|
PLATE ANTMC VOL DR LT STD
|
Facility
|
IP
|
$7,745.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,323.50 |
| Max. Negotiated Rate |
$7,435.20 |
| Rate for Payer: Aetna Commercial |
$5,963.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,041.10
|
| Rate for Payer: Cash Price |
$3,872.50
|
| Rate for Payer: Cigna Commercial |
$6,428.35
|
| Rate for Payer: First Health Commercial |
$7,357.75
|
| Rate for Payer: Humana Commercial |
$6,583.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,350.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,715.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,323.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,815.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,808.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,196.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,738.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,344.05
|
| Rate for Payer: PHCS Commercial |
$7,435.20
|
| Rate for Payer: United Healthcare All Payer |
$6,815.60
|
|
|
PLATE ANTMC VOL DR RT NAR
|
Facility
|
IP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE ANTMC VOL DR RT NAR
|
Facility
|
OP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem Medicaid |
$1,676.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Humana KY Medicaid |
$1,676.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,710.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE ANTMC VOL DR RT NAR LG
|
Facility
|
OP
|
$5,004.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,501.37 |
| Max. Negotiated Rate |
$4,804.40 |
| Rate for Payer: Aetna Commercial |
$3,853.53
|
| Rate for Payer: Anthem Medicaid |
$1,721.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,903.57
|
| Rate for Payer: Cash Price |
$2,502.29
|
| Rate for Payer: Cigna Commercial |
$4,153.80
|
| Rate for Payer: First Health Commercial |
$4,754.35
|
| Rate for Payer: Humana Commercial |
$4,253.89
|
| Rate for Payer: Humana KY Medicaid |
$1,721.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,738.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,103.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,693.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,755.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,404.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,753.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,003.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,353.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,453.16
|
| Rate for Payer: PHCS Commercial |
$4,804.40
|
| Rate for Payer: United Healthcare All Payer |
$4,404.03
|
|
|
PLATE ANTMC VOL DR RT NAR LG
|
Facility
|
IP
|
$5,004.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,501.37 |
| Max. Negotiated Rate |
$4,804.40 |
| Rate for Payer: Aetna Commercial |
$3,853.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,903.57
|
| Rate for Payer: Cash Price |
$2,502.29
|
| Rate for Payer: Cigna Commercial |
$4,153.80
|
| Rate for Payer: First Health Commercial |
$4,754.35
|
| Rate for Payer: Humana Commercial |
$4,253.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,103.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,693.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,404.03
|
| Rate for Payer: Ohio Health Group HMO |
$3,753.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,003.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,353.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,453.16
|
| Rate for Payer: PHCS Commercial |
$4,804.40
|
| Rate for Payer: United Healthcare All Payer |
$4,404.03
|
|
|
PLATE ANTMC VOL DR RT STD
|
Facility
|
IP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
|
PLATE ANTMC VOL DR RT STD
|
Facility
|
OP
|
$8,931.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,679.38 |
| Max. Negotiated Rate |
$8,574.00 |
| Rate for Payer: Aetna Commercial |
$6,877.06
|
| Rate for Payer: Anthem Medicaid |
$3,071.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.38
|
| Rate for Payer: Cash Price |
$4,465.62
|
| Rate for Payer: Cigna Commercial |
$7,412.94
|
| Rate for Payer: First Health Commercial |
$8,484.69
|
| Rate for Payer: Humana Commercial |
$7,591.56
|
| Rate for Payer: Humana KY Medicaid |
$3,071.46
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,133.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,145.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,770.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,162.56
|
| Rate for Payer: PHCS Commercial |
$8,574.00
|
| Rate for Payer: United Healthcare All Payer |
$7,859.50
|
|
|
PLATE ANTMC VOL DR RT STD LG
|
Facility
|
OP
|
$7,180.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.28 |
| Max. Negotiated Rate |
$6,893.69 |
| Rate for Payer: Aetna Commercial |
$5,529.32
|
| Rate for Payer: Anthem Medicaid |
$2,469.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,601.13
|
| Rate for Payer: Cash Price |
$3,590.46
|
| Rate for Payer: Cigna Commercial |
$5,960.17
|
| Rate for Payer: First Health Commercial |
$6,821.88
|
| Rate for Payer: Humana Commercial |
$6,103.79
|
| Rate for Payer: Humana KY Medicaid |
$2,469.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,888.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,299.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,519.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,319.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,744.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,247.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,954.84
|
| Rate for Payer: PHCS Commercial |
$6,893.69
|
| Rate for Payer: United Healthcare All Payer |
$6,319.22
|
|
|
PLATE ANTMC VOL DR RT STD LG
|
