|
PLATE TIBLK 3.5M 185M 10 R 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 187M 13 L L-P
|
Facility
|
IP
|
$8,742.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.49 |
| Max. Negotiated Rate |
$8,392.51 |
| Rate for Payer: Aetna Commercial |
$6,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,818.92
|
| Rate for Payer: Cash Price |
$4,371.10
|
| Rate for Payer: Cigna Commercial |
$7,256.03
|
| Rate for Payer: First Health Commercial |
$8,305.09
|
| Rate for Payer: Humana Commercial |
$7,430.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,168.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,451.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,622.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,693.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,556.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,710.08
|
| Rate for Payer: PHCS Commercial |
$8,392.51
|
| Rate for Payer: United Healthcare All Payer |
$7,693.14
|
|
|
PLATE TIBLK 3.5M 187M 13 L L-P
|
Facility
|
OP
|
$8,742.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.49 |
| Max. Negotiated Rate |
$8,392.51 |
| Rate for Payer: Aetna Commercial |
$6,731.49
|
| Rate for Payer: Anthem Medicaid |
$3,006.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,818.92
|
| Rate for Payer: Cash Price |
$4,371.10
|
| Rate for Payer: Cigna Commercial |
$7,256.03
|
| Rate for Payer: First Health Commercial |
$8,305.09
|
| Rate for Payer: Humana Commercial |
$7,430.87
|
| Rate for Payer: Humana KY Medicaid |
$3,006.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,037.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,168.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,451.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,622.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,066.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,693.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,556.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,710.08
|
| Rate for Payer: PHCS Commercial |
$8,392.51
|
| Rate for Payer: United Healthcare All Payer |
$7,693.14
|
|
|
PLATE TIBLK 3.5M 187M 13 R L-P
|
Facility
|
OP
|
$8,742.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.49 |
| Max. Negotiated Rate |
$8,392.51 |
| Rate for Payer: Aetna Commercial |
$6,731.49
|
| Rate for Payer: Anthem Medicaid |
$3,006.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,818.92
|
| Rate for Payer: Cash Price |
$4,371.10
|
| Rate for Payer: Cigna Commercial |
$7,256.03
|
| Rate for Payer: First Health Commercial |
$8,305.09
|
| Rate for Payer: Humana Commercial |
$7,430.87
|
| Rate for Payer: Humana KY Medicaid |
$3,006.44
|
| Rate for Payer: Kentucky WC Medicaid |
$3,037.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,168.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,451.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,622.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,066.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,693.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,556.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,710.08
|
| Rate for Payer: PHCS Commercial |
$8,392.51
|
| Rate for Payer: United Healthcare All Payer |
$7,693.14
|
|
|
PLATE TIBLK 3.5M 187M 13 R L-P
|
Facility
|
IP
|
$8,742.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.49 |
| Max. Negotiated Rate |
$8,392.51 |
| Rate for Payer: Aetna Commercial |
$6,731.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,818.92
|
| Rate for Payer: Cash Price |
$4,371.10
|
| Rate for Payer: Cigna Commercial |
$7,256.03
|
| Rate for Payer: First Health Commercial |
$8,305.09
|
| Rate for Payer: Humana Commercial |
$7,430.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,168.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,451.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,622.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,693.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,556.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,748.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,136.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,710.08
|
| Rate for Payer: PHCS Commercial |
$8,392.51
|
| Rate for Payer: United Healthcare All Payer |
$7,693.14
|
|
|
PLATE TIBLK 3.5M 223M 13 L M-D
|
Facility
|
IP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
|
|
PLATE TIBLK 3.5M 223M 13 L M-D
|
Facility
|
OP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem Medicaid |
$3,236.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Humana KY Medicaid |
$3,236.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,269.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,301.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
|
|
PLATE TIBLK 3.5M 223M 13 R M-D
|
Facility
|
IP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
|
|
PLATE TIBLK 3.5M 223M 13 R M-D
|
Facility
|
OP
|
$9,410.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,223.39 |
| Max. Negotiated Rate |
$9,034.27 |
| Rate for Payer: Aetna Commercial |
$7,246.24
|
| Rate for Payer: Anthem Medicaid |
$3,236.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,340.35
|
| Rate for Payer: Cash Price |
$4,705.35
|
| Rate for Payer: Cigna Commercial |
$7,810.88
|
| Rate for Payer: First Health Commercial |
$8,940.16
|
| Rate for Payer: Humana Commercial |
$7,999.10
|
| Rate for Payer: Humana KY Medicaid |
$3,236.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,269.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,716.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,945.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,823.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,301.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,281.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,058.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,882.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,223.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,917.32
