|
PLATE L PROFYLE M COMP RI 6H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE L PROFYLE M COMP RI 6H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
| Rate for Payer: Aetna Commercial |
$3,052.28
|
|
|
PLATE LP TB LK 3.5M 10H 149M L
|
Facility
|
IP
|
$8,647.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.20 |
| Max. Negotiated Rate |
$8,301.76 |
| Rate for Payer: Aetna Commercial |
$6,658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.18
|
| Rate for Payer: Cash Price |
$4,323.83
|
| Rate for Payer: Cigna Commercial |
$7,177.57
|
| Rate for Payer: First Health Commercial |
$8,215.29
|
| Rate for Payer: Humana Commercial |
$7,350.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.78
|
| Rate for Payer: PHCS Commercial |
$8,301.76
|
| Rate for Payer: United Healthcare All Payer |
$7,609.95
|
|
|
PLATE LP TB LK 3.5M 10H 149M L
|
Facility
|
OP
|
$8,647.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.20 |
| Max. Negotiated Rate |
$8,301.76 |
| Rate for Payer: Aetna Commercial |
$6,658.71
|
| Rate for Payer: Anthem Medicaid |
$2,973.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.18
|
| Rate for Payer: Cash Price |
$4,323.83
|
| Rate for Payer: Cigna Commercial |
$7,177.57
|
| Rate for Payer: First Health Commercial |
$8,215.29
|
| Rate for Payer: Humana Commercial |
$7,350.52
|
| Rate for Payer: Humana KY Medicaid |
$2,973.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,004.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.78
|
| Rate for Payer: PHCS Commercial |
$8,301.76
|
| Rate for Payer: United Healthcare All Payer |
$7,609.95
|
|
|
PLATE LP TB LK 3.5M 10H 149M R
|
Facility
|
OP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem Medicaid |
$2,953.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Humana KY Medicaid |
$2,953.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,983.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,012.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE LP TB LK 3.5M 10H 149M R
|
Facility
|
IP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE LP TB LK 3.5M 13H 187M R
|
Facility
|
IP
|
$8,742.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.49 |
| Max. Negotiated Rate |
$8,392.51 |
| Rate for Payer: Aetna Commercial |
$6,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,818.92
|
| Rate for Payer: Cash Price |
$4,371.10
|
| Rate for Payer: Cigna Commercial |
$7,256.03
|
| Rate for Payer: First Health Commercial |
$8,305.09
|
| Rate for Payer: Humana Commercial |
$7,430.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,168.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,451.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,622.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,693.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,556.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,710.08
|
| Rate for Payer: PHCS Commercial |
$8,392.51
|
| Rate for Payer: United Healthcare All Payer |
$7,693.14
|
|
|
PLATE LP TB LK 3.5M 13H 187M R
|
Facility
|
OP
|
$8,742.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.49 |
| Max. Negotiated Rate |
$8,392.51 |
| Rate for Payer: Aetna Commercial |
$6,731.49
|
| Rate for Payer: Anthem Medicaid |
$3,006.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,818.92
|
| Rate for Payer: Cash Price |
$4,371.10
|
| Rate for Payer: Cigna Commercial |
$7,256.03
|
| Rate for Payer: First Health Commercial |
$8,305.09
|
| Rate for Payer: Humana Commercial |
$7,430.87
|
| Rate for Payer: Humana KY Medicaid |
$3,006.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,037.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,168.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,451.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,622.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,066.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,693.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,556.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,710.08
|
| Rate for Payer: PHCS Commercial |
$8,392.51
|
| Rate for Payer: United Healthcare All Payer |
$7,693.14
|
|
|
PLATE LP TB LK 3.5M 8H 123M L
|
Facility
|
IP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE LP TB LK 3.5M 8H 123M L
|
Facility
|
OP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem Medicaid |
$2,953.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Humana KY Medicaid |
$2,953.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,983.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,012.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE LP TB LK 4.5M 10H 201M L
|
Facility
|
IP
|
$7,783.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.83 |
| Max. Negotiated Rate |
$7,472.01 |
| Rate for Payer: Aetna Commercial |
$5,993.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,071.01
