|
PLATE HUM LK PRX 13H L 4.5*220
|
Facility
|
OP
|
$9,489.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.74 |
| Max. Negotiated Rate |
$9,109.58 |
| Rate for Payer: Aetna Commercial |
$7,306.65
|
| Rate for Payer: Anthem Medicaid |
$3,263.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.54
|
| Rate for Payer: Cash Price |
$4,744.58
|
| Rate for Payer: Cigna Commercial |
$7,875.99
|
| Rate for Payer: First Health Commercial |
$9,014.69
|
| Rate for Payer: Humana Commercial |
$8,065.78
|
| Rate for Payer: Humana KY Medicaid |
$3,263.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,781.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.51
|
| Rate for Payer: PHCS Commercial |
$9,109.58
|
| Rate for Payer: United Healthcare All Payer |
$8,350.45
|
|
|
PLATE HUM LK PRX 13H L 4.5*220
|
Facility
|
IP
|
$9,489.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.74 |
| Max. Negotiated Rate |
$9,109.58 |
| Rate for Payer: Aetna Commercial |
$7,306.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.54
|
| Rate for Payer: Cash Price |
$4,744.58
|
| Rate for Payer: Cigna Commercial |
$7,875.99
|
| Rate for Payer: First Health Commercial |
$9,014.69
|
| Rate for Payer: Humana Commercial |
$8,065.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,781.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.51
|
| Rate for Payer: PHCS Commercial |
$9,109.58
|
| Rate for Payer: United Healthcare All Payer |
$8,350.45
|
|
|
PLATE HUM LK PRX 13H R 4.5*220
|
Facility
|
OP
|
$9,489.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.74 |
| Max. Negotiated Rate |
$9,109.58 |
| Rate for Payer: Aetna Commercial |
$7,306.65
|
| Rate for Payer: Anthem Medicaid |
$3,263.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.54
|
| Rate for Payer: Cash Price |
$4,744.58
|
| Rate for Payer: Cigna Commercial |
$7,875.99
|
| Rate for Payer: First Health Commercial |
$9,014.69
|
| Rate for Payer: Humana Commercial |
$8,065.78
|
| Rate for Payer: Humana KY Medicaid |
$3,263.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,296.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,781.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,328.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.51
|
| Rate for Payer: PHCS Commercial |
$9,109.58
|
| Rate for Payer: United Healthcare All Payer |
$8,350.45
|
|
|
PLATE HUM LK PRX 13H R 4.5*220
|
Facility
|
IP
|
$9,489.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,846.74 |
| Max. Negotiated Rate |
$9,109.58 |
| Rate for Payer: Aetna Commercial |
$7,306.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,401.54
|
| Rate for Payer: Cash Price |
$4,744.58
|
| Rate for Payer: Cigna Commercial |
$7,875.99
|
| Rate for Payer: First Health Commercial |
$9,014.69
|
| Rate for Payer: Humana Commercial |
$8,065.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,781.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,002.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,846.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,350.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,116.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,591.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,255.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,547.51
|
| Rate for Payer: PHCS Commercial |
$9,109.58
|
| Rate for Payer: United Healthcare All Payer |
$8,350.45
|
|
|
PLATE HUM LK PRX 15H R 4.5*246
|
Facility
|
IP
|
$9,711.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,913.60 |
| Max. Negotiated Rate |
$9,323.51 |
| Rate for Payer: Aetna Commercial |
$7,478.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,575.35
|
| Rate for Payer: Cash Price |
$4,855.99
|
| Rate for Payer: Cigna Commercial |
$8,060.95
|
| Rate for Payer: First Health Commercial |
$9,226.39
|
| Rate for Payer: Humana Commercial |
$8,255.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,963.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,167.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,546.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,283.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,769.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,449.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,701.27
|
| Rate for Payer: PHCS Commercial |
$9,323.51
|
| Rate for Payer: United Healthcare All Payer |
$8,546.55
|
|
|
PLATE HUM LK PRX 15H R 4.5*246
|
Facility
|
OP
|
$9,711.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,913.60 |
| Max. Negotiated Rate |
$9,323.51 |
| Rate for Payer: Aetna Commercial |
$7,478.23
|
| Rate for Payer: Anthem Medicaid |
$3,339.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,575.35
|
| Rate for Payer: Cash Price |
$4,855.99
|
| Rate for Payer: Cigna Commercial |
$8,060.95
|
| Rate for Payer: First Health Commercial |
$9,226.39
|
| Rate for Payer: Humana Commercial |
