|
PLATE MD PRX LCP 4.5 14H 286 L
|
Facility
|
IP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
|
PLATE MD PRX LCP 4.5 14H 286 R
|
Facility
|
OP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem Medicaid |
$2,490.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Humana KY Medicaid |
$2,490.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
|
PLATE MD PRX LCP 4.5 14H 286 R
|
Facility
|
IP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
|
PLATE MD PRX LCP 4.5 16H 322 L
|
Facility
|
OP
|
$7,290.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.20 |
| Max. Negotiated Rate |
$6,999.02 |
| Rate for Payer: Aetna Commercial |
$5,613.80
|
| Rate for Payer: Anthem Medicaid |
$2,507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.71
|
| Rate for Payer: Cash Price |
$3,645.32
|
| Rate for Payer: Cigna Commercial |
$6,051.24
|
| Rate for Payer: First Health Commercial |
$6,926.12
|
| Rate for Payer: Humana Commercial |
$6,197.05
|
| Rate for Payer: Humana KY Medicaid |
$2,507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,342.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.55
|
| Rate for Payer: PHCS Commercial |
$6,999.02
|
| Rate for Payer: United Healthcare All Payer |
$6,415.77
|
|
|
PLATE MD PRX LCP 4.5 16H 322 L
|
Facility
|
IP
|
$7,290.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.20 |
| Max. Negotiated Rate |
$6,999.02 |
| Rate for Payer: Aetna Commercial |
$5,613.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.71
|
| Rate for Payer: Cash Price |
$3,645.32
|
| Rate for Payer: Cigna Commercial |
$6,051.24
|
| Rate for Payer: First Health Commercial |
$6,926.12
|
| Rate for Payer: Humana Commercial |
$6,197.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,342.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.55
|
| Rate for Payer: PHCS Commercial |
$6,999.02
|
| Rate for Payer: United Healthcare All Payer |
$6,415.77
|
|
|
PLATE MD PRX LCP 4.5 16H 322 R
|
Facility
|
OP
|
$7,290.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.20 |
| Max. Negotiated Rate |
$6,999.02 |
| Rate for Payer: Aetna Commercial |
$5,613.80
|
| Rate for Payer: Anthem Medicaid |
$2,507.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.71
|
| Rate for Payer: Cash Price |
$3,645.32
|
| Rate for Payer: Cigna Commercial |
$6,051.24
|
| Rate for Payer: First Health Commercial |
$6,926.12
|
| Rate for Payer: Humana Commercial |
$6,197.05
|
| Rate for Payer: Humana KY Medicaid |
$2,507.25
|
| Rate for Payer: Kentucky WC Medicaid |
$2,532.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,557.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,342.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.55
|
| Rate for Payer: PHCS Commercial |
$6,999.02
|
| Rate for Payer: United Healthcare All Payer |
$6,415.77
|
|
|
PLATE MD PRX LCP 4.5 16H 322 R
|
Facility
|
IP
|
$7,290.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,187.20 |
| Max. Negotiated Rate |
$6,999.02 |
| Rate for Payer: Aetna Commercial |
$5,613.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,686.71
|
| Rate for Payer: Cash Price |
$3,645.32
|
| Rate for Payer: Cigna Commercial |
$6,051.24
|
| Rate for Payer: First Health Commercial |
$6,926.12
|
| Rate for Payer: Humana Commercial |
$6,197.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,978.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,380.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,187.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,415.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,467.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,832.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,342.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,030.55
|
| Rate for Payer: PHCS Commercial |
$6,999.02
|
| Rate for Payer: United Healthcare All Payer |
$6,415.77
|
|
|
PLATE MD UTILITY 2.7MM
|
Facility
|
IP
|
$6,762.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$6,492.10 |
| Rate for Payer: Aetna Commercial |
$5,207.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,274.83
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cigna Commercial |
$5,612.96
|
| Rate for Payer: First Health Commercial |
$6,424.47
|
| Rate for Payer: Humana Commercial |
$5,748.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,545.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,990.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,951.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,071.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,410.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,883.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,666.19
|
| Rate for Payer: PHCS Commercial |
$6,492.10
|
| Rate for Payer: United Healthcare All Payer |
$5,951.09
|
|
|
PLATE MD UTILITY 2.7MM
|
Facility
|
OP
|
$6,762.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$6,492.10 |