|
| Rate for Payer: Cash Price |
$3,891.67
|
| Rate for Payer: Cigna Commercial |
$6,460.17
|
| Rate for Payer: First Health Commercial |
$7,394.17
|
| Rate for Payer: Humana Commercial |
$6,615.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,382.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,744.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,335.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,849.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.84
|
| Rate for Payer: PHCS Commercial |
$7,472.01
|
| Rate for Payer: United Healthcare All Payer |
$6,849.34
|
|
|
PLATE LP TB LK 4.5M 10H 201M L
|
Facility
|
OP
|
$7,783.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.83 |
| Max. Negotiated Rate |
$7,472.01 |
| Rate for Payer: Aetna Commercial |
$5,993.17
|
| Rate for Payer: Anthem Medicaid |
$2,676.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,071.01
|
| Rate for Payer: Cash Price |
$3,891.67
|
| Rate for Payer: Cigna Commercial |
$6,460.17
|
| Rate for Payer: First Health Commercial |
$7,394.17
|
| Rate for Payer: Humana Commercial |
$6,615.84
|
| Rate for Payer: Humana KY Medicaid |
$2,676.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,382.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,744.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,335.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,730.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,849.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,837.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.84
|
| Rate for Payer: PHCS Commercial |
$7,472.01
|
| Rate for Payer: United Healthcare All Payer |
$6,849.34
|
|
|
PLATE LP TB LK 4.5M 13H 255M L
|
Facility
|
OP
|
$8,731.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.06 |
| Max. Negotiated Rate |
$8,382.00 |
| Rate for Payer: Aetna Commercial |
$6,723.06
|
| Rate for Payer: Anthem Medicaid |
$3,002.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
| Rate for Payer: Cash Price |
$4,365.62
|
| Rate for Payer: Cigna Commercial |
$7,246.94
|
| Rate for Payer: First Health Commercial |
$8,294.69
|
| Rate for Payer: Humana Commercial |
$7,421.56
|
| Rate for Payer: Humana KY Medicaid |
$3,002.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,033.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,062.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
| Rate for Payer: PHCS Commercial |
$8,382.00
|
| Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
|
PLATE LP TB LK 4.5M 13H 255M L
|
Facility
|
IP
|
$8,731.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,135.06 |
| Max. Negotiated Rate |
$8,382.00 |
| Rate for Payer: Aetna Commercial |
$6,723.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,810.38
|
| Rate for Payer: Cash Price |
$4,365.62
|
| Rate for Payer: Cigna Commercial |
$7,246.94
|
| Rate for Payer: First Health Commercial |
$8,294.69
|
| Rate for Payer: Humana Commercial |
$7,421.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,159.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,443.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,619.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,683.50
|
| Rate for Payer: Ohio Health Group HMO |
$6,548.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,746.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,135.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,706.69
|
| Rate for Payer: PHCS Commercial |
$8,382.00
|
| Rate for Payer: United Healthcare All Payer |
$7,683.50
|
|
|
PLATE LP TB LK 4.5M 16H 309M L
|
Facility
|
OP
|
$8,809.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.26 |
| Max. Negotiated Rate |
$8,457.34 |
| Rate for Payer: Aetna Commercial |
$6,783.49
|
| Rate for Payer: Anthem Medicaid |
$3,029.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,871.59
|
| Rate for Payer: Cash Price |
$4,404.86
|
| Rate for Payer: Cigna Commercial |
$7,312.08
|
| Rate for Payer: First Health Commercial |
$8,369.24
|
| Rate for Payer: Humana Commercial |
$7,488.27
|
| Rate for Payer: Humana KY Medicaid |
$3,029.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,501.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,607.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,761.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.02
|
| Rate for Payer: PHCS Commercial |
$8,457.34
|
| Rate for Payer: United Healthcare All Payer |
$7,752.56
|
|
|
PLATE LP TB LK 4.5M 16H 309M L
|
Facility
|
IP
|
$8,809.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.26 |
| Max. Negotiated Rate |
$8,457.34 |
| Rate for Payer: Humana Commercial |
$7,488.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,501.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,607.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,761.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.02