$8,255.19
|
| Rate for Payer: Humana KY Medicaid |
$3,339.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,373.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,963.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,167.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,406.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,546.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,283.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,769.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,449.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,701.27
|
| Rate for Payer: PHCS Commercial |
$9,323.51
|
| Rate for Payer: United Healthcare All Payer |
$8,546.55
|
|
|
PLATE HUM LK PRX 3H L 3.5*89
|
Facility
|
OP
|
$7,882.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.84 |
| Max. Negotiated Rate |
$7,567.48 |
| Rate for Payer: Aetna Commercial |
$6,069.75
|
| Rate for Payer: Anthem Medicaid |
$2,710.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.58
|
| Rate for Payer: Cash Price |
$3,941.39
|
| Rate for Payer: Cigna Commercial |
$6,542.72
|
| Rate for Payer: First Health Commercial |
$7,488.65
|
| Rate for Payer: Humana Commercial |
$6,700.37
|
| Rate for Payer: Humana KY Medicaid |
$2,710.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,817.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.13
|
| Rate for Payer: PHCS Commercial |
$7,567.48
|
| Rate for Payer: United Healthcare All Payer |
$6,936.86
|
|
|
PLATE HUM LK PRX 3H L 3.5*89
|
Facility
|
IP
|
$7,882.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.84 |
| Max. Negotiated Rate |
$7,567.48 |
| Rate for Payer: Aetna Commercial |
$6,069.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.58
|
| Rate for Payer: Cash Price |
$3,941.39
|
| Rate for Payer: Cigna Commercial |
$6,542.72
|
| Rate for Payer: First Health Commercial |
$7,488.65
|
| Rate for Payer: Humana Commercial |
$6,700.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,817.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,912.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,306.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,858.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,439.13
|
| Rate for Payer: PHCS Commercial |
$7,567.48
|
| Rate for Payer: United Healthcare All Payer |
$6,936.86
|
|
|
PLATE HUM LK PRX 3H L 4.5*93
|
Facility
|
OP
|
$8,557.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.19 |
| Max. Negotiated Rate |
$8,215.02 |
| Rate for Payer: Aetna Commercial |
$6,589.13
|
| Rate for Payer: Anthem Medicaid |
$2,942.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,674.70
|
| Rate for Payer: Cash Price |
$4,278.65
|
| Rate for Payer: Cigna Commercial |
$7,102.57
|
| Rate for Payer: First Health Commercial |
$8,129.44
|
| Rate for Payer: Humana Commercial |
$7,273.71
|
| Rate for Payer: Humana KY Medicaid |
$2,942.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,972.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,315.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,001.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,530.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,845.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,444.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,904.54
|
| Rate for Payer: PHCS Commercial |
$8,215.02
|
| Rate for Payer: United Healthcare All Payer |
$7,530.43
|
|
|
PLATE HUM LK PRX 3H L 4.5*93
|
Facility
|
IP
|
$8,557.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.19 |
| Max. Negotiated Rate |
$8,215.02 |
| Rate for Payer: Aetna Commercial |
$6,589.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,674.70
|
| Rate for Payer: Cash Price |
$4,278.65
|
| Rate for Payer: Cigna Commercial |
$7,102.57
|
| Rate for Payer: First Health Commercial |
$8,129.44
|
| Rate for Payer: Humana Commercial |
$7,273.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,315.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,530.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,845.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,444.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,904.54
|
| Rate for Payer: PHCS Commercial |
$8,215.02
|
| Rate for Payer: United Healthcare All Payer |
$7,530.43
|
|
|
PLATE HUM LK PRX 3H R 4.5*93
|
Facility
|
OP
|
$8,557.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.19 |
| Max. Negotiated Rate |
$8,215.02 |
| Rate for Payer: Aetna Commercial |
$6,589.13
|
| Rate for Payer: Anthem Medicaid |
$2,942.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,674.70
|
| Rate for Payer: Cash Price |
$4,278.65
|
| Rate for Payer: Cigna Commercial |
$7,102.57
|
| Rate for Payer: First Health Commercial |
$8,129.44
|
| Rate for Payer: Humana Commercial |
$7,273.71
|
| Rate for Payer: Humana KY Medicaid |
