|
PLATE HUM LK PRX 11H L 4.5*195
|
Facility
|
IP
|
$9,093.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.13 |
| Max. Negotiated Rate |
$8,729.60 |
| Rate for Payer: Aetna Commercial |
$7,001.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.80
|
| Rate for Payer: Cash Price |
$4,546.66
|
| Rate for Payer: Cigna Commercial |
$7,547.46
|
| Rate for Payer: First Health Commercial |
$8,638.66
|
| Rate for Payer: Humana Commercial |
$7,729.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,456.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,002.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,820.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.93
|
| Rate for Payer: PHCS Commercial |
$8,729.60
|
| Rate for Payer: United Healthcare All Payer |
$8,002.13
|
|
|
PLATE HUM LK PRX 11H L 4.5*195
|
Facility
|
OP
|
$9,093.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.13 |
| Max. Negotiated Rate |
$8,729.60 |
| Rate for Payer: Aetna Commercial |
$7,001.86
|
| Rate for Payer: Anthem Medicaid |
$3,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.80
|
| Rate for Payer: Cash Price |
$4,546.66
|
| Rate for Payer: Cigna Commercial |
$7,547.46
|
| Rate for Payer: First Health Commercial |
$8,638.66
|
| Rate for Payer: Humana Commercial |
$7,729.33
|
| Rate for Payer: Humana KY Medicaid |
$3,127.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,456.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,002.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,820.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.93
|
| Rate for Payer: PHCS Commercial |
$8,729.60
|
| Rate for Payer: United Healthcare All Payer |
$8,002.13
|
|
|
PLATE HUM LK PRX 11H R 4.5*195
|
Facility
|
IP
|
$9,093.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.13 |
| Max. Negotiated Rate |
$8,729.60 |
| Rate for Payer: Aetna Commercial |
$7,001.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.80
|
| Rate for Payer: Cash Price |
$4,546.66
|
| Rate for Payer: Cigna Commercial |
$7,547.46
|
| Rate for Payer: First Health Commercial |
$8,638.66
|
| Rate for Payer: Humana Commercial |
$7,729.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,456.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,002.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,820.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.93
|
| Rate for Payer: PHCS Commercial |
$8,729.60
|
| Rate for Payer: United Healthcare All Payer |
$8,002.13
|
|
|
PLATE HUM LK PRX 11H R 4.5*195
|
Facility
|
OP
|
$9,093.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,182.13 |
| Max. Negotiated Rate |
$8,729.60 |
| Rate for Payer: Aetna Commercial |
$7,001.86
|
| Rate for Payer: Anthem Medicaid |
$3,127.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,092.80
|
| Rate for Payer: Cash Price |
$4,546.66
|
| Rate for Payer: Cigna Commercial |
$7,547.46
|
| Rate for Payer: First Health Commercial |
$8,638.66
|
| Rate for Payer: Humana Commercial |
$7,729.33
|
| Rate for Payer: Humana KY Medicaid |
$3,127.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,159.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,456.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,710.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,728.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,189.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,002.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,820.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,818.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,182.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,818.93
|
| Rate for Payer: PHCS Commercial |
$8,729.60
|
| Rate for Payer: United Healthcare All Payer |
$8,002.13
|
|
|
PLATE HUM LK PRX 13H L 3.5*216
|
Facility
|
OP
|
$8,478.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.25 |
| Max. Negotiated Rate |
$8,139.70 |
| Rate for Payer: Aetna Commercial |
$6,528.71
|
| Rate for Payer: Anthem Medicaid |
$2,915.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,613.50
|
| Rate for Payer: Cash Price |
$4,239.43
|
| Rate for Payer: Cigna Commercial |
$7,037.45
|
| Rate for Payer: First Health Commercial |
$8,054.91
|
| Rate for Payer: Humana Commercial |
$7,207.02
|
| Rate for Payer: Humana KY Medicaid |
$2,915.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,945.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,952.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,257.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,543.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,974.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,461.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,359.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,695.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,628.44
|
| Rate for Payer: PHCS Commercial |
$8,139.70
|
| Rate for Payer: United Healthcare All Payer |
$7,461.39
|
|
|
PLATE HUM LK PRX 13H L 3.5*216
|
Facility
|
IP
|
$8,478.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,102.25 |
