|
PLATE MD PROX LCP 4.5 6H 142 L
|
Facility
|
OP
|
$6,856.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.34 |
| Max. Negotiated Rate |
$6,582.17 |
| Rate for Payer: Aetna Commercial |
$5,279.45
|
| Rate for Payer: Anthem Medicaid |
$2,357.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,348.02
|
| Rate for Payer: Cash Price |
$3,428.21
|
| Rate for Payer: Cigna Commercial |
$5,690.84
|
| Rate for Payer: First Health Commercial |
$6,513.61
|
| Rate for Payer: Humana Commercial |
$5,827.97
|
| Rate for Payer: Humana KY Medicaid |
$2,357.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,381.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,622.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,060.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,056.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,405.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,033.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,142.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,125.49
|
| Rate for Payer: PHCS Commercial |
$6,582.17
|
| Rate for Payer: United Healthcare All Payer |
$6,033.66
|
|
|
PLATE MD PROX LCP 4.5 6H 142 L
|
Facility
|
IP
|
$6,856.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.34 |
| Max. Negotiated Rate |
$6,582.17 |
| Rate for Payer: Aetna Commercial |
$5,279.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,348.02
|
| Rate for Payer: Cash Price |
$3,428.21
|
| Rate for Payer: Cigna Commercial |
$5,690.84
|
| Rate for Payer: First Health Commercial |
$6,513.61
|
| Rate for Payer: Humana Commercial |
$5,827.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,622.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,060.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,056.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,033.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,142.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,125.49
|
| Rate for Payer: PHCS Commercial |
$6,582.17
|
| Rate for Payer: United Healthcare All Payer |
$6,033.66
|
|
|
PLATE MD PROX LCP 4.5 6H 142 R
|
Facility
|
IP
|
$6,856.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.34 |
| Max. Negotiated Rate |
$6,582.17 |
| Rate for Payer: Aetna Commercial |
$5,279.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,348.02
|
| Rate for Payer: Cash Price |
$3,428.21
|
| Rate for Payer: Cigna Commercial |
$5,690.84
|
| Rate for Payer: First Health Commercial |
$6,513.61
|
| Rate for Payer: Humana Commercial |
$5,827.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,622.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,060.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,056.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,033.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,142.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,125.49
|
| Rate for Payer: PHCS Commercial |
$6,582.17
|
| Rate for Payer: United Healthcare All Payer |
$6,033.66
|
|
|
PLATE MD PROX LCP 4.5 6H 142 R
|
Facility
|
OP
|
$6,856.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$891.34 |
| Max. Negotiated Rate |
$6,582.17 |
| Rate for Payer: Aetna Commercial |
$5,279.45
|
| Rate for Payer: Anthem Medicaid |
$2,357.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,348.02
|
| Rate for Payer: Cash Price |
$3,428.21
|
| Rate for Payer: Cigna Commercial |
$5,690.84
|
| Rate for Payer: First Health Commercial |
$6,513.61
|
| Rate for Payer: Humana Commercial |
$5,827.97
|
| Rate for Payer: Humana KY Medicaid |
$2,357.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,381.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,622.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,060.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,056.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,405.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,033.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,142.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,371.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$891.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,125.49
|
| Rate for Payer: PHCS Commercial |
$6,582.17
|
| Rate for Payer: United Healthcare All Payer |
$6,033.66
|
|
|
PLATE MD PROX LCP 4.5 8H 178 R
|
Facility
|
IP
|
$6,903.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.51 |
| Max. Negotiated Rate |
$6,627.79 |
| Rate for Payer: Humana Commercial |
$5,868.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,661.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,095.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,075.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,177.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.22
|
| Rate for Payer: PHCS Commercial |
$6,627.79
|
| Rate for Payer: United Healthcare All Payer |
$6,075.48
|
| Rate for Payer: Aetna Commercial |
$5,316.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,385.08
|
| Rate for Payer: Cash Price |
$3,451.98
|
| Rate for Payer: Cigna Commercial |
$5,730.28
|
| Rate for Payer: First Health Commercial |
$6,558.75
|
|
|
PLATE MD PROX LCP 4.5 8H 178 R
|
Facility
|
OP
|
$6,903.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.51 |
| Max. Negotiated Rate |
$6,627.79 |
| Rate for Payer: Aetna Commercial |
$5,316.04