$2,942.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,972.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,315.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,001.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,530.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,845.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,444.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,904.54
|
| Rate for Payer: PHCS Commercial |
$8,215.02
|
| Rate for Payer: United Healthcare All Payer |
$7,530.43
|
|
|
PLATE HUM LK PRX 3H R 4.5*93
|
Facility
|
IP
|
$8,557.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.19 |
| Max. Negotiated Rate |
$8,215.02 |
| Rate for Payer: Aetna Commercial |
$6,589.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,674.70
|
| Rate for Payer: Cash Price |
$4,278.65
|
| Rate for Payer: Cigna Commercial |
$7,102.57
|
| Rate for Payer: First Health Commercial |
$8,129.44
|
| Rate for Payer: Humana Commercial |
$7,273.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,315.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,530.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,845.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,444.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,904.54
|
| Rate for Payer: PHCS Commercial |
$8,215.02
|
| Rate for Payer: United Healthcare All Payer |
$7,530.43
|
|
|
PLATE HUM LK PRX 5H L 3.5*115
|
Facility
|
IP
|
$8,023.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.16 |
| Max. Negotiated Rate |
$7,702.91 |
| Rate for Payer: Aetna Commercial |
$6,178.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,258.61
|
| Rate for Payer: Cash Price |
$4,011.93
|
| Rate for Payer: Cigna Commercial |
$6,659.80
|
| Rate for Payer: First Health Commercial |
$7,622.67
|
| Rate for Payer: Humana Commercial |
$6,820.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,579.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,921.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,061.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,419.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,980.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,536.46
|
| Rate for Payer: PHCS Commercial |
$7,702.91
|
| Rate for Payer: United Healthcare All Payer |
$7,061.00
|
|
|
PLATE HUM LK PRX 5H L 3.5*115
|
Facility
|
OP
|
$8,023.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.16 |
| Max. Negotiated Rate |
$7,702.91 |
| Rate for Payer: Aetna Commercial |
$6,178.37
|
| Rate for Payer: Anthem Medicaid |
$2,759.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,258.61
|
| Rate for Payer: Cash Price |
$4,011.93
|
| Rate for Payer: Cigna Commercial |
$6,659.80
|
| Rate for Payer: First Health Commercial |
$7,622.67
|
| Rate for Payer: Humana Commercial |
$6,820.28
|
| Rate for Payer: Humana KY Medicaid |
$2,759.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,787.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,579.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,921.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,814.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,061.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,419.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,980.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,536.46
|
| Rate for Payer: PHCS Commercial |
$7,702.91
|
| Rate for Payer: United Healthcare All Payer |
$7,061.00
|
|
|
PLATE HUM LK PRX 5H L 4.5*119
|
Facility
|
IP
|
$8,766.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,629.99 |
| Max. Negotiated Rate |
$8,415.97 |
| Rate for Payer: Aetna Commercial |
$6,750.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,837.98
|
| Rate for Payer: Cash Price |
$4,383.32
|
| Rate for Payer: Cigna Commercial |
$7,276.31
|
| Rate for Payer: First Health Commercial |
$8,328.31
|
| Rate for Payer: Humana Commercial |
$7,451.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,469.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,574.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,626.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,048.98
|
| Rate for Payer: PHCS Commercial |
$8,415.97
|
| Rate for Payer: United Healthcare All Payer |
$7,714.64
|
|
|
PLATE HUM LK PRX 5H L 4.5*119
|
Facility
|
OP
|
$8,766.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,629.99 |
| Max. Negotiated Rate |
$8,415.97 |
| Rate for Payer: Aetna Commercial |
$6,750.31
|
| Rate for Payer: Anthem Medicaid |
$3,014.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,837.98
|
| Rate for Payer: Cash Price |
$4,383.32
|
| Rate for Payer: Cigna Commercial |
$7,276.31
|
| Rate for Payer: First Health Commercial |
$8,328.31
|
| Rate for Payer: Humana Commercial |
$7,451.64
|
| Rate for Payer: Humana KY Medicaid |