Facility
|
IP
|
$7,180.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.28 |
| Max. Negotiated Rate |
$6,893.69 |
| Rate for Payer: Aetna Commercial |
$5,529.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,601.13
|
| Rate for Payer: Cash Price |
$3,590.46
|
| Rate for Payer: Cigna Commercial |
$5,960.17
|
| Rate for Payer: First Health Commercial |
$6,821.88
|
| Rate for Payer: Humana Commercial |
$6,103.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,888.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,299.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,319.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,744.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,247.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,954.84
|
| Rate for Payer: PHCS Commercial |
$6,893.69
|
| Rate for Payer: United Healthcare All Payer |
$6,319.22
|
|
|
PLATE ANT PRCES LONG RIGHT
|
Facility
|
IP
|
$7,196.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.98 |
| Max. Negotiated Rate |
$6,908.73 |
| Rate for Payer: Aetna Commercial |
$5,541.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,613.34
|
| Rate for Payer: Cash Price |
$3,598.29
|
| Rate for Payer: Cigna Commercial |
$5,973.17
|
| Rate for Payer: First Health Commercial |
$6,836.76
|
| Rate for Payer: Humana Commercial |
$6,117.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,397.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,757.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,965.65
|
| Rate for Payer: PHCS Commercial |
$6,908.73
|
| Rate for Payer: United Healthcare All Payer |
$6,333.00
|
|
|
PLATE ANT PRCES LONG RIGHT
|
Facility
|
OP
|
$7,196.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.98 |
| Max. Negotiated Rate |
$6,908.73 |
| Rate for Payer: Aetna Commercial |
$5,541.37
|
| Rate for Payer: Anthem Medicaid |
$2,474.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,613.34
|
| Rate for Payer: Cash Price |
$3,598.29
|
| Rate for Payer: Cigna Commercial |
$5,973.17
|
| Rate for Payer: First Health Commercial |
$6,836.76
|
| Rate for Payer: Humana Commercial |
$6,117.10
|
| Rate for Payer: Humana KY Medicaid |
$2,474.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,500.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,901.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,311.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,333.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,397.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,757.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,261.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,965.65
|
| Rate for Payer: PHCS Commercial |
$6,908.73
|
| Rate for Payer: United Healthcare All Payer |
$6,333.00
|
|
|
PLATE AXSOS 3 DIS TIB 8H
|
Facility
|
IP
|
$9,972.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,991.89 |
| Max. Negotiated Rate |
$9,574.04 |
| Rate for Payer: Aetna Commercial |
$7,679.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,778.91
|
| Rate for Payer: Cash Price |
$4,986.48
|
| Rate for Payer: Cigna Commercial |
$8,277.56
|
| Rate for Payer: First Health Commercial |
$9,474.31
|
| Rate for Payer: Humana Commercial |
$8,477.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,177.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,360.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,991.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,776.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,479.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,978.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,676.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,881.34
|
| Rate for Payer: PHCS Commercial |
$9,574.04
|
| Rate for Payer: United Healthcare All Payer |
$8,776.20
|
|
|
PLATE AXSOS 3 DIS TIB 8H
|
Facility
|
OP
|
$9,972.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,991.89 |
| Max. Negotiated Rate |
$9,574.04 |
| Rate for Payer: Aetna Commercial |
$7,679.18
|
| Rate for Payer: Anthem Medicaid |
$3,429.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,778.91
|
| Rate for Payer: Cash Price |
$4,986.48
|
| Rate for Payer: Cigna Commercial |
$8,277.56
|
| Rate for Payer: First Health Commercial |
$9,474.31
|
| Rate for Payer: Humana Commercial |
$8,477.02
|
| Rate for Payer: Humana KY Medicaid |
$3,429.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,464.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,177.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,360.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,991.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,498.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,776.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,479.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,978.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,676.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,881.34
|
| Rate for Payer: PHCS Commercial |
$9,574.04
|
| Rate for Payer: United Healthcare All Payer |
$8,776.20
|
|
|
PLATE AXSOS 3 TI COMP 10H
|
Facility
|
IP
|
$8,158.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,447.55 |
| Max. Negotiated Rate |
$7,832.17 |
| Rate for Payer: Aetna Commercial |
$6,282.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.64
|
| Rate for Payer: Cash Price |
$4,079.25
|
| Rate for Payer: Cigna Commercial |
$6,771.56
|
| Rate for Payer: First Health Commercial |
$7,750.58
|
| Rate for Payer: Humana Commercial |
$6,934.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,526.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,097.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,629.37
|
| Rate for Payer: PHCS Commercial |
$7,832.17
