|
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
|
|
|
PLATE TIBLK 4.5M 309M 16 L L-P
|
Facility
|
OP
|
$8,809.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.26 |
| Max. Negotiated Rate |
$8,457.34 |
| Rate for Payer: Aetna Commercial |
$6,783.49
|
| Rate for Payer: Anthem Medicaid |
$3,029.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,871.59
|
| Rate for Payer: Cash Price |
$4,404.86
|
| Rate for Payer: Cigna Commercial |
$7,312.08
|
| Rate for Payer: First Health Commercial |
$8,369.24
|
| Rate for Payer: Humana Commercial |
$7,488.27
|
| Rate for Payer: Humana KY Medicaid |
$3,029.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,501.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,607.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,761.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.02
|
| Rate for Payer: PHCS Commercial |
$8,457.34
|
| Rate for Payer: United Healthcare All Payer |
$7,752.56
|
|
|
PLATE TIBLK 4.5M 309M 16 L L-P
|
Facility
|
IP
|
$8,809.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.26 |
| Max. Negotiated Rate |
$8,457.34 |
| Rate for Payer: Aetna Commercial |
$6,783.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,871.59
|
| Rate for Payer: Cash Price |
$4,404.86
|
| Rate for Payer: Cigna Commercial |
$7,312.08
|
| Rate for Payer: First Health Commercial |
$8,369.24
|
| Rate for Payer: Humana Commercial |
$7,488.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,501.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,607.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,761.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.02
|
| Rate for Payer: PHCS Commercial |
$8,457.34
|
| Rate for Payer: United Healthcare All Payer |
$7,752.56
|
|
|
PLATE TIBLK 4.5M 309M 16 R L-P
|
Facility
|
IP
|
$8,809.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.26 |
| Max. Negotiated Rate |
$8,457.34 |
| Rate for Payer: Aetna Commercial |
$6,783.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,871.59
|
| Rate for Payer: Cash Price |
$4,404.86
|
| Rate for Payer: Cigna Commercial |
$7,312.08
|
| Rate for Payer: First Health Commercial |
$8,369.24
|
| Rate for Payer: Humana Commercial |
$7,488.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,501.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,607.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,761.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.02
|
| Rate for Payer: PHCS Commercial |
$8,457.34
|
| Rate for Payer: United Healthcare All Payer |
$7,752.56
|
|
|
PLATE TIBLK 4.5M 309M 16 R L-P
|
Facility
|
OP
|
$8,809.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,145.26 |
| Max. Negotiated Rate |
$8,457.34 |
| Rate for Payer: Humana Commercial |
$7,488.27
|
| Rate for Payer: Humana KY Medicaid |
$3,029.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,060.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,223.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,501.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,642.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,090.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,752.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,607.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,761.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,145.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,731.02
|
| Rate for Payer: PHCS Commercial |
$8,457.34
|
| Rate for Payer: United Healthcare All Payer |
$7,752.56
|
| Rate for Payer: Aetna Commercial |
$6,783.49
|
| Rate for Payer: Anthem Medicaid |
$3,029.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,871.59
|
| Rate for Payer: Cash Price |
$4,404.86
|
| Rate for Payer: Cigna Commercial |
$7,312.08
|
| Rate for Payer: First Health Commercial |
$8,369.24
|
|
|
PLATE TIB LK 4.5M 94M 4 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 94M 4 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 94M 4 R 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 94M 4 R 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 A-D 3.5MM 107MM 6
|
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 A-D 3.5MM 107MM 6
|
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 A-D 3.5MM 74MM 3
|
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 A-D 3.5MM 74MM 3
|
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 L-P 3.5*93 6 L
|
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 L-P 3.5*93 6 L
|
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 L-P 3.5M 4H 68M 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 L-P 3.5M 4H 68M 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 L-P 3.5M 68M 4 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 L-P 3.5M 68M 4 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 L-P 3.5M 93M 6 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 L-P 3.5M 93M 6 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 M-D 3.5M 127M 6 L
|
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: 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
|
| Rate for Payer: Aetna Commercial |
$4,328.09
|
|
|
PLATE TIB LK M-D 3.5M 127M 6 L
|
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 M-D 3.5M 127M 6 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 M-D 3.5M 127M 6 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
|
|
