|
PLATE TIB LK 3.5M A-D 6H 107M
|
Facility
|
OP
|
$5,520.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.61 |
| Max. Negotiated Rate |
$5,299.30 |
| Rate for Payer: Aetna Commercial |
$4,250.48
|
| Rate for Payer: Anthem Medicaid |
$1,898.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,305.68
|
| Rate for Payer: Cash Price |
$2,760.05
|
| Rate for Payer: Cigna Commercial |
$4,581.68
|
| Rate for Payer: First Health Commercial |
$5,244.10
|
| Rate for Payer: Humana Commercial |
$4,692.08
|
| Rate for Payer: Humana KY Medicaid |
$1,898.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,917.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,526.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,073.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,936.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,857.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,140.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.23
|
| Rate for Payer: PHCS Commercial |
$5,299.30
|
| Rate for Payer: United Healthcare All Payer |
$4,857.69
|
|
|
PLATE TIB LK 3.5M A-D 6H 107M
|
Facility
|
IP
|
$5,520.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.61 |
| Max. Negotiated Rate |
$5,299.30 |
| Rate for Payer: Aetna Commercial |
$4,250.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,305.68
|
| Rate for Payer: Cash Price |
$2,760.05
|
| Rate for Payer: Cigna Commercial |
$4,581.68
|
| Rate for Payer: First Health Commercial |
$5,244.10
|
| Rate for Payer: Humana Commercial |
$4,692.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,526.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,073.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,656.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,857.69
|
| Rate for Payer: Ohio Health Group HMO |
$4,140.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,104.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$717.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,711.23
|
| Rate for Payer: PHCS Commercial |
$5,299.30
|
| Rate for Payer: United Healthcare All Payer |
$4,857.69
|
|
|
PLATE TIB LK 3.5M L-P 6H 93M R
|
Facility
|
IP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Aetna Commercial |
$4,328.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
|
|
PLATE TIB LK 3.5M L-P 6H 93M R
|
Facility
|
OP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Aetna Commercial |
$4,328.09
|
| Rate for Payer: Anthem Medicaid |
$1,933.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Humana KY Medicaid |
$1,933.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,952.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,971.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
|
|
PLATE TIB LK 3.5MM A-D 3H 74MM
|
Facility
|
OP
|
$5,324.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.22 |
| Max. Negotiated Rate |
$5,111.81 |
| Rate for Payer: Aetna Commercial |
$4,100.10
|
| Rate for Payer: Anthem Medicaid |
$1,831.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,153.34
|
| Rate for Payer: Cash Price |
$2,662.40
|
| Rate for Payer: Cigna Commercial |
$4,419.58
|
| Rate for Payer: First Health Commercial |
$5,058.56
|
| Rate for Payer: Humana Commercial |
$4,526.08
|
| Rate for Payer: Humana KY Medicaid |
$1,831.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,849.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,366.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,929.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,597.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,867.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,685.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,993.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.69
|
| Rate for Payer: PHCS Commercial |
$5,111.81
|
| Rate for Payer: United Healthcare All Payer |
$4,685.82
|
|
|
PLATE TIB LK 3.5MM A-D 3H 74MM
|
Facility
|
IP
|
$5,324.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.22 |
| Max. Negotiated Rate |
$5,111.81 |
| Rate for Payer: Aetna Commercial |
$4,100.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,153.34
|
| Rate for Payer: Cash Price |
$2,662.40
|
| Rate for Payer: Cigna Commercial |
$4,419.58
|
| Rate for Payer: First Health Commercial |
$5,058.56
|
| Rate for Payer: Humana Commercial |
$4,526.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,366.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,929.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,597.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,685.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,993.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,064.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,650.69
|
| Rate for Payer: PHCS Commercial |
$5,111.81
|
| Rate for Payer: United Healthcare All Payer |
$4,685.82
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M L
|
Facility
|
IP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M L
|
Facility
|
OP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Anthem Medicaid |
$1,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Humana KY Medicaid |
$1,889.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,927.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
| Rate for Payer: Aetna Commercial |
$4,231.07
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M R
|
Facility
|
OP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem Medicaid |