| Max. Negotiated Rate |
$8,139.70 |
| Rate for Payer: Aetna Commercial |
$6,528.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,613.50
|
| Rate for Payer: Cash Price |
$4,239.43
|
| Rate for Payer: Cigna Commercial |
$7,037.45
|
| Rate for Payer: First Health Commercial |
$8,054.91
|
| Rate for Payer: Humana Commercial |
$7,207.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,952.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,257.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,543.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,461.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,359.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,695.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,102.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,628.44
|
| Rate for Payer: PHCS Commercial |
$8,139.70
|
| Rate for Payer: United Healthcare All Payer |
$7,461.39
|
|
|
PLATE HUM LK PRX 13H L 4.5*220
|
Facility
|
IP
|
$9,289.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.59 |
| Max. Negotiated Rate |
$8,917.58 |
| Rate for Payer: Aetna Commercial |
$7,152.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.54
|
| Rate for Payer: Cash Price |
$4,644.58
|
| Rate for Payer: Cigna Commercial |
$7,709.99
|
| Rate for Payer: First Health Commercial |
$8,824.69
|
| Rate for Payer: Humana Commercial |
$7,895.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,617.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.64
|
| Rate for Payer: PHCS Commercial |
$8,917.58
|
| Rate for Payer: United Healthcare All Payer |
$8,174.45
|
|
|
PLATE HUM LK PRX 13H L 4.5*220
|
Facility
|
OP
|
$9,289.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.59 |
| Max. Negotiated Rate |
$8,917.58 |
| Rate for Payer: Humana Commercial |
$7,895.78
|
| Rate for Payer: Humana KY Medicaid |
$3,194.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,227.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,617.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.64
|
| Rate for Payer: PHCS Commercial |
$8,917.58
|
| Rate for Payer: United Healthcare All Payer |
$8,174.45
|
| Rate for Payer: Aetna Commercial |
$7,152.65
|
| Rate for Payer: Anthem Medicaid |
$3,194.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.54
|
| Rate for Payer: Cash Price |
$4,644.58
|
| Rate for Payer: Cigna Commercial |
$7,709.99
|
| Rate for Payer: First Health Commercial |
$8,824.69
|
|
|
PLATE HUM LK PRX 13H R 4.5*220
|
Facility
|
IP
|
$9,289.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.59 |
| Max. Negotiated Rate |
$8,917.58 |
| Rate for Payer: Aetna Commercial |
$7,152.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.54
|
| Rate for Payer: Cash Price |
$4,644.58
|
| Rate for Payer: Cigna Commercial |
$7,709.99
|
| Rate for Payer: First Health Commercial |
$8,824.69
|
| Rate for Payer: Humana Commercial |
$7,895.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,617.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.64
|
| Rate for Payer: PHCS Commercial |
$8,917.58
|
| Rate for Payer: United Healthcare All Payer |
$8,174.45
|
|
|
PLATE HUM LK PRX 13H R 4.5*220
|
Facility
|
OP
|
$9,289.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.59 |
| Max. Negotiated Rate |
$8,917.58 |
| Rate for Payer: Aetna Commercial |
$7,152.65
|
| Rate for Payer: Anthem Medicaid |
$3,194.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,245.54
|
| Rate for Payer: Cash Price |
$4,644.58
|
| Rate for Payer: Cigna Commercial |
$7,709.99
|
| Rate for Payer: First Health Commercial |
$8,824.69
|
| Rate for Payer: Humana Commercial |
$7,895.78
|
| Rate for Payer: Humana KY Medicaid |
$3,194.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,227.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,617.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,855.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,786.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,258.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,174.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,966.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,857.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,207.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,879.64
|
| Rate for Payer: PHCS Commercial |
$8,917.58
|
| Rate for Payer: United Healthcare All Payer |
$8,174.45
|
|
|
PLATE HUM LK PRX 15H R 4.5*246
|
Facility
|
OP
|
$9,511.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.56 |
| Max. Negotiated Rate |
$9,131.51 |
| Rate for Payer: Aetna Commercial |
$7,324.23
|
| Rate for Payer: Anthem Medicaid |
$3,271.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.35
|
| Rate for Payer: Cash Price |
$4,755.99
|
| Rate for Payer: Cigna Commercial |
$7,894.95
|
| Rate for Payer: First Health Commercial |
$9,036.39
|
| Rate for Payer: Humana Commercial |
$8,085.19
|
| Rate for Payer: Humana KY Medicaid |
$3,271.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,304.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,336.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,948.72