| Rate for Payer: Aetna Commercial |
$5,207.20
|
| Rate for Payer: Anthem Medicaid |
$2,325.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,274.83
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cigna Commercial |
$5,612.96
|
| Rate for Payer: First Health Commercial |
$6,424.47
|
| Rate for Payer: Humana Commercial |
$5,748.21
|
| Rate for Payer: Humana KY Medicaid |
$2,325.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,349.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,545.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,990.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,372.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,951.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,071.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,410.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,883.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,666.19
|
| Rate for Payer: PHCS Commercial |
$6,492.10
|
| Rate for Payer: United Healthcare All Payer |
$5,951.09
|
|
|
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 |
$6.90 |
| 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 |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE MED DIST HUM LK 5 79MM L
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| 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: 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: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE MED DIST HUM LK 5 79MM R
|
Facility
|
IP
|
$6,882.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.81 |
| Max. Negotiated Rate |
$6,607.38 |
| Rate for Payer: Aetna Commercial |
$5,299.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,368.50
|
| Rate for Payer: Cash Price |
$3,441.34
|
| Rate for Payer: Cigna Commercial |
$5,712.63
|
| Rate for Payer: First Health Commercial |
$6,538.56
|
| Rate for Payer: Humana Commercial |
$5,850.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,643.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,079.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,056.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,162.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,506.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,987.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.06
|
| Rate for Payer: PHCS Commercial |
$6,607.38
|
| Rate for Payer: United Healthcare All Payer |
$6,056.77
|
|
|
PLATE MED DIST HUM LK 5 79MM R
|
Facility
|
OP
|
$6,882.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.81 |
| Max. Negotiated Rate |
$6,607.38 |
| Rate for Payer: Aetna Commercial |
$5,299.67
|
| Rate for Payer: Anthem Medicaid |
$2,366.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,368.50
|
| Rate for Payer: Cash Price |
$3,441.34
|
| Rate for Payer: Cigna Commercial |
$5,712.63
|
| Rate for Payer: First Health Commercial |
$6,538.56
|
| Rate for Payer: Humana Commercial |
$5,850.29
|
| Rate for Payer: Humana KY Medicaid |
$2,366.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,391.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,643.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,079.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,414.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,056.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,162.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,506.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,987.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.06
|
| Rate for Payer: PHCS Commercial |
$6,607.38
|
| Rate for Payer: United Healthcare All Payer |
$6,056.77
|
|
|
PLATE MED DIST HUM LK 7 103M L
|
Facility
|
IP
|
$7,328.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$7,035.22 |
| Rate for Payer: Aetna Commercial |
$5,642.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,716.11
|
| Rate for Payer: Cash Price |
$3,664.18
|
| Rate for Payer: Cigna Commercial |
$6,082.53
|
| Rate for Payer: First Health Commercial |
$6,961.93
|
| Rate for Payer: Humana Commercial |
$6,229.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,496.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.56
|
| Rate for Payer: PHCS Commercial |
$7,035.22
|
| Rate for Payer: United Healthcare All Payer |
$6,448.95
|
|
|
PLATE MED DIST HUM LK 7 103M L
|
Facility
|
OP
|
$7,328.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$7,035.22 |
| Rate for Payer: Aetna Commercial |
$5,642.83
|
| Rate for Payer: Anthem Medicaid |
$2,520.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,716.11
|
| Rate for Payer: Cash Price |
$3,664.18
|
| Rate for Payer: Cigna Commercial |
$6,082.53
|
| Rate for Payer: First Health Commercial |
$6,961.93
|
| Rate for Payer: Humana Commercial |
$6,229.10
|
| Rate for Payer: Humana KY Medicaid |
