|
PLATE TUB LCK 3.5MM 8 107MM
|
Facility
|
OP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem Medicaid |
$675.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Humana KY Medicaid |
$675.80
|
| Rate for Payer: Kentucky WC Medicaid |
$682.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
|
|
PLATE TUB LCK 3.5MM 9 120MM
|
Facility
|
OP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Anthem Medicaid |
$662.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Humana KY Medicaid |
$662.45
|
| Rate for Payer: Kentucky WC Medicaid |
$669.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
| Rate for Payer: Aetna Commercial |
$1,483.24
|
|
|
PLATE TUB LCK 3.5MM 9 120MM
|
Facility
|
IP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE TUB L-K 3.5M 1/3 5H 62M
|
Facility
|
IP
|
$2,024.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$1,943.14 |
| Rate for Payer: Aetna Commercial |
$1,558.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.80
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna Commercial |
$1,680.00
|
| Rate for Payer: First Health Commercial |
$1,922.90
|
| Rate for Payer: Humana Commercial |
$1,720.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.47
|
| Rate for Payer: PHCS Commercial |
$1,943.14
|
| Rate for Payer: United Healthcare All Payer |
$1,781.21
|
|
|
PLATE TUB L-K 3.5M 1/3 5H 62M
|
Facility
|
OP
|
$2,024.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$1,943.14 |
| Rate for Payer: Aetna Commercial |
$1,558.56
|
| Rate for Payer: Anthem Medicaid |
$696.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.80
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna Commercial |
$1,680.00
|
| Rate for Payer: First Health Commercial |
$1,922.90
|
| Rate for Payer: Humana Commercial |
$1,720.48
|
| Rate for Payer: Humana KY Medicaid |
$696.09
|
| Rate for Payer: Kentucky WC Medicaid |
$703.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.47
|
| Rate for Payer: PHCS Commercial |
$1,943.14
|
| Rate for Payer: United Healthcare All Payer |
$1,781.21
|
|
|
PLATE TUB L-K 3.5M 1/3 6H 74M
|
Facility
|
OP
|
$2,112.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$2,027.81 |
| Rate for Payer: Aetna Commercial |
$1,626.47
|
| Rate for Payer: Anthem Medicaid |
$726.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.59
|
| Rate for Payer: Cash Price |
$1,056.15
|
| Rate for Payer: Cigna Commercial |
$1,753.21
|
| Rate for Payer: First Health Commercial |
$2,006.68
|
| Rate for Payer: Humana Commercial |
$1,795.46
|
| Rate for Payer: Humana KY Medicaid |
$726.42
|
| Rate for Payer: Kentucky WC Medicaid |
$733.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,732.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,584.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.81
|
| Rate for Payer: PHCS Commercial |
$2,027.81
|
| Rate for Payer: United Healthcare All Payer |
$1,858.82
|
|
|
PLATE TUB L-K 3.5M 1/3 6H 74M
|
Facility
|
IP
|
$2,112.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$2,027.81 |
| Rate for Payer: Aetna Commercial |
$1,626.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.59
|
| Rate for Payer: Cash Price |
$1,056.15
|
| Rate for Payer: Cigna Commercial |
$1,753.21
|
| Rate for Payer: First Health Commercial |
$2,006.68
|
| Rate for Payer: Humana Commercial |
$1,795.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,732.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,584.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.81
|
| Rate for Payer: PHCS Commercial |
$2,027.81
|
| Rate for Payer: United Healthcare All Payer |
$1,858.82
|
|
|
PLATE TUB L-K 3.5M 1/3 7H 86M
|
Facility
|
IP
|
$2,194.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$2,106.43 |
| Rate for Payer: Aetna Commercial |
$1,689.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,711.48
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$1,821.19
|
| Rate for Payer: First Health Commercial |
$2,084.49
|
| Rate for Payer: Humana Commercial |
$1,865.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,799.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,619.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,930.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,645.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$680.20
|
| Rate for Payer: PHCS Commercial |
$2,106.43
|
| Rate for Payer: United Healthcare All Payer |
$1,930.90
|
|
|
PLATE TUB L-K 3.5M 1/3 7H 86M
|
Facility
|
OP
|
$2,194.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$2,106.43 |
| Rate for Payer: Aetna Commercial |
$1,689.53
|
| Rate for Payer: Anthem Medicaid |
$754.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,711.48
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$1,821.19
|
| Rate for Payer: First Health Commercial |
$2,084.49
|
| Rate for Payer: Humana Commercial |
$1,865.07
|
| Rate for Payer: Humana KY Medicaid |
$754.59
|
| Rate for Payer: Kentucky WC Medicaid |
$762.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,799.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,619.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,930.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,645.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$680.20
|
| Rate for Payer: PHCS Commercial |
$2,106.43
|
| Rate for Payer: United Healthcare All Payer |
$1,930.90
|
|
|
PLATE TUB L-K 3.5M 1/3 8H 98M
|
Facility
|
OP
|
$3,126.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.39 |
| Max. Negotiated Rate |
$3,001.06 |
| Rate for Payer: Aetna Commercial |
$2,407.10
|
| Rate for Payer: Anthem Medicaid |
$1,075.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,438.36
|
| Rate for Payer: Cash Price |