|
| Rate for Payer: United Healthcare All Payer |
$7,179.49
|
|
|
PLATE AXSOS 3 TI COMP 10H
|
Facility
|
OP
|
$8,158.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,447.55 |
| Max. Negotiated Rate |
$7,832.17 |
| Rate for Payer: Aetna Commercial |
$6,282.05
|
| Rate for Payer: Anthem Medicaid |
$2,805.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.64
|
| Rate for Payer: Cash Price |
$4,079.25
|
| Rate for Payer: Cigna Commercial |
$6,771.56
|
| Rate for Payer: First Health Commercial |
$7,750.58
|
| Rate for Payer: Humana Commercial |
$6,934.73
|
| Rate for Payer: Humana KY Medicaid |
$2,805.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,862.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,526.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,097.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,629.37
|
| Rate for Payer: PHCS Commercial |
$7,832.17
|
| Rate for Payer: United Healthcare All Payer |
$7,179.49
|
|
|
PLATE AXSOS 3 TI COMP 7H
|
Facility
|
IP
|
$7,818.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.59 |
| Max. Negotiated Rate |
$7,505.88 |
| Rate for Payer: Aetna Commercial |
$6,020.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.52
|
| Rate for Payer: Cash Price |
$3,909.31
|
| Rate for Payer: Cigna Commercial |
$6,489.45
|
| Rate for Payer: First Health Commercial |
$7,427.69
|
| Rate for Payer: Humana Commercial |
$6,645.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,411.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,880.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,802.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.85
|
| Rate for Payer: PHCS Commercial |
$7,505.88
|
| Rate for Payer: United Healthcare All Payer |
$6,880.39
|
|
|
PLATE AXSOS 3 TI COMP 7H
|
Facility
|
OP
|
$7,818.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.59 |
| Max. Negotiated Rate |
$7,505.88 |
| Rate for Payer: Aetna Commercial |
$6,020.34
|
| Rate for Payer: Anthem Medicaid |
$2,688.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,098.52
|
| Rate for Payer: Cash Price |
$3,909.31
|
| Rate for Payer: Cigna Commercial |
$6,489.45
|
| Rate for Payer: First Health Commercial |
$7,427.69
|
| Rate for Payer: Humana Commercial |
$6,645.83
|
| Rate for Payer: Humana KY Medicaid |
$2,688.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,716.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,411.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,770.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,345.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,742.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,880.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,863.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,254.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,802.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,394.85
|
| Rate for Payer: PHCS Commercial |
$7,505.88
|
| Rate for Payer: United Healthcare All Payer |
$6,880.39
|
|
|
PLATE AXSOS 3 TI COMP 9H
|
Facility
|
OP
|
$8,158.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,447.55 |
| Max. Negotiated Rate |
$7,832.17 |
| Rate for Payer: Aetna Commercial |
$6,282.05
|
| Rate for Payer: Anthem Medicaid |
$2,805.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.64
|
| Rate for Payer: Cash Price |
$4,079.25
|
| Rate for Payer: Cigna Commercial |
$6,771.56
|
| Rate for Payer: First Health Commercial |
$7,750.58
|
| Rate for Payer: Humana Commercial |
$6,934.73
|
| Rate for Payer: Humana KY Medicaid |
$2,805.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,834.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,862.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,526.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,097.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,629.37
|
| Rate for Payer: PHCS Commercial |
$7,832.17
|
| Rate for Payer: United Healthcare All Payer |
$7,179.49
|
|
|
PLATE AXSOS 3 TI COMP 9H
|
Facility
|
IP
|
$8,158.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,447.55 |
| Max. Negotiated Rate |
$7,832.17 |
| Rate for Payer: Aetna Commercial |
$6,282.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,363.64
|
| Rate for Payer: Cash Price |
$4,079.25
|
| Rate for Payer: Cigna Commercial |
$6,771.56
|
| Rate for Payer: First Health Commercial |
$7,750.58
|
| Rate for Payer: Humana Commercial |
$6,934.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,689.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,020.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,179.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,118.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,526.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,097.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,629.37
|
| Rate for Payer: PHCS Commercial |
$7,832.17
|
| Rate for Payer: United Healthcare All Payer |
$7,179.49
|
|
|
PLATE AXSOS 4.0 TI COMP 12H
|
Facility
|
IP
|
$7,644.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.39 |
| Max. Negotiated Rate |
$7,338.84 |
| Rate for Payer: Aetna Commercial |
$5,886.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.80
|
| Rate for Payer: Cash Price |
$3,822.31
|
| Rate for Payer: Cigna Commercial |
$6,345.03
|
| Rate for Payer: First Health Commercial |
$7,262.39
|
| Rate for Payer: Humana Commercial |
$6,497.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,268.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,727.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,733.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,115.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,650.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,274.79