$2,520.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,570.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,496.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.56
|
| Rate for Payer: PHCS Commercial |
$7,035.22
|
| Rate for Payer: United Healthcare All Payer |
$6,448.95
|
|
|
PLATE MED DIST HUM LK 7 103M R
|
Facility
|
OP
|
$7,328.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$7,035.22 |
| Rate for Payer: Aetna Commercial |
$5,642.83
|
| Rate for Payer: Anthem Medicaid |
$2,520.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,716.11
|
| Rate for Payer: Cash Price |
$3,664.18
|
| Rate for Payer: Cigna Commercial |
$6,082.53
|
| Rate for Payer: First Health Commercial |
$6,961.93
|
| Rate for Payer: Humana Commercial |
$6,229.10
|
| Rate for Payer: Humana KY Medicaid |
$2,520.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,570.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,496.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.56
|
| Rate for Payer: PHCS Commercial |
$7,035.22
|
| Rate for Payer: United Healthcare All Payer |
$6,448.95
|
|
|
PLATE MED DIST HUM LK 7 103M R
|
Facility
|
IP
|
$7,328.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$7,035.22 |
| Rate for Payer: Aetna Commercial |
$5,642.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,716.11
|
| Rate for Payer: Cash Price |
$3,664.18
|
| Rate for Payer: Cigna Commercial |
$6,082.53
|
| Rate for Payer: First Health Commercial |
$6,961.93
|
| Rate for Payer: Humana Commercial |
$6,229.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,496.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.56
|
| Rate for Payer: PHCS Commercial |
$7,035.22
|
| Rate for Payer: United Healthcare All Payer |
$6,448.95
|
|
|
PLATE MED DIST HUM LK 9 127M R
|
Facility
|
OP
|
$7,652.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.74 |
| Max. Negotiated Rate |
$7,346.37 |
| Rate for Payer: Aetna Commercial |
$5,892.40
|
| Rate for Payer: Anthem Medicaid |
$2,631.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,968.93
|
| Rate for Payer: Cash Price |
$3,826.24
|
| Rate for Payer: Cigna Commercial |
$6,351.55
|
| Rate for Payer: First Health Commercial |
$7,269.85
|
| Rate for Payer: Humana Commercial |
$6,504.60
|
| Rate for Payer: Humana KY Medicaid |
$2,631.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,658.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,275.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,647.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,295.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,684.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,734.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,739.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,121.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,657.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,280.20
|
| Rate for Payer: PHCS Commercial |
$7,346.37
|
| Rate for Payer: United Healthcare All Payer |
$6,734.17
|
|
|
PLATE MED DIST HUM LK 9 127M R
|
Facility
|
IP
|
$7,652.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.74 |
| Max. Negotiated Rate |
$7,346.37 |
| Rate for Payer: Aetna Commercial |
$5,892.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,968.93
|
| Rate for Payer: Cash Price |
$3,826.24
|
| Rate for Payer: Cigna Commercial |
$6,351.55
|
| Rate for Payer: First Health Commercial |
$7,269.85
|
| Rate for Payer: Humana Commercial |
$6,504.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,275.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,647.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,295.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,734.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,739.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,121.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,657.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,280.20
|
| Rate for Payer: PHCS Commercial |
$7,346.37
|
| Rate for Payer: United Healthcare All Payer |
$6,734.17
|
|
|
PLATE MED DST HUM LK 11 151M L
|
Facility
|
IP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE MED DST HUM LK 11 151M L
|
Facility
|
OP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem Medicaid |
$2,710.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Humana KY Medicaid |
$2,710.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE MED DST HUM LK 11 151M R
|
Facility
|
OP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem Medicaid |
$2,710.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Humana KY Medicaid |
$2,710.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE MED DST HUM LK 11 151M R
|
Facility
|
IP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE MED DST HUM LK 13 174M L
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE MED DST HUM LK 13 174M L
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