$1,563.05
|
| Rate for Payer: Cigna Commercial |
$2,594.66
|
| Rate for Payer: First Health Commercial |
$2,969.80
|
| Rate for Payer: Humana Commercial |
$2,657.18
|
| Rate for Payer: Humana KY Medicaid |
$1,075.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,086.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,563.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,307.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,096.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,344.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.09
|
| Rate for Payer: PHCS Commercial |
$3,001.06
|
| Rate for Payer: United Healthcare All Payer |
$2,750.97
|
|
|
PLATE TUB L-K 3.5M 1/3 8H 98M
|
Facility
|
IP
|
$3,126.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$406.39 |
| Max. Negotiated Rate |
$3,001.06 |
| Rate for Payer: Aetna Commercial |
$2,407.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,438.36
|
| Rate for Payer: Cash Price |
$1,563.05
|
| Rate for Payer: Cigna Commercial |
$2,594.66
|
| Rate for Payer: First Health Commercial |
$2,969.80
|
| Rate for Payer: Humana Commercial |
$2,657.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,563.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,307.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$937.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,750.97
|
| Rate for Payer: Ohio Health Group HMO |
$2,344.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$625.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$406.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$969.09
|
| Rate for Payer: PHCS Commercial |
$3,001.06
|
| Rate for Payer: United Healthcare All Payer |
$2,750.97
|
|
|
PLATE TUB LK 3.5MM 107MM 8H
|
Facility
|
OP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem Medicaid |
$675.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Humana KY Medicaid |
$675.80
|
| Rate for Payer: Kentucky WC Medicaid |
$682.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
|
|
PLATE TUB LK 3.5MM 107MM 8H
|
Facility
|
IP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
|
|
PLATE TUB LK 3.5MM 120MM 9H
|
Facility
|
OP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem Medicaid |
$662.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Humana KY Medicaid |
$662.45
|
| Rate for Payer: Kentucky WC Medicaid |
$669.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE TUB LK 3.5MM 120MM 9H
|
Facility
|
IP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE TUB LK 3.5MM 133MM 10H
|
Facility
|
OP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem Medicaid |
$675.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Humana KY Medicaid |
$675.80
|
| Rate for Payer: Kentucky WC Medicaid |
$682.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
|
|
PLATE TUB LK 3.5MM 133MM 10H
|
Facility
|
IP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
|
|
PLATE TUB LK 3.5MM 158MM 12H
|
Facility
|
OP
|
$1,984.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$1,905.17 |
| Rate for Payer: Aetna Commercial |
$1,528.10
|
| Rate for Payer: Anthem Medicaid |
$682.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.95
|
| Rate for Payer: Cash Price |
$992.28
|
| Rate for Payer: Cigna Commercial |
$1,647.18
|
| Rate for Payer: First Health Commercial |
$1,885.32
|
| Rate for Payer: Humana Commercial |
$1,686.87
|
| Rate for Payer: Humana KY Medicaid |
$682.49
|
| Rate for Payer: Kentucky WC Medicaid |
$689.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$696.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.21
|
| Rate for Payer: PHCS Commercial |
$1,905.17
|
| Rate for Payer: United Healthcare All Payer |
$1,746.40
|
|
|
PLATE TUB LK 3.5MM 158MM 12H
|
Facility
|
IP
|
$1,984.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$257.99 |
| Max. Negotiated Rate |
$1,905.17 |
| Rate for Payer: Aetna Commercial |
$1,528.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,547.95
|
| Rate for Payer: Cash Price |
$992.28
|
| Rate for Payer: Cigna Commercial |
$1,647.18
|
| Rate for Payer: First Health Commercial |
$1,885.32
|
| Rate for Payer: Humana Commercial |
$1,686.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,627.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,464.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$595.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,746.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,488.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$396.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$257.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$615.21
|
| Rate for Payer: PHCS Commercial |
$1,905.17
|
| Rate for Payer: United Healthcare All Payer |
$1,746.40
|
|
|
PLATE TUB LK 3.5MM 57MM 4H
|
Facility
|
OP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem Medicaid |
$660.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Humana KY Medicaid |
$660.22
|
| Rate for Payer: Kentucky WC Medicaid |
$666.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
|
|
PLATE TUB LK 3.5MM 57MM 4H
|
Facility
|
IP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
|
|
PLATE TUB LK 3.5MM 70MM 5H
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE TUB LK 3.5MM 70MM 5H
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE TUB LK 3.5MM 82MM 6H
|
Facility
|
IP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
|
|
PLATE TUB LK 3.5MM 82MM 6H
|
Facility
|
OP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Humana KY Medicaid |
$660.22
|
| Rate for Payer: Kentucky WC Medicaid |
$666.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem Medicaid |
$660.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
|