|
| Rate for Payer: Anthem Medicaid |
$2,374.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,385.08
|
| Rate for Payer: Cash Price |
$3,451.98
|
| Rate for Payer: Cigna Commercial |
$5,730.28
|
| Rate for Payer: First Health Commercial |
$6,558.75
|
| Rate for Payer: Humana Commercial |
$5,868.36
|
| Rate for Payer: Humana KY Medicaid |
$2,374.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,661.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,095.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,421.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,075.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,177.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.22
|
| Rate for Payer: PHCS Commercial |
$6,627.79
|
| Rate for Payer: United Healthcare All Payer |
$6,075.48
|
|
|
PLATE MD PRX LCP 4.5 10H 214 L
|
Facility
|
OP
|
$6,948.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.25 |
| Max. Negotiated Rate |
$6,670.12 |
| Rate for Payer: Aetna Commercial |
$5,349.99
|
| Rate for Payer: Anthem Medicaid |
$2,389.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,419.47
|
| Rate for Payer: Cash Price |
$3,474.02
|
| Rate for Payer: Cigna Commercial |
$5,766.87
|
| Rate for Payer: First Health Commercial |
$6,600.64
|
| Rate for Payer: Humana Commercial |
$5,905.83
|
| Rate for Payer: Humana KY Medicaid |
$2,389.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,697.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,127.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,114.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.89
|
| Rate for Payer: PHCS Commercial |
$6,670.12
|
| Rate for Payer: United Healthcare All Payer |
$6,114.28
|
|
|
PLATE MD PRX LCP 4.5 10H 214 L
|
Facility
|
IP
|
$6,948.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.25 |
| Max. Negotiated Rate |
$6,670.12 |
| Rate for Payer: Aetna Commercial |
$5,349.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,419.47
|
| Rate for Payer: Cash Price |
$3,474.02
|
| Rate for Payer: Cigna Commercial |
$5,766.87
|
| Rate for Payer: First Health Commercial |
$6,600.64
|
| Rate for Payer: Humana Commercial |
$5,905.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,697.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,127.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,114.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.89
|
| Rate for Payer: PHCS Commercial |
$6,670.12
|
| Rate for Payer: United Healthcare All Payer |
$6,114.28
|
|
|
PLATE MD PRX LCP 4.5 10H 214 R
|
Facility
|
OP
|
$6,948.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.25 |
| Max. Negotiated Rate |
$6,670.12 |
| Rate for Payer: Aetna Commercial |
$5,349.99
|
| Rate for Payer: Anthem Medicaid |
$2,389.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,419.47
|
| Rate for Payer: Cash Price |
$3,474.02
|
| Rate for Payer: Cigna Commercial |
$5,766.87
|
| Rate for Payer: First Health Commercial |
$6,600.64
|
| Rate for Payer: Humana Commercial |
$5,905.83
|
| Rate for Payer: Humana KY Medicaid |
$2,389.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,697.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,127.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,114.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.89
|
| Rate for Payer: PHCS Commercial |
$6,670.12
|
| Rate for Payer: United Healthcare All Payer |
$6,114.28
|
|
|
PLATE MD PRX LCP 4.5 10H 214 R
|
Facility
|
IP
|
$6,948.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.25 |
| Max. Negotiated Rate |
$6,670.12 |
| Rate for Payer: Aetna Commercial |
$5,349.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,419.47
|
| Rate for Payer: Cash Price |
$3,474.02
|
| Rate for Payer: Cigna Commercial |
$5,766.87
|
| Rate for Payer: First Health Commercial |
$6,600.64
|
| Rate for Payer: Humana Commercial |
$5,905.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,697.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,127.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,114.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,211.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.89
|
| Rate for Payer: PHCS Commercial |
$6,670.12
|
| Rate for Payer: United Healthcare All Payer |
$6,114.28
|
|
|
PLATE MD PRX LCP 4.5 12H 250 L
|
Facility
|
OP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem Medicaid |
$2,405.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Humana KY Medicaid |
$2,405.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
|
|
PLATE MD PRX LCP 4.5 12H 250 L
|
Facility
|
IP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
|
|
PLATE MD PRX LCP 4.5 12H 250 R
|
Facility
|
OP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Humana KY Medicaid |
$2,405.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem Medicaid |
$2,405.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
|
|
PLATE MD PRX LCP 4.5 12H 250 R
|
Facility
|
IP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
|
|
PLATE MD PRX LCP 4.5 14H 286 L
|
Facility
|
OP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem Medicaid |
$2,422.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Humana KY Medicaid |
$2,422.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE MD PRX LCP 4.5 14H 286 L
|