$3,014.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,469.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,574.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,626.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,048.98
|
| Rate for Payer: PHCS Commercial |
$8,415.97
|
| Rate for Payer: United Healthcare All Payer |
$7,714.64
|
|
|
PLATE HUM LK PRX 5H R 4.5*119
|
Facility
|
OP
|
$8,766.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,629.99 |
| Max. Negotiated Rate |
$8,415.97 |
| Rate for Payer: Aetna Commercial |
$6,750.31
|
| Rate for Payer: Anthem Medicaid |
$3,014.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,837.98
|
| Rate for Payer: Cash Price |
$4,383.32
|
| Rate for Payer: Cigna Commercial |
$7,276.31
|
| Rate for Payer: First Health Commercial |
$8,328.31
|
| Rate for Payer: Humana Commercial |
$7,451.64
|
| Rate for Payer: Humana KY Medicaid |
$3,014.85
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,469.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,574.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,626.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,048.98
|
| Rate for Payer: PHCS Commercial |
$8,415.97
|
| Rate for Payer: United Healthcare All Payer |
$7,714.64
|
|
|
PLATE HUM LK PRX 5H R 4.5*119
|
Facility
|
IP
|
$8,766.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,629.99 |
| Max. Negotiated Rate |
$8,415.97 |
| Rate for Payer: Aetna Commercial |
$6,750.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,837.98
|
| Rate for Payer: Cash Price |
$4,383.32
|
| Rate for Payer: Cigna Commercial |
$7,276.31
|
| Rate for Payer: First Health Commercial |
$8,328.31
|
| Rate for Payer: Humana Commercial |
$7,451.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,469.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,629.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,574.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,626.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,048.98
|
| Rate for Payer: PHCS Commercial |
$8,415.97
|
| Rate for Payer: United Healthcare All Payer |
$7,714.64
|
|
|
PLATE HUM LK PRX 7H L 3.5*140
|
Facility
|
OP
|
$8,023.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.16 |
| Max. Negotiated Rate |
$7,702.91 |
| Rate for Payer: Aetna Commercial |
$6,178.37
|
| Rate for Payer: Anthem Medicaid |
$2,759.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,258.61
|
| Rate for Payer: Cash Price |
$4,011.93
|
| Rate for Payer: Cigna Commercial |
$6,659.80
|
| Rate for Payer: First Health Commercial |
$7,622.67
|
| Rate for Payer: Humana Commercial |
$6,820.28
|
| Rate for Payer: Humana KY Medicaid |
$2,759.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,787.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,579.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,921.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,814.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,061.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,419.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,980.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,536.46
|
| Rate for Payer: PHCS Commercial |
$7,702.91
|
| Rate for Payer: United Healthcare All Payer |
$7,061.00
|
|
|
PLATE HUM LK PRX 7H L 3.5*140
|
Facility
|
IP
|
$8,023.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,407.16 |
| Max. Negotiated Rate |
$7,702.91 |
| Rate for Payer: Aetna Commercial |
$6,178.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,258.61
|
| Rate for Payer: Cash Price |
$4,011.93
|
| Rate for Payer: Cigna Commercial |
$6,659.80
|
| Rate for Payer: First Health Commercial |
$7,622.67
|
| Rate for Payer: Humana Commercial |
$6,820.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,579.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,921.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,407.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,061.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,017.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,419.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,980.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,536.46
|
| Rate for Payer: PHCS Commercial |
$7,702.91
|
| Rate for Payer: United Healthcare All Payer |
$7,061.00
|
|
|
PLATE HUM LK PRX 7H L 4.5*144
|
Facility
|
IP
|
$8,888.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,666.45 |
| Max. Negotiated Rate |
$8,532.65 |
| Rate for Payer: Aetna Commercial |
$6,843.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,932.78
|
| Rate for Payer: Cash Price |
$4,444.09
|
| Rate for Payer: Cigna Commercial |
$7,377.19
|
| Rate for Payer: First Health Commercial |
$8,443.77
|
| Rate for Payer: Humana Commercial |
$7,554.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,288.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,559.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,666.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,821.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,666.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,732.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,132.84