|
| Rate for Payer: PHCS Commercial |
$9,034.27
|
| Rate for Payer: United Healthcare All Payer |
$8,281.42
|
|
|
PLATE TIBLK 3.5M 262M 16 L M-D
|
Facility
|
OP
|
$9,511.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.56 |
| Max. Negotiated Rate |
$9,131.51 |
| Rate for Payer: Aetna Commercial |
$7,324.23
|
| Rate for Payer: Anthem Medicaid |
$3,271.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.35
|
| Rate for Payer: Cash Price |
$4,755.99
|
| Rate for Payer: Cigna Commercial |
$7,894.95
|
| Rate for Payer: First Health Commercial |
$9,036.39
|
| Rate for Payer: Humana Commercial |
$8,085.19
|
| Rate for Payer: Humana KY Medicaid |
$3,271.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,304.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,336.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,948.72
|
| Rate for Payer: PHCS Commercial |
$9,131.51
|
| Rate for Payer: United Healthcare All Payer |
$8,370.55
|
|
|
PLATE TIBLK 3.5M 262M 16 L M-D
|
Facility
|
IP
|
$9,511.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.56 |
| Max. Negotiated Rate |
$9,131.51 |
| Rate for Payer: Aetna Commercial |
$7,324.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.35
|
| Rate for Payer: Cash Price |
$4,755.99
|
| Rate for Payer: Cigna Commercial |
$7,894.95
|
| Rate for Payer: First Health Commercial |
$9,036.39
|
| Rate for Payer: Humana Commercial |
$8,085.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,948.72
|
| Rate for Payer: PHCS Commercial |
$9,131.51
|
| Rate for Payer: United Healthcare All Payer |
$8,370.55
|
|
|
PLATE TIBLK 3.5M 262M 16 R M-D
|
Facility
|
OP
|
$9,511.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.56 |
| Max. Negotiated Rate |
$9,131.51 |
| Rate for Payer: Aetna Commercial |
$7,324.23
|
| Rate for Payer: Anthem Medicaid |
$3,271.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.35
|
| Rate for Payer: Cash Price |
$4,755.99
|
| Rate for Payer: Cigna Commercial |
$7,894.95
|
| Rate for Payer: First Health Commercial |
$9,036.39
|
| Rate for Payer: Humana Commercial |
$8,085.19
|
| Rate for Payer: Humana KY Medicaid |
$3,271.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,304.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,336.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,948.72
|
| Rate for Payer: PHCS Commercial |
$9,131.51
|
| Rate for Payer: United Healthcare All Payer |
$8,370.55
|
|
|
PLATE TIBLK 3.5M 262M 16 R M-D
|
Facility
|
IP
|
$9,511.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,236.56 |
| Max. Negotiated Rate |
$9,131.51 |
| Rate for Payer: Aetna Commercial |
$7,324.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,419.35
|
| Rate for Payer: Cash Price |
$4,755.99
|
| Rate for Payer: Cigna Commercial |
$7,894.95
|
| Rate for Payer: First Health Commercial |
$9,036.39
|
| Rate for Payer: Humana Commercial |
$8,085.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,799.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,019.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,853.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,370.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,133.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,902.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,948.72
|
| Rate for Payer: PHCS Commercial |
$9,131.51
|
| Rate for Payer: United Healthcare All Payer |
$8,370.55
|
|
|
PLATE TIB LK 3.5M 73M 4 L L-P
|
Facility
|
OP
|
$7,209.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.22 |
| Max. Negotiated Rate |
$6,921.00 |
| Rate for Payer: Humana Commercial |
$6,127.97
|
| Rate for Payer: Humana KY Medicaid |
$2,479.31
|
| Rate for Payer: Kentucky WC Medicaid |
$2,504.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,529.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,407.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.91
|
| Rate for Payer: PHCS Commercial |
$6,921.00
|
| Rate for Payer: United Healthcare All Payer |
$6,344.25
|
| Rate for Payer: Aetna Commercial |
$5,551.22
|
| Rate for Payer: Anthem Medicaid |
$2,479.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.32
|
| Rate for Payer: Cash Price |
$3,604.69
|
| Rate for Payer: Cigna Commercial |
$5,983.79
|
| Rate for Payer: First Health Commercial |
$6,848.91
|
|
|
PLATE TIB LK 3.5M 73M 4 L L-P
|
Facility
|
IP
|
$7,209.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$937.22 |
| Max. Negotiated Rate |
$6,921.00 |
| Rate for Payer: Aetna Commercial |
$5,551.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,623.32
|
| Rate for Payer: Cash Price |
$3,604.69
|
| Rate for Payer: Cigna Commercial |
$5,983.79
|
| Rate for Payer: First Health Commercial |
$6,848.91
|
| Rate for Payer: Humana Commercial |
$6,127.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,911.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,320.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,162.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,344.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,407.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,441.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$937.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,234.91
|
| Rate for Payer: PHCS Commercial |
$6,921.00
|
| Rate for Payer: United Healthcare All Payer |
$6,344.25
|
|
|
PLATE TIB LK 3.5M 73M 4 R L-P
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE TIB LK 3.5M 73M 4 R L-P
|
Facility
|
IP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE TIBLK 3.5M 98M 6 L A-L-D
|
Facility
|
OP
|
$9,309.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.22 |
| Max. Negotiated Rate |
$8,937.03 |
| Rate for Payer: Aetna Commercial |
$7,168.25
|
| Rate for Payer: Anthem Medicaid |
$3,201.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,261.34
|
| Rate for Payer: Cash Price |
$4,654.70
|
| Rate for Payer: Cigna Commercial |
$7,726.81
|
| Rate for Payer: First Health Commercial |
