|
PLATE TIB LK 3.5M 108M 4 R M-D
|
Facility
|
IP
|
$9,154.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.03 |
| Max. Negotiated Rate |
$8,787.94 |
| Rate for Payer: Aetna Commercial |
$7,048.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,140.20
|
| Rate for Payer: Cash Price |
$4,577.05
|
| Rate for Payer: Cigna Commercial |
$7,597.90
|
| Rate for Payer: First Health Commercial |
$8,696.40
|
| Rate for Payer: Humana Commercial |
$7,780.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,506.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,755.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,746.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,055.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,865.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.77
|
| Rate for Payer: PHCS Commercial |
$8,787.94
|
| Rate for Payer: United Healthcare All Payer |
$8,055.61
|
|
|
PLATE TIB LK 3.5M 108M 4 R M-D
|
Facility
|
OP
|
$9,154.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.03 |
| Max. Negotiated Rate |
$8,787.94 |
| Rate for Payer: Aetna Commercial |
$7,048.66
|
| Rate for Payer: Anthem Medicaid |
$3,148.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,140.20
|
| Rate for Payer: Cash Price |
$4,577.05
|
| Rate for Payer: Cigna Commercial |
$7,597.90
|
| Rate for Payer: First Health Commercial |
$8,696.40
|
| Rate for Payer: Humana Commercial |
$7,780.98
|
| Rate for Payer: Humana KY Medicaid |
$3,148.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,180.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,506.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,755.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,746.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,211.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,055.61
|
| Rate for Payer: Ohio Health Group HMO |
$6,865.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,830.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,837.77
|
| Rate for Payer: PHCS Commercial |
$8,787.94
|
| Rate for Payer: United Healthcare All Payer |
$8,055.61
|
|
|
PLATE TIBLK 3.5M123M 8 L A-L-D
|
Facility
|
IP
|
$9,329.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.86 |
| Max. Negotiated Rate |
$8,956.48 |
| Rate for Payer: Aetna Commercial |
$7,183.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,277.14
|
| Rate for Payer: Cash Price |
$4,664.83
|
| Rate for Payer: Cigna Commercial |
$7,743.63
|
| Rate for Payer: First Health Commercial |
$8,863.19
|
| Rate for Payer: Humana Commercial |
$7,930.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,650.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,885.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,798.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,210.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,997.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,865.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.20
|
| Rate for Payer: PHCS Commercial |
$8,956.48
|
| Rate for Payer: United Healthcare All Payer |
$8,210.11
|
|
|
PLATE TIBLK 3.5M123M 8 L A-L-D
|
Facility
|
OP
|
$9,329.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.86 |
| Max. Negotiated Rate |
$8,956.48 |
| Rate for Payer: Aetna Commercial |
$7,183.85
|
| Rate for Payer: Anthem Medicaid |
$3,208.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,277.14
|
| Rate for Payer: Cash Price |
$4,664.83
|
| Rate for Payer: Cigna Commercial |
$7,743.63
|
| Rate for Payer: First Health Commercial |
$8,863.19
|
| Rate for Payer: Humana Commercial |
$7,930.22
|
| Rate for Payer: Humana KY Medicaid |
$3,208.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,241.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,650.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,885.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,798.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,272.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,210.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,997.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,865.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.20
|
| Rate for Payer: PHCS Commercial |
$8,956.48
|
| Rate for Payer: United Healthcare All Payer |
$8,210.11
|
|
|
PLATE TIB LK 3.5M 123M 8 L L-P
|
Facility
|
IP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE TIB LK 3.5M 123M 8 L L-P
|
Facility
|
OP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem Medicaid |
$2,953.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Humana KY Medicaid |
$2,953.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,983.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,012.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE TIBLK 3.5M123M 8 R A-L-D
|
Facility
|
OP
|
$9,329.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.86 |
| Max. Negotiated Rate |
$8,956.48 |
| Rate for Payer: Aetna Commercial |
$7,183.85
|
| Rate for Payer: Anthem Medicaid |
$3,208.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,277.14
|
| Rate for Payer: Cash Price |
$4,664.83
|
| Rate for Payer: Cigna Commercial |
$7,743.63
|
| Rate for Payer: First Health Commercial |
$8,863.19
|
| Rate for Payer: Humana Commercial |
$7,930.22
|
| Rate for Payer: Humana KY Medicaid |
$3,208.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,241.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,650.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,885.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,798.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,272.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,210.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,997.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,865.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.20