$1,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Humana KY Medicaid |
$1,889.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,927.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M R
|
Facility
|
IP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TIB LK 4.5M 130M 6 L L-P
|
Facility
|
IP
|
$8,451.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.74 |
| Max. Negotiated Rate |
$8,113.77 |
| Rate for Payer: Aetna Commercial |
$6,507.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,592.44
|
| Rate for Payer: Cash Price |
$4,225.92
|
| Rate for Payer: Cigna Commercial |
$7,015.03
|
| Rate for Payer: First Health Commercial |
$8,029.25
|
| Rate for Payer: Humana Commercial |
$7,184.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,930.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,437.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,338.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.07
|
| Rate for Payer: PHCS Commercial |
$8,113.77
|
| Rate for Payer: United Healthcare All Payer |
$7,437.62
|
|
|
PLATE TIB LK 4.5M 130M 6 L L-P
|
Facility
|
OP
|
$8,451.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,098.74 |
| Max. Negotiated Rate |
$8,113.77 |
| Rate for Payer: Aetna Commercial |
$6,507.92
|
| Rate for Payer: Anthem Medicaid |
$2,906.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,592.44
|
| Rate for Payer: Cash Price |
$4,225.92
|
| Rate for Payer: Cigna Commercial |
$7,015.03
|
| Rate for Payer: First Health Commercial |
$8,029.25
|
| Rate for Payer: Humana Commercial |
$7,184.06
|
| Rate for Payer: Humana KY Medicaid |
$2,906.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,936.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,930.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,237.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,535.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,964.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,437.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,338.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,690.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,098.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.07
|
| Rate for Payer: PHCS Commercial |
$8,113.77
|
| Rate for Payer: United Healthcare All Payer |
$7,437.62
|
|
|
PLATE TIB LK 4.5M 130M 6 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 4.5M 130M 6 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 TIB LK 4.5M 165M 8 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 4.5M 165M 8 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 TIB LK 4.5M 165M 8 R L-P
|
Facility
|
OP
|
$8,513.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.81 |
| Max. Negotiated Rate |
$8,173.33 |
| Rate for Payer: Aetna Commercial |
$6,555.70
|
| Rate for Payer: Anthem Medicaid |
$2,927.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,640.83
|
| Rate for Payer: Cash Price |
$4,256.95
|
| Rate for Payer: Cigna Commercial |
$7,066.53
|
| Rate for Payer: First Health Commercial |
$8,088.20
|
| Rate for Payer: Humana Commercial |
$7,236.81
|
| Rate for Payer: Humana KY Medicaid |
$2,927.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,957.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,981.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,283.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,554.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,986.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,492.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,385.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,106.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,639.31
|
| Rate for Payer: PHCS Commercial |
$8,173.33
|
| Rate for Payer: United Healthcare All Payer |
$7,492.22
|
|
|
PLATE TIB LK 4.5M 165M 8 R L-P
|
Facility
|
IP
|
$8,513.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.81 |
| Max. Negotiated Rate |
$8,173.33 |
| Rate for Payer: Aetna Commercial |
$6,555.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,640.83
|
| Rate for Payer: Cash Price |
$4,256.95
|
| Rate for Payer: Cigna Commercial |
$7,066.53
|
| Rate for Payer: First Health Commercial |
$8,088.20
|
| Rate for Payer: Humana Commercial |
$7,236.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,981.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,283.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,554.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,492.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,385.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,106.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,639.31
|
| Rate for Payer: PHCS Commercial |
$8,173.33
|
| Rate for Payer: United Healthcare All Payer |
$7,492.22
|
|
|
PLATE TIBLK 4.5M 201M 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 4.5M 201M 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 4.5M 201M 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: 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 4.5M 201M 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: 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
|
| 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
|
|
|
PLATE TIBLK 4.5M 255M 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 4.5M 255M 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 4.5M 255M 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
|
|