$8,843.94
|
| Rate for Payer: Humana Commercial |
$7,913.00
|
| Rate for Payer: Humana KY Medicaid |
$3,201.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,234.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,633.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,870.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,192.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,982.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,861.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,885.92
|
| Rate for Payer: PHCS Commercial |
$8,937.03
|
| Rate for Payer: United Healthcare All Payer |
$8,192.28
|
|
|
PLATE TIBLK 3.5M 98M 6 L A-L-D
|
Facility
|
IP
|
$9,309.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.22 |
| Max. Negotiated Rate |
$8,937.03 |
| Rate for Payer: Aetna Commercial |
$7,168.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,261.34
|
| Rate for Payer: Cash Price |
$4,654.70
|
| Rate for Payer: Cigna Commercial |
$7,726.81
|
| Rate for Payer: First Health Commercial |
$8,843.94
|
| Rate for Payer: Humana Commercial |
$7,913.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,633.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,870.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,192.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,982.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,861.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,885.92
|
| Rate for Payer: PHCS Commercial |
$8,937.03
|
| Rate for Payer: United Healthcare All Payer |
$8,192.28
|
|
|
PLATE TIB LK 3.5M 98M 6 L L-P
|
Facility
|
IP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE TIB LK 3.5M 98M 6 L L-P
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE TIBLK 3.5M 98M 6 R A-L-D
|
Facility
|
OP
|
$9,309.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.22 |
| Max. Negotiated Rate |
$8,937.03 |
| Rate for Payer: Aetna Commercial |
$7,168.25
|
| Rate for Payer: Anthem Medicaid |
$3,201.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,261.34
|
| Rate for Payer: Cash Price |
$4,654.70
|
| Rate for Payer: Cigna Commercial |
$7,726.81
|
| Rate for Payer: First Health Commercial |
$8,843.94
|
| Rate for Payer: Humana Commercial |
$7,913.00
|
| Rate for Payer: Humana KY Medicaid |
$3,201.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,234.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,633.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,870.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,265.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,192.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,982.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,861.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,885.92
|
| Rate for Payer: PHCS Commercial |
$8,937.03
|
| Rate for Payer: United Healthcare All Payer |
$8,192.28
|
|
|
PLATE TIBLK 3.5M 98M 6 R A-L-D
|
Facility
|
IP
|
$9,309.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,210.22 |
| Max. Negotiated Rate |
$8,937.03 |
| Rate for Payer: Aetna Commercial |
$7,168.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,261.34
|
| Rate for Payer: Cash Price |
$4,654.70
|
| Rate for Payer: Cigna Commercial |
$7,726.81
|
| Rate for Payer: First Health Commercial |
$8,843.94
|
| Rate for Payer: Humana Commercial |
$7,913.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,633.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,870.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,792.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,192.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,982.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,861.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,210.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,885.92
|
| Rate for Payer: PHCS Commercial |
$8,937.03
|
| Rate for Payer: United Healthcare All Payer |
$8,192.28
|
|
|
PLATE TIB LK 3.5M 98M 6 R L-P
|
Facility
|
OP
|
$8,496.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$8,157.04 |
| Rate for Payer: Aetna Commercial |
$6,542.63
|
| Rate for Payer: Anthem Medicaid |
$2,922.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,627.60
|
| Rate for Payer: Cash Price |
$4,248.46
|
| Rate for Payer: Cigna Commercial |
$7,052.44
|
| Rate for Payer: First Health Commercial |
$8,072.07
|
| Rate for Payer: Humana Commercial |
$7,222.38
|
| Rate for Payer: Humana KY Medicaid |
$2,922.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,951.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,967.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,270.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,549.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,980.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,477.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,372.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,634.05
|
| Rate for Payer: PHCS Commercial |
$8,157.04
|
| Rate for Payer: United Healthcare All Payer |
$7,477.29
|
|
|
PLATE TIB LK 3.5M 98M 6 R L-P
|
Facility
|
IP
|
$8,496.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.60 |
| Max. Negotiated Rate |
$8,157.04 |
| Rate for Payer: Aetna Commercial |
$6,542.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,627.60
|
| Rate for Payer: Cash Price |
$4,248.46
|
| Rate for Payer: Cigna Commercial |
$7,052.44
|
| Rate for Payer: First Health Commercial |
$8,072.07
|
| Rate for Payer: Humana Commercial |
$7,222.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,967.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,270.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,549.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,477.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,372.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,104.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,634.05
|
| Rate for Payer: PHCS Commercial |
$8,157.04
|
| Rate for Payer: United Healthcare All Payer |
$7,477.29
|
|