|
| Rate for Payer: PHCS Commercial |
$8,956.48
|
| Rate for Payer: United Healthcare All Payer |
$8,210.11
|
|
|
PLATE TIBLK 3.5M123M 8 R A-L-D
|
Facility
|
IP
|
$9,329.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,212.86 |
| Max. Negotiated Rate |
$8,956.48 |
| Rate for Payer: Aetna Commercial |
$7,183.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,277.14
|
| Rate for Payer: Cash Price |
$4,664.83
|
| Rate for Payer: Cigna Commercial |
$7,743.63
|
| Rate for Payer: First Health Commercial |
$8,863.19
|
| Rate for Payer: Humana Commercial |
$7,930.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,650.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,885.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,798.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,210.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,997.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,865.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,212.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,892.20
|
| Rate for Payer: PHCS Commercial |
$8,956.48
|
| Rate for Payer: United Healthcare All Payer |
$8,210.11
|
|
|
PLATE TIB LK 3.5M 123M 8 R L-P
|
Facility
|
IP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE TIB LK 3.5M 123M 8 R L-P
|
Facility
|
OP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem Medicaid |
$2,953.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Humana KY Medicaid |
$2,953.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,983.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,012.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE TIB LK 3.5M 134M 6 L M-D
|
Facility
|
IP
|
$9,208.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.06 |
| Max. Negotiated Rate |
$8,839.80 |
| Rate for Payer: Aetna Commercial |
$7,090.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,182.33
|
| Rate for Payer: Cash Price |
$4,604.06
|
| Rate for Payer: Cigna Commercial |
$7,642.74
|
| Rate for Payer: First Health Commercial |
$8,747.71
|
| Rate for Payer: Humana Commercial |
$7,826.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,550.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,795.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,762.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,103.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,906.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,841.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,197.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.52
|
| Rate for Payer: PHCS Commercial |
$8,839.80
|
| Rate for Payer: United Healthcare All Payer |
$8,103.15
|
|
|
PLATE TIB LK 3.5M 134M 6 L M-D
|
Facility
|
OP
|
$9,208.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.06 |
| Max. Negotiated Rate |
$8,839.80 |
| Rate for Payer: Aetna Commercial |
$7,090.25
|
| Rate for Payer: Anthem Medicaid |
$3,166.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,182.33
|
| Rate for Payer: Cash Price |
$4,604.06
|
| Rate for Payer: Cigna Commercial |
$7,642.74
|
| Rate for Payer: First Health Commercial |
$8,747.71
|
| Rate for Payer: Humana Commercial |
$7,826.90
|
| Rate for Payer: Humana KY Medicaid |
$3,166.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,198.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,550.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,795.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,762.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,230.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,103.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,906.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,841.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,197.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.52
|
| Rate for Payer: PHCS Commercial |
$8,839.80
|
| Rate for Payer: United Healthcare All Payer |
$8,103.15
|
|
|
PLATE TIB LK 3.5M 134M 6 R M-D
|
Facility
|
OP
|
$9,208.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.06 |
| Max. Negotiated Rate |
$8,839.80 |
| Rate for Payer: Aetna Commercial |
$7,090.25
|
| Rate for Payer: Anthem Medicaid |
$3,166.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,182.33
|
| Rate for Payer: Cash Price |
$4,604.06
|
| Rate for Payer: Cigna Commercial |
$7,642.74
|
| Rate for Payer: First Health Commercial |
$8,747.71
|
| Rate for Payer: Humana Commercial |
$7,826.90
|
| Rate for Payer: Humana KY Medicaid |
$3,166.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,198.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,550.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,795.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,762.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,230.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,103.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,906.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,841.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,197.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.52
|
| Rate for Payer: PHCS Commercial |
$8,839.80
|
| Rate for Payer: United Healthcare All Payer |
$8,103.15
|
|
|
PLATE TIB LK 3.5M 134M 6 R M-D
|
Facility
|
IP
|
$9,208.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.06 |
| Max. Negotiated Rate |
$8,839.80 |