Facility
|
IP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE MD PRX LCP 4.5 14H 286 R
|
Facility
|
OP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem Medicaid |
$2,422.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Humana KY Medicaid |
$2,422.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE MD PRX LCP 4.5 14H 286 R
|
Facility
|
IP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE MD PRX LCP 4.5 16H 322 L
|
Facility
|
IP
|
$7,090.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.78 |
| Max. Negotiated Rate |
$6,807.02 |
| Rate for Payer: Aetna Commercial |
$5,459.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.71
|
| Rate for Payer: Cash Price |
$3,545.32
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: First Health Commercial |
$6,736.12
|
| Rate for Payer: Humana Commercial |
$6,027.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,232.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,317.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.10
|
| Rate for Payer: PHCS Commercial |
$6,807.02
|
| Rate for Payer: United Healthcare All Payer |
$6,239.77
|
|
|
PLATE MD PRX LCP 4.5 16H 322 L
|
Facility
|
OP
|
$7,090.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.78 |
| Max. Negotiated Rate |
$6,807.02 |
| Rate for Payer: Aetna Commercial |
$5,459.80
|
| Rate for Payer: Anthem Medicaid |
$2,438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.71
|
| Rate for Payer: Cash Price |
$3,545.32
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: First Health Commercial |
$6,736.12
|
| Rate for Payer: Humana Commercial |
$6,027.05
|
| Rate for Payer: Humana KY Medicaid |
$2,438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,232.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,317.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.10
|
| Rate for Payer: PHCS Commercial |
$6,807.02
|
| Rate for Payer: United Healthcare All Payer |
$6,239.77
|
|
|
PLATE MD PRX LCP 4.5 16H 322 R
|
Facility
|
IP
|
$7,090.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.78 |
| Max. Negotiated Rate |
$6,807.02 |
| Rate for Payer: Aetna Commercial |
$5,459.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.71
|
| Rate for Payer: Cash Price |
$3,545.32
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: First Health Commercial |
$6,736.12
|
| Rate for Payer: Humana Commercial |
$6,027.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,232.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,317.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.10
|
| Rate for Payer: PHCS Commercial |
$6,807.02
|
| Rate for Payer: United Healthcare All Payer |
$6,239.77
|
|
|
PLATE MD PRX LCP 4.5 16H 322 R
|
Facility
|
OP
|
$7,090.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.78 |
| Max. Negotiated Rate |
$6,807.02 |
| Rate for Payer: Aetna Commercial |
$5,459.80
|
| Rate for Payer: Anthem Medicaid |
$2,438.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,530.71
|
| Rate for Payer: Cash Price |
$3,545.32
|
| Rate for Payer: Cigna Commercial |
$5,885.24
|
| Rate for Payer: First Health Commercial |
$6,736.12
|
| Rate for Payer: Humana Commercial |
$6,027.05
|
| Rate for Payer: Humana KY Medicaid |
$2,438.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,232.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,239.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,317.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,198.10
|
| Rate for Payer: PHCS Commercial |
$6,807.02
|
| Rate for Payer: United Healthcare All Payer |
$6,239.77
|
|
|
PLATE MD UTILITY 2.7MM
|
Facility
|
OP
|
$6,562.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$853.14 |
| Max. Negotiated Rate |
$6,300.10 |
| Rate for Payer: Aetna Commercial |
$5,053.20
|
| Rate for Payer: Anthem Medicaid |
$2,256.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.83
|
| Rate for Payer: Cash Price |
$3,281.30
|
| Rate for Payer: Cigna Commercial |
$5,446.96
|
| Rate for Payer: First Health Commercial |
$6,234.47
|
| Rate for Payer: Humana Commercial |
$5,578.21
|
| Rate for Payer: Humana KY Medicaid |
$2,256.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,279.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,302.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.09
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.41
|
| Rate for Payer: PHCS Commercial |
$6,300.10
|
| Rate for Payer: United Healthcare All Payer |
$5,775.09
|
|
|
PLATE MD UTILITY 2.7MM
|
Facility
|
IP
|
$6,562.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$853.14 |
| Max. Negotiated Rate |
$6,300.10 |
| Rate for Payer: Aetna Commercial |
$5,053.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.83
|
| Rate for Payer: Cash Price |
$3,281.30
|
| Rate for Payer: Cigna Commercial |
$5,446.96
|
| Rate for Payer: First Health Commercial |
$6,234.47
|
| Rate for Payer: Humana Commercial |
$5,578.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.09
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.41
|
| Rate for Payer: PHCS Commercial |
$6,300.10
|
| Rate for Payer: United Healthcare All Payer |
$5,775.09
|
|
|
PLATE MED DIST HUM LK 5 79MM L
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7.13
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