|
| Rate for Payer: PHCS Commercial |
$8,457.34
|
| Rate for Payer: United Healthcare All Payer |
$7,752.56
|
| Rate for Payer: Aetna Commercial |
$6,783.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,871.59
|
| Rate for Payer: Cash Price |
$4,404.86
|
| Rate for Payer: Cigna Commercial |
$7,312.08
|
| Rate for Payer: First Health Commercial |
$8,369.24
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M L
|
Facility
|
OP
|
$8,451.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.74 |
| Max. Negotiated Rate |
$8,113.77 |
| Rate for Payer: Aetna Commercial |
$6,507.92
|
| Rate for Payer: Anthem Medicaid |
$2,906.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,592.44
|
| Rate for Payer: Cash Price |
$4,225.92
|
| Rate for Payer: Cigna Commercial |
$7,015.03
|
| Rate for Payer: First Health Commercial |
$8,029.25
|
| Rate for Payer: Humana Commercial |
$7,184.06
|
| Rate for Payer: Humana KY Medicaid |
$2,906.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,936.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,930.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,964.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,437.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,338.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.07
|
| Rate for Payer: PHCS Commercial |
$8,113.77
|
| Rate for Payer: United Healthcare All Payer |
$7,437.62
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M L
|
Facility
|
IP
|
$8,451.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.74 |
| Max. Negotiated Rate |
$8,113.77 |
| Rate for Payer: Aetna Commercial |
$6,507.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,592.44
|
| Rate for Payer: Cash Price |
$4,225.92
|
| Rate for Payer: Cigna Commercial |
$7,015.03
|
| Rate for Payer: First Health Commercial |
$8,029.25
|
| Rate for Payer: Humana Commercial |
$7,184.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,930.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,437.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,338.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.07
|
| Rate for Payer: PHCS Commercial |
$8,113.77
|
| Rate for Payer: United Healthcare All Payer |
$7,437.62
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M R
|
Facility
|
OP
|
$8,451.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.74 |
| Max. Negotiated Rate |
$8,113.77 |
| Rate for Payer: Aetna Commercial |
$6,507.92
|
| Rate for Payer: Anthem Medicaid |
$2,906.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,592.44
|
| Rate for Payer: Cash Price |
$4,225.92
|
| Rate for Payer: Cigna Commercial |
$7,015.03
|
| Rate for Payer: First Health Commercial |
$8,029.25
|
| Rate for Payer: Humana Commercial |
$7,184.06
|
| Rate for Payer: Humana KY Medicaid |
$2,906.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,936.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,930.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,964.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,437.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,338.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.07
|
| Rate for Payer: PHCS Commercial |
$8,113.77
|
| Rate for Payer: United Healthcare All Payer |
$7,437.62
|
|
|
PLATE L-P TIB LK 3.5M 4H 73M R
|
Facility
|
IP
|
$8,451.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.74 |
| Max. Negotiated Rate |
$8,113.77 |
| Rate for Payer: Aetna Commercial |
$6,507.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,592.44
|
| Rate for Payer: Cash Price |
$4,225.92
|
| Rate for Payer: Cigna Commercial |
$7,015.03
|
| Rate for Payer: First Health Commercial |
$8,029.25
|
| Rate for Payer: Humana Commercial |
$7,184.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,930.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,437.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,338.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.07
|
| Rate for Payer: PHCS Commercial |
$8,113.77
|
| Rate for Payer: United Healthcare All Payer |
$7,437.62
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M L
|
Facility
|
IP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M L
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M R
|
Facility
|
IP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE L-P TIB LK 3.5M 6H 98M R
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
|
|
PLATE LP TIB LK 3.5M 8H 123M R
|
Facility
|
OP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem Medicaid |
$2,953.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Humana KY Medicaid |
$2,953.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,983.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,012.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
