SUPERIOR DECR 8H BR R
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE SUPERIOR DECREASED 10H L
|
Facility
|
OP
|
$7,357.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.46 |
| Max. Negotiated Rate |
$7,063.06 |
| Rate for Payer: Aetna Commercial |
$5,665.16
|
| Rate for Payer: Anthem Medicaid |
$2,530.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,738.73
|
| Rate for Payer: Cash Price |
$3,678.68
|
| Rate for Payer: Cigna Commercial |
$6,106.60
|
| Rate for Payer: First Health Commercial |
$6,989.48
|
| Rate for Payer: Humana Commercial |
$6,253.75
|
| Rate for Payer: Humana KY Medicaid |
$2,530.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,555.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,033.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,429.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,207.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,580.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,474.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,518.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$956.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.78
|
| Rate for Payer: PHCS Commercial |
$7,063.06
|
| Rate for Payer: United Healthcare All Payer |
$6,474.47
|
|
|
PLATE SUPERIOR DECREASED 10H L
|
Facility
|
IP
|
$7,357.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$956.46 |
| Max. Negotiated Rate |
$7,063.06 |
| Rate for Payer: Aetna Commercial |
$5,665.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,738.73
|
| Rate for Payer: Cash Price |
$3,678.68
|
| Rate for Payer: Cigna Commercial |
$6,106.60
|
| Rate for Payer: First Health Commercial |
$6,989.48
|
| Rate for Payer: Humana Commercial |
$6,253.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,033.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,429.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,207.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,474.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,518.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,471.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$956.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,280.78
|
| Rate for Payer: PHCS Commercial |
$7,063.06
|
| Rate for Payer: United Healthcare All Payer |
$6,474.47
|
|
|
PLATE SUPERIOR DECREASED 10H R
|
Facility
|
OP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem Medicaid |
$1,807.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Humana KY Medicaid |
$1,807.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,825.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,843.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