|
| Rate for Payer: PHCS Commercial |
$9,131.51
|
| Rate for Payer: United Healthcare All Payer |
$8,370.55
|
|
|
PLATE HUM LK PRX 15H R 4.5*246
|
Facility
|
IP
|
$9,511.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.56 |
| Max. Negotiated Rate |
$9,131.51 |
| Rate for Payer: Aetna Commercial |
$7,324.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.35
|
| Rate for Payer: Cash Price |
$4,755.99
|
| Rate for Payer: Cigna Commercial |
$7,894.95
|
| Rate for Payer: First Health Commercial |
$9,036.39
|
| Rate for Payer: Humana Commercial |
$8,085.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,948.72
|
| Rate for Payer: PHCS Commercial |
$9,131.51
|
| Rate for Payer: United Healthcare All Payer |
$8,370.55
|
|
|
PLATE HUM LK PRX 3H L 3.5*89
|
Facility
|
OP
|
$7,682.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.76 |
| Max. Negotiated Rate |
$7,375.48 |
| Rate for Payer: Aetna Commercial |
$5,915.75
|
| Rate for Payer: Anthem Medicaid |
$2,642.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.58
|
| Rate for Payer: Cash Price |
$3,841.39
|
| Rate for Payer: Cigna Commercial |
$6,376.72
|
| Rate for Payer: First Health Commercial |
$7,298.65
|
| Rate for Payer: Humana Commercial |
$6,530.37
|
| Rate for Payer: Humana KY Medicaid |
$2,642.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,669.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,695.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.66
|
| Rate for Payer: PHCS Commercial |
$7,375.48
|
| Rate for Payer: United Healthcare All Payer |
$6,760.86
|
|
|
PLATE HUM LK PRX 3H L 3.5*89
|
Facility
|
IP
|
$7,682.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.76 |
| Max. Negotiated Rate |
$7,375.48 |
| Rate for Payer: Aetna Commercial |
$5,915.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.58
|
| Rate for Payer: Cash Price |
$3,841.39
|
| Rate for Payer: Cigna Commercial |
$6,376.72
|
| Rate for Payer: First Health Commercial |
$7,298.65
|
| Rate for Payer: Humana Commercial |
$6,530.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,762.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.66
|
| Rate for Payer: PHCS Commercial |
$7,375.48
|
| Rate for Payer: United Healthcare All Payer |
$6,760.86
|
|
|
PLATE HUM LK PRX 3H L 4.5*93
|
Facility
|
OP
|
$8,357.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.45 |
| Max. Negotiated Rate |
$8,023.02 |
| Rate for Payer: Aetna Commercial |
$6,435.13
|
| Rate for Payer: Anthem Medicaid |
$2,874.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.70
|
| Rate for Payer: Cash Price |
$4,178.65
|
| Rate for Payer: Cigna Commercial |
$6,936.57
|
| Rate for Payer: First Health Commercial |
$7,939.44
|
| Rate for Payer: Humana Commercial |
$7,103.71
|
| Rate for Payer: Humana KY Medicaid |
$2,874.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,931.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,354.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.77
|
| Rate for Payer: PHCS Commercial |
$8,023.02
|
| Rate for Payer: United Healthcare All Payer |
$7,354.43
|
|
|
PLATE HUM LK PRX 3H L 4.5*93
|
Facility
|
IP
|
$8,357.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.45 |
| Max. Negotiated Rate |
$8,023.02 |
| Rate for Payer: Aetna Commercial |
$6,435.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.70
|
| Rate for Payer: Cash Price |
$4,178.65
|
| Rate for Payer: Cigna Commercial |
$6,936.57
|
| Rate for Payer: First Health Commercial |
$7,939.44
|
| Rate for Payer: Humana Commercial |
$7,103.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,354.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.77
|
| Rate for Payer: PHCS Commercial |
$8,023.02
|
| Rate for Payer: United Healthcare All Payer |
$7,354.43
|
|
|
PLATE HUM LK PRX 3H R 4.5*93
|
Facility
|
OP
|
$8,357.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.45 |
| Max. Negotiated Rate |
$8,023.02 |
| Rate for Payer: Aetna Commercial |
$6,435.13
|
| Rate for Payer: Anthem Medicaid |
$2,874.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.70
|
| Rate for Payer: Cash Price |
$4,178.65
|
| Rate for Payer: Cigna Commercial |
$6,936.57
|
| Rate for Payer: First Health Commercial |
$7,939.44
|
| Rate for Payer: Humana Commercial |
$7,103.71
|
| Rate for Payer: Humana KY Medicaid |
$2,874.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,931.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,354.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.77
|
| Rate for Payer: PHCS Commercial |
$8,023.02
|
| Rate for Payer: United Healthcare All Payer |
$7,354.43
|
|
|
PLATE HUM LK PRX 3H R 4.5*93
|
Facility
|
IP
|
$8,357.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.45 |
| Max. Negotiated Rate |
$8,023.02 |
| Rate for Payer: Aetna Commercial |
$6,435.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.70
|
| Rate for Payer: Cash Price |
$4,178.65
|
| Rate for Payer: Cigna Commercial |
$6,936.57
|