|
| Rate for Payer: PHCS Commercial |
$7,338.84
|
| Rate for Payer: United Healthcare All Payer |
$6,727.27
|
|
|
PLATE AXSOS 4.0 TI COMP 12H
|
Facility
|
OP
|
$7,644.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.39 |
| Max. Negotiated Rate |
$7,338.84 |
| Rate for Payer: Aetna Commercial |
$5,886.36
|
| Rate for Payer: Anthem Medicaid |
$2,628.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.80
|
| Rate for Payer: Cash Price |
$3,822.31
|
| Rate for Payer: Cigna Commercial |
$6,345.03
|
| Rate for Payer: First Health Commercial |
$7,262.39
|
| Rate for Payer: Humana Commercial |
$6,497.93
|
| Rate for Payer: Humana KY Medicaid |
$2,628.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,655.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,268.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,681.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,727.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,733.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,115.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,650.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,274.79
|
| Rate for Payer: PHCS Commercial |
$7,338.84
|
| Rate for Payer: United Healthcare All Payer |
$6,727.27
|
|
|
PLATE AXSOS 4.0 TI COMP 9H
|
Facility
|
OP
|
$7,644.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.41 |
| Max. Negotiated Rate |
$7,338.91 |
| Rate for Payer: Aetna Commercial |
$5,886.42
|
| Rate for Payer: Anthem Medicaid |
$2,629.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.87
|
| Rate for Payer: Cash Price |
$3,822.35
|
| Rate for Payer: Cigna Commercial |
$6,345.10
|
| Rate for Payer: First Health Commercial |
$7,262.47
|
| Rate for Payer: Humana Commercial |
$6,497.99
|
| Rate for Payer: Humana KY Medicaid |
$2,629.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,655.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,268.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,681.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,727.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,733.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,115.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,650.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,274.84
|
| Rate for Payer: PHCS Commercial |
$7,338.91
|
| Rate for Payer: United Healthcare All Payer |
$6,727.34
|
|
|
PLATE AXSOS 4.0 TI COMP 9H
|
Facility
|
IP
|
$7,644.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,293.41 |
| Max. Negotiated Rate |
$7,338.91 |
| Rate for Payer: Aetna Commercial |
$5,886.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,962.87
|
| Rate for Payer: Cash Price |
$3,822.35
|
| Rate for Payer: Cigna Commercial |
$6,345.10
|
| Rate for Payer: First Health Commercial |
$7,262.47
|
| Rate for Payer: Humana Commercial |
$6,497.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,268.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,641.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,293.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,727.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,733.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,115.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,650.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,274.84
|
| Rate for Payer: PHCS Commercial |
$7,338.91
|
| Rate for Payer: United Healthcare All Payer |
$6,727.34
|
|
|
PLATE AXSOS LAT HUM 12H L
|
Facility
|
IP
|
$10,122.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,036.66 |
| Max. Negotiated Rate |
$9,717.32 |
| Rate for Payer: Aetna Commercial |
$7,794.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,895.32
|
| Rate for Payer: Cash Price |
$5,061.10
|
| Rate for Payer: Cigna Commercial |
$8,401.43
|
| Rate for Payer: First Health Commercial |
$9,616.10
|
| Rate for Payer: Humana Commercial |
$8,603.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,300.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,470.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,036.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,907.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,591.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,097.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,806.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,984.32
|
| Rate for Payer: PHCS Commercial |
$9,717.32
|
| Rate for Payer: United Healthcare All Payer |
$8,907.54
|
|
|
PLATE AXSOS LAT HUM 12H L
|
Facility
|
OP
|
$10,122.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,036.66 |
| Max. Negotiated Rate |
$9,717.32 |
| Rate for Payer: Aetna Commercial |
$7,794.10
|
| Rate for Payer: Anthem Medicaid |
$3,481.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,895.32
|
| Rate for Payer: Cash Price |
$5,061.10
|
| Rate for Payer: Cigna Commercial |
$8,401.43
|
| Rate for Payer: First Health Commercial |
$9,616.10
|
| Rate for Payer: Humana Commercial |
$8,603.88
|
| Rate for Payer: Humana KY Medicaid |
$3,481.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,516.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,300.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,470.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,036.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,550.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,907.54
|
| Rate for Payer: Ohio Health Group HMO |
$7,591.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,097.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,806.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,984.32
|
| Rate for Payer: PHCS Commercial |
$9,717.32
|
| Rate for Payer: United Healthcare All Payer |
$8,907.54
|
|
