|
PLATE TI TIB A/P SLOPED 05.0
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 05.0
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 07.5
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 07.5
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 09.0
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 09.0
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 10.0
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 10.0
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
| Rate for Payer: Aetna Commercial |
$5,107.02
|
|
|
PLATE TI TIB A/P SLOPED 11.0
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 11.0
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 12.5
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 12.5
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 15.0
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 15.0
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 17.5
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TIB A/P SLOPED 17.5
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI TUB W/COLLAR 10H 127
|
Facility
|
OP
|
$1,166.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.66 |
| Max. Negotiated Rate |
$1,119.98 |
| Rate for Payer: Aetna Commercial |
$898.32
|
| Rate for Payer: Anthem Medicaid |
$401.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.99
|
| Rate for Payer: Cash Price |
$583.33
|
| Rate for Payer: Cigna Commercial |
$968.32
|
| Rate for Payer: First Health Commercial |
$1,108.32
|
| Rate for Payer: Humana Commercial |
$991.65
|
| Rate for Payer: Humana KY Medicaid |
$401.21
|
| Rate for Payer: Kentucky WC Medicaid |
$405.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.65
|
| Rate for Payer: Ohio Health Group HMO |
$874.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.66
|
| Rate for Payer: PHCS Commercial |
$1,119.98
|
| Rate for Payer: United Healthcare All Payer |
$1,026.65
|
|
|
PLATE TI TUB W/COLLAR 10H 127
|
Facility
|
IP
|
$1,166.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$151.66 |
| Max. Negotiated Rate |
$1,119.98 |
| Rate for Payer: Aetna Commercial |
$898.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$909.99
|
| Rate for Payer: Cash Price |
$583.33
|
| Rate for Payer: Cigna Commercial |
$968.32
|
| Rate for Payer: First Health Commercial |
$1,108.32
|
| Rate for Payer: Humana Commercial |
$991.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$956.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$860.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$350.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,026.65
|
| Rate for Payer: Ohio Health Group HMO |
$874.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$233.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$151.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$361.66
|
| Rate for Payer: PHCS Commercial |
$1,119.98
|
| Rate for Payer: United Healthcare All Payer |
$1,026.65
|
|
|
PLATE TI TUB W/COLLAR 2H 25MM
|
Facility
|
OP
|
$1,116.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.11 |
| Max. Negotiated Rate |
$1,071.61 |
| Rate for Payer: Aetna Commercial |
$859.52
|
| Rate for Payer: Anthem Medicaid |
$383.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.68
|
| Rate for Payer: Cash Price |
$558.13
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$1,060.45
|
| Rate for Payer: Humana Commercial |
$948.82
|
| Rate for Payer: Humana KY Medicaid |
$383.88
|
| Rate for Payer: Kentucky WC Medicaid |
$387.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.31
|
| Rate for Payer: Ohio Health Group HMO |
$837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.04
|
| Rate for Payer: PHCS Commercial |
$1,071.61
|
| Rate for Payer: United Healthcare All Payer |
$982.31
|
|
|
PLATE TI TUB W/COLLAR 2H 25MM
|
Facility
|
IP
|
$1,116.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.11 |
| Max. Negotiated Rate |
$1,071.61 |
| Rate for Payer: Aetna Commercial |
$859.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.68
|
| Rate for Payer: Cash Price |
$558.13
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$1,060.45
|
| Rate for Payer: Humana Commercial |
$948.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.31
|
| Rate for Payer: Ohio Health Group HMO |
$837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.04
|
| Rate for Payer: PHCS Commercial |
$1,071.61
|
| Rate for Payer: United Healthcare All Payer |
$982.31
|
|
|
PLATE TI TUB W/COLLAR 3H 37MM
|
Facility
|
IP
|
$1,116.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.11 |
| Max. Negotiated Rate |
$1,071.61 |
| Rate for Payer: Humana Commercial |
$948.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.31
|
| Rate for Payer: Ohio Health Group HMO |
$837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.04
|
| Rate for Payer: PHCS Commercial |
$1,071.61
|
| Rate for Payer: United Healthcare All Payer |
$982.31
|
| Rate for Payer: Aetna Commercial |
$859.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.68
|
| Rate for Payer: Cash Price |
$558.13
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$1,060.45
|
|
|
PLATE TI TUB W/COLLAR 3H 37MM
|
Facility
|
OP
|
$1,116.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.11 |
| Max. Negotiated Rate |
$1,071.61 |
| Rate for Payer: Aetna Commercial |
$859.52
|
| Rate for Payer: Anthem Medicaid |
$383.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.68
|
| Rate for Payer: Cash Price |
$558.13
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$1,060.45
|
| Rate for Payer: Humana Commercial |
$948.82
|
| Rate for Payer: Humana KY Medicaid |
$383.88
|
| Rate for Payer: Kentucky WC Medicaid |
$387.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.31
|
| Rate for Payer: Ohio Health Group HMO |
$837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.04
|
| Rate for Payer: PHCS Commercial |
$1,071.61
|
| Rate for Payer: United Healthcare All Payer |
$982.31
|
|
|
PLATE TI TUB W/COLLAR 4H 49MM
|
Facility
|
IP
|
$1,116.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.11 |
| Max. Negotiated Rate |
$1,071.61 |
| Rate for Payer: Aetna Commercial |
$859.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.68
|
| Rate for Payer: Cash Price |
$558.13
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$1,060.45
|
| Rate for Payer: Humana Commercial |
$948.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.31
|
| Rate for Payer: Ohio Health Group HMO |
$837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.04
|
| Rate for Payer: PHCS Commercial |
$1,071.61
|
| Rate for Payer: United Healthcare All Payer |
$982.31
|
|
|
PLATE TI TUB W/COLLAR 4H 49MM
|
Facility
|
OP
|
$1,116.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.11 |
| Max. Negotiated Rate |
$1,071.61 |
| Rate for Payer: Aetna Commercial |
$859.52
|
| Rate for Payer: Anthem Medicaid |
$383.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.68
|
| Rate for Payer: Cash Price |
$558.13
|
| Rate for Payer: Cigna Commercial |
$926.50
|
| Rate for Payer: First Health Commercial |
$1,060.45
|
| Rate for Payer: Humana Commercial |
$948.82
|
| Rate for Payer: Humana KY Medicaid |
$383.88
|
| Rate for Payer: Kentucky WC Medicaid |
$387.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$823.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.31
|
| Rate for Payer: Ohio Health Group HMO |
$837.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.04
|
| Rate for Payer: PHCS Commercial |
$1,071.61
|
| Rate for Payer: United Healthcare All Payer |
$982.31
|
|
|
PLATE TI TUB W/COLLAR 5H 61MM
|
Facility
|
OP
|
$1,132.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.18 |
| Max. Negotiated Rate |
$1,086.84 |
| Rate for Payer: Aetna Commercial |
$871.73
|
| Rate for Payer: Anthem Medicaid |
$389.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$883.05
|
| Rate for Payer: Cash Price |
$566.06
|
| Rate for Payer: Cigna Commercial |
$939.66
|
| Rate for Payer: First Health Commercial |
$1,075.51
|
| Rate for Payer: Humana Commercial |
$962.30
|
| Rate for Payer: Humana KY Medicaid |
$389.34
|
| Rate for Payer: Kentucky WC Medicaid |
$393.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$928.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$835.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$339.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$397.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$996.27
|
| Rate for Payer: Ohio Health Group HMO |
$849.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$350.96
|
| Rate for Payer: PHCS Commercial |
$1,086.84
|
| Rate for Payer: United Healthcare All Payer |
$996.27
|
|