| Rate for Payer: First Health Commercial |
$7,939.44
|
| Rate for Payer: Humana Commercial |
$7,103.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,354.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.77
|
| Rate for Payer: PHCS Commercial |
$8,023.02
|
| Rate for Payer: United Healthcare All Payer |
$7,354.43
|
|
|
PLATE HUM LK PRX 5H L 3.5*115
|
Facility
|
IP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
|
|
PLATE HUM LK PRX 5H L 3.5*115
|
Facility
|
OP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem Medicaid |
$2,690.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Humana KY Medicaid |
$2,690.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,718.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,744.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
|
|
PLATE HUM LK PRX 5H L 4.5*119
|
Facility
|
OP
|
$8,566.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.66 |
| Max. Negotiated Rate |
$8,223.97 |
| Rate for Payer: Aetna Commercial |
$6,596.31
|
| Rate for Payer: Anthem Medicaid |
$2,946.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.98
|
| Rate for Payer: Cash Price |
$4,283.32
|
| Rate for Payer: Cigna Commercial |
$7,110.31
|
| Rate for Payer: First Health Commercial |
$8,138.31
|
| Rate for Payer: Humana Commercial |
$7,281.64
|
| Rate for Payer: Humana KY Medicaid |
$2,946.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.66
|
| Rate for Payer: PHCS Commercial |
$8,223.97
|
| Rate for Payer: United Healthcare All Payer |
$7,538.64
|
|
|
PLATE HUM LK PRX 5H L 4.5*119
|
Facility
|
IP
|
$8,566.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.66 |
| Max. Negotiated Rate |
$8,223.97 |
| Rate for Payer: Aetna Commercial |
$6,596.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.98
|
| Rate for Payer: Cash Price |
$4,283.32
|
| Rate for Payer: Cigna Commercial |
$7,110.31
|
| Rate for Payer: First Health Commercial |
$8,138.31
|
| Rate for Payer: Humana Commercial |
$7,281.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.66
|
| Rate for Payer: PHCS Commercial |
$8,223.97
|
| Rate for Payer: United Healthcare All Payer |
$7,538.64
|
|
|
PLATE HUM LK PRX 5H R 4.5*119
|
Facility
|
OP
|
$8,566.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.66 |
| Max. Negotiated Rate |
$8,223.97 |
| Rate for Payer: Aetna Commercial |
$6,596.31
|
| Rate for Payer: Anthem Medicaid |
$2,946.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.98
|
| Rate for Payer: Cash Price |
$4,283.32
|
| Rate for Payer: Cigna Commercial |
$7,110.31
|
| Rate for Payer: First Health Commercial |
$8,138.31
|
| Rate for Payer: Humana Commercial |
$7,281.64
|
| Rate for Payer: Humana KY Medicaid |
$2,946.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,976.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,005.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.66
|
| Rate for Payer: PHCS Commercial |
$8,223.97
|
| Rate for Payer: United Healthcare All Payer |
$7,538.64
|
|
|
PLATE HUM LK PRX 5H R 4.5*119
|
Facility
|
IP
|
$8,566.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.66 |
| Max. Negotiated Rate |
$8,223.97 |
| Rate for Payer: Aetna Commercial |
$6,596.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,681.98
|
| Rate for Payer: Cash Price |
$4,283.32
|
| Rate for Payer: Cigna Commercial |
$7,110.31
|
| Rate for Payer: First Health Commercial |
$8,138.31
|
| Rate for Payer: Humana Commercial |
$7,281.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,024.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,322.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,569.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,538.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,424.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,713.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,113.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,655.66
|
| Rate for Payer: PHCS Commercial |
$8,223.97
|
| Rate for Payer: United Healthcare All Payer |
$7,538.64
|
|
|
PLATE HUM LK PRX 7H L 3.5*140
|
Facility
|
IP
|
$7,823.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.10 |
| Max. Negotiated Rate |
$7,510.91 |
| Rate for Payer: Aetna Commercial |
$6,024.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,102.61
|
| Rate for Payer: Cash Price |
$3,911.93
|
| Rate for Payer: Cigna Commercial |
$6,493.80
|
| Rate for Payer: First Health Commercial |
$7,432.67
|
| Rate for Payer: Humana Commercial |
$6,650.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,415.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,774.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,347.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,885.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,867.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,564.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,017.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,425.40
|
| Rate for Payer: PHCS Commercial |
$7,510.91
|
| Rate for Payer: United Healthcare All Payer |
$6,885.00
|
|