| Rate for Payer: Aetna Commercial |
$7,090.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,182.33
|
| Rate for Payer: Cash Price |
$4,604.06
|
| Rate for Payer: Cigna Commercial |
$7,642.74
|
| Rate for Payer: First Health Commercial |
$8,747.71
|
| Rate for Payer: Humana Commercial |
$7,826.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,550.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,795.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,762.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,103.15
|
| Rate for Payer: Ohio Health Group HMO |
$6,906.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,841.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,197.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,854.52
|
| Rate for Payer: PHCS Commercial |
$8,839.80
|
| Rate for Payer: United Healthcare All Payer |
$8,103.15
|
|
|
PLATE TIBLK 3.5M 149M 10 L L-P
|
Facility
|
IP
|
$8,647.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.20 |
| Max. Negotiated Rate |
$8,301.76 |
| Rate for Payer: Aetna Commercial |
$6,658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.18
|
| Rate for Payer: Cash Price |
$4,323.83
|
| Rate for Payer: Cigna Commercial |
$7,177.57
|
| Rate for Payer: First Health Commercial |
$8,215.29
|
| Rate for Payer: Humana Commercial |
$7,350.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.78
|
| Rate for Payer: PHCS Commercial |
$8,301.76
|
| Rate for Payer: United Healthcare All Payer |
$7,609.95
|
|
|
PLATE TIBLK 3.5M 149M 10 L L-P
|
Facility
|
OP
|
$8,647.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.20 |
| Max. Negotiated Rate |
$8,301.76 |
| Rate for Payer: Aetna Commercial |
$6,658.71
|
| Rate for Payer: Anthem Medicaid |
$2,973.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.18
|
| Rate for Payer: Cash Price |
$4,323.83
|
| Rate for Payer: Cigna Commercial |
$7,177.57
|
| Rate for Payer: First Health Commercial |
$8,215.29
|
| Rate for Payer: Humana Commercial |
$7,350.52
|
| Rate for Payer: Humana KY Medicaid |
$2,973.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,004.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.78
|
| Rate for Payer: PHCS Commercial |
$8,301.76
|
| Rate for Payer: United Healthcare All Payer |
$7,609.95
|
|
|
PLATE TIBLK 3.5M 149M 10 R L-P
|
Facility
|
IP
|
$8,647.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.20 |
| Max. Negotiated Rate |
$8,301.76 |
| Rate for Payer: Aetna Commercial |
$6,658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.18
|
| Rate for Payer: Cash Price |
$4,323.83
|
| Rate for Payer: Cigna Commercial |
$7,177.57
|
| Rate for Payer: First Health Commercial |
$8,215.29
|
| Rate for Payer: Humana Commercial |
$7,350.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.78
|
| Rate for Payer: PHCS Commercial |
$8,301.76
|
| Rate for Payer: United Healthcare All Payer |
$7,609.95
|
|
|
PLATE TIBLK 3.5M 149M 10 R L-P
|
Facility
|
OP
|
$8,647.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.20 |
| Max. Negotiated Rate |
$8,301.76 |
| Rate for Payer: Anthem Medicaid |
$2,973.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,745.18
|
| Rate for Payer: Cash Price |
$4,323.83
|
| Rate for Payer: Cigna Commercial |
$7,177.57
|
| Rate for Payer: First Health Commercial |
$8,215.29
|
| Rate for Payer: Humana Commercial |
$7,350.52
|
| Rate for Payer: Humana KY Medicaid |
$2,973.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,004.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,091.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,381.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,594.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,609.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,485.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.78
|
| Rate for Payer: PHCS Commercial |
$8,301.76
|
| Rate for Payer: United Healthcare All Payer |
$7,609.95
|
| Rate for Payer: Aetna Commercial |
$6,658.71
|
|
|
PLATE TIB LK 3.5M 160M 8 L M-D
|
Facility
|
IP
|
$9,829.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.82 |
| Max. Negotiated Rate |
$9,436.18 |
| Rate for Payer: Aetna Commercial |
$7,568.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,666.89
|
| Rate for Payer: Cash Price |
$4,914.68
|
| Rate for Payer: Cigna Commercial |
$8,158.36
|
| Rate for Payer: First Health Commercial |
$9,337.88
|
| Rate for Payer: Humana Commercial |
$8,354.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,060.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,254.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,649.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,372.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,047.10
|
| Rate for Payer: PHCS Commercial |
$9,436.18
|
| Rate for Payer: United Healthcare All Payer |
$8,649.83
|
|
|
PLATE TIB LK 3.5M 160M 8 L M-D
|
Facility
|
OP
|
$9,829.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.82 |
| Max. Negotiated Rate |
$9,436.18 |
| Rate for Payer: Aetna Commercial |
$7,568.60
|
| Rate for Payer: Anthem Medicaid |
$3,380.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,666.89
|
| Rate for Payer: Cash Price |
$4,914.68
|
| Rate for Payer: Cigna Commercial |
$8,158.36
|
| Rate for Payer: First Health Commercial |
$9,337.88
|
| Rate for Payer: Humana Commercial |
$8,354.95
|
| Rate for Payer: Humana KY Medicaid |