|
| Rate for Payer: PHCS Commercial |
$8,532.65
|
| Rate for Payer: United Healthcare All Payer |
$7,821.60
|
|
|
PLATE HUM LK PRX 7H L 4.5*144
|
Facility
|
OP
|
$8,888.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,666.45 |
| Max. Negotiated Rate |
$8,532.65 |
| Rate for Payer: Aetna Commercial |
$6,843.90
|
| Rate for Payer: Anthem Medicaid |
$3,056.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,932.78
|
| Rate for Payer: Cash Price |
$4,444.09
|
| Rate for Payer: Cigna Commercial |
$7,377.19
|
| Rate for Payer: First Health Commercial |
$8,443.77
|
| Rate for Payer: Humana Commercial |
$7,554.95
|
| Rate for Payer: Humana KY Medicaid |
$3,056.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,087.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,288.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,559.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,666.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,117.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,821.60
|
| Rate for Payer: Ohio Health Group HMO |
$6,666.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,732.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,132.84
|
| Rate for Payer: PHCS Commercial |
$8,532.65
|
| Rate for Payer: United Healthcare All Payer |
$7,821.60
|
|
|
PLATE HUM LK PRX 7H R 4.5*144
|
Facility
|
OP
|
$8,888.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,666.56 |
| Max. Negotiated Rate |
$8,533.00 |
| Rate for Payer: Aetna Commercial |
$6,844.18
|
| Rate for Payer: Anthem Medicaid |
$3,056.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,933.06
|
| Rate for Payer: Cash Price |
$4,444.27
|
| Rate for Payer: Cigna Commercial |
$7,377.49
|
| Rate for Payer: First Health Commercial |
$8,444.11
|
| Rate for Payer: Humana Commercial |
$7,555.26
|
| Rate for Payer: Humana KY Medicaid |
$3,056.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,087.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,288.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,559.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,666.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,118.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,821.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,733.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,133.09
|
| Rate for Payer: PHCS Commercial |
$8,533.00
|
| Rate for Payer: United Healthcare All Payer |
$7,821.92
|
|
|
PLATE HUM LK PRX 7H R 4.5*144
|
Facility
|
IP
|
$8,888.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,666.56 |
| Max. Negotiated Rate |
$8,533.00 |
| Rate for Payer: Aetna Commercial |
$6,844.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,933.06
|
| Rate for Payer: Cash Price |
$4,444.27
|
| Rate for Payer: Cigna Commercial |
$7,377.49
|
| Rate for Payer: First Health Commercial |
$8,444.11
|
| Rate for Payer: Humana Commercial |
$7,555.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,288.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,559.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,666.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,821.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,666.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,110.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,733.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,133.09
|
| Rate for Payer: PHCS Commercial |
$8,533.00
|
| Rate for Payer: United Healthcare All Payer |
$7,821.92
|
|
|
PLATE HUM LK PRX 9H L 3.5*165
|
Facility
|
OP
|
$8,361.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.45 |
| Max. Negotiated Rate |
$8,027.03 |
| Rate for Payer: Aetna Commercial |
$6,438.35
|
| Rate for Payer: Anthem Medicaid |
$2,875.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,521.96
|
| Rate for Payer: Cash Price |
$4,180.74
|
| Rate for Payer: Cigna Commercial |
$6,940.04
|
| Rate for Payer: First Health Commercial |
$7,943.42
|
| Rate for Payer: Humana Commercial |
$7,107.27
|
| Rate for Payer: Humana KY Medicaid |
$2,875.52
|
| Rate for Payer: Kentucky WC Medicaid |
$2,904.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,856.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,170.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,508.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,933.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,358.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,689.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,274.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,769.43
|
| Rate for Payer: PHCS Commercial |
$8,027.03
|
| Rate for Payer: United Healthcare All Payer |
$7,358.11
|
|