$3,380.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,414.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,060.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,254.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,448.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,649.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,372.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,047.10
|
| Rate for Payer: PHCS Commercial |
$9,436.18
|
| Rate for Payer: United Healthcare All Payer |
$8,649.83
|
|
|
PLATE TIB LK 3.5M 160M 8 R M-D
|
Facility
|
IP
|
$9,829.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.82 |
| Max. Negotiated Rate |
$9,436.18 |
| Rate for Payer: Aetna Commercial |
$7,568.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,666.89
|
| Rate for Payer: Cash Price |
$4,914.68
|
| Rate for Payer: Cigna Commercial |
$8,158.36
|
| Rate for Payer: First Health Commercial |
$9,337.88
|
| Rate for Payer: Humana Commercial |
$8,354.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,060.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,254.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,649.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,372.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,047.10
|
| Rate for Payer: PHCS Commercial |
$9,436.18
|
| Rate for Payer: United Healthcare All Payer |
$8,649.83
|
|
|
PLATE TIB LK 3.5M 160M 8 R M-D
|
Facility
|
OP
|
$9,829.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,277.82 |
| Max. Negotiated Rate |
$9,436.18 |
| Rate for Payer: Aetna Commercial |
$7,568.60
|
| Rate for Payer: Anthem Medicaid |
$3,380.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,666.89
|
| Rate for Payer: Cash Price |
$4,914.68
|
| Rate for Payer: Cigna Commercial |
$8,158.36
|
| Rate for Payer: First Health Commercial |
$9,337.88
|
| Rate for Payer: Humana Commercial |
$8,354.95
|
| Rate for Payer: Humana KY Medicaid |
$3,380.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,414.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,060.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,254.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,948.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,448.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,649.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,372.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,965.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,277.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,047.10
|
| Rate for Payer: PHCS Commercial |
$9,436.18
|
| Rate for Payer: United Healthcare All Payer |
$8,649.83
|
|
|
PLATE TIBLK 3.5M 185M 10 L M-D
|
Facility
|
IP
|
$9,318.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.43 |
| Max. Negotiated Rate |
$8,945.97 |
| Rate for Payer: Aetna Commercial |
$7,175.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,268.60
|
| Rate for Payer: Cash Price |
$4,659.36
|
| Rate for Payer: Cigna Commercial |
$7,734.54
|
| Rate for Payer: First Health Commercial |
$8,852.78
|
| Rate for Payer: Humana Commercial |
$7,920.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,641.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,877.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,795.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,200.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,989.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,888.80
|
| Rate for Payer: PHCS Commercial |
$8,945.97
|
| Rate for Payer: United Healthcare All Payer |
$8,200.47
|
|
|
PLATE TIBLK 3.5M 185M 10 L M-D
|
Facility
|
OP
|
$9,318.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.43 |
| Max. Negotiated Rate |
$8,945.97 |
| Rate for Payer: Aetna Commercial |
$7,175.41
|
| Rate for Payer: Anthem Medicaid |
$3,204.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,268.60
|
| Rate for Payer: Cash Price |
$4,659.36
|
| Rate for Payer: Cigna Commercial |
$7,734.54
|
| Rate for Payer: First Health Commercial |
$8,852.78
|
| Rate for Payer: Humana Commercial |
$7,920.91
|
| Rate for Payer: Humana KY Medicaid |
$3,204.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,237.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,641.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,877.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,795.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,269.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,200.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,989.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,888.80
|
| Rate for Payer: PHCS Commercial |
$8,945.97
|
| Rate for Payer: United Healthcare All Payer |
$8,200.47
|
|
|
PLATE TIBLK 3.5M 185M 10 R M-D
|
Facility
|
IP
|
$9,318.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.43 |
| Max. Negotiated Rate |
$8,945.97 |
| Rate for Payer: Aetna Commercial |
$7,175.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,268.60
|
| Rate for Payer: Cash Price |
$4,659.36
|
| Rate for Payer: Cigna Commercial |
$7,734.54
|
| Rate for Payer: First Health Commercial |
$8,852.78
|
| Rate for Payer: Humana Commercial |
$7,920.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,641.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,877.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,795.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,200.47
|
| Rate for Payer: Ohio Health Group HMO |
$6,989.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,863.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,211.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,888.80
|
| Rate for Payer: PHCS Commercial |
$8,945.97
|
| Rate for Payer: United Healthcare All Payer |
$8,200.47
|
|
