|
PLATE P-L-D HUM LK 5 80MM L
|
Facility
|
IP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE P-L-D HUM LK 5 80MM L
|
Facility
|
OP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem Medicaid |
$2,404.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Humana KY Medicaid |
$2,404.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,452.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE P-L-D HUM LK 5 80MM R
|
Facility
|
IP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE P-L-D HUM LK 5 80MM R
|
Facility
|
OP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem Medicaid |
$2,404.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Humana KY Medicaid |
$2,404.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,452.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
|
PLATE P-L-D HUM LK 7 107MM R
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE P-L-D HUM LK 7 107MM R
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE P-L-D HUM LK 7 80MM L
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE P-L-D HUM LK 7 80MM L
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE P-L-D HUM LK 9 132MM L
|
Facility
|
OP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem Medicaid |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Humana KY Medicaid |
$2,664.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,691.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE P-L-D HUM LK 9 132MM L
|
Facility
|
IP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE P-L-D HUM LK 9 132MM R
|
Facility
|
OP
|
$7,821.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,346.33 |
| Max. Negotiated Rate |
$7,508.26 |
| Rate for Payer: Aetna Commercial |
$6,022.25
|
| Rate for Payer: Anthem Medicaid |
$2,689.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,100.46
|
| Rate for Payer: Cash Price |
$3,910.55
|
| Rate for Payer: Cigna Commercial |
$6,491.51
|
| Rate for Payer: First Health Commercial |
$7,430.05
|
| Rate for Payer: Humana Commercial |
$6,647.94
|
| Rate for Payer: Humana KY Medicaid |
$2,689.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,717.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,413.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,771.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,743.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,882.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,865.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,256.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,804.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.56
|
| Rate for Payer: PHCS Commercial |
$7,508.26
|
| Rate for Payer: United Healthcare All Payer |
$6,882.57
|
|
|
PLATE P-L-D HUM LK 9 132MM R
|
Facility
|
IP
|
$7,821.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,346.33 |
| Max. Negotiated Rate |
$7,508.26 |
| Rate for Payer: Aetna Commercial |
$6,022.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,100.46
|
| Rate for Payer: Cash Price |
$3,910.55
|
| Rate for Payer: Cigna Commercial |
$6,491.51
|
| Rate for Payer: First Health Commercial |
$7,430.05
|
| Rate for Payer: Humana Commercial |
$6,647.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,413.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,771.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,346.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,882.57
|
| Rate for Payer: Ohio Health Group HMO |
$5,865.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,256.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,804.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,396.56
|
| Rate for Payer: PHCS Commercial |
$7,508.26
|
| Rate for Payer: United Healthcare All Payer |
$6,882.57
|
|
|
PLATE POLARUS 3 POST 4H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 POST 4H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 POST 4H R
|
Facility
|
IP
|
$7,336.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.86 |
| Max. Negotiated Rate |
$7,042.75 |
| Rate for Payer: Aetna Commercial |
$5,648.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,722.24
|
| Rate for Payer: Cash Price |
$3,668.10
|
| Rate for Payer: Cigna Commercial |
$6,089.05
|
| Rate for Payer: First Health Commercial |
$6,969.39
|
| Rate for Payer: Humana Commercial |
$6,235.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,015.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,414.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,455.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,502.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,868.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,382.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.98
|
| Rate for Payer: PHCS Commercial |
$7,042.75
|
| Rate for Payer: United Healthcare All Payer |
$6,455.86
|
|
|
PLATE POLARUS 3 POST 4H R
|
Facility
|
OP
|
$7,336.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.86 |
| Max. Negotiated Rate |
$7,042.75 |
| Rate for Payer: Aetna Commercial |
$5,648.87
|
| Rate for Payer: Anthem Medicaid |
$2,522.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,722.24
|
| Rate for Payer: Cash Price |
$3,668.10
|
| Rate for Payer: Cigna Commercial |
$6,089.05
|
| Rate for Payer: First Health Commercial |
$6,969.39
|
| Rate for Payer: Humana Commercial |
$6,235.77
|
| Rate for Payer: Humana KY Medicaid |
$2,522.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,548.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,015.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,414.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,573.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,455.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,502.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,868.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,382.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.98
|
| Rate for Payer: PHCS Commercial |
$7,042.75
|
| Rate for Payer: United Healthcare All Payer |
$6,455.86
|
|
|
PLATE POLARUS 3 POST 6H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 POST 6H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 POST 6H R
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 POST 6H R
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 10H L
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 10H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 10H R
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 10H R
|
Facility
|
OP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem Medicaid |
$2,403.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Humana KY Medicaid |
$2,403.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,451.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
|
PLATE POLARUS 3 STD 14H L
|
Facility
|
IP
|
$6,989.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,096.84 |
| Max. Negotiated Rate |
$6,709.87 |
| Rate for Payer: Aetna Commercial |
$5,381.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,451.77
|
| Rate for Payer: Cash Price |
$3,494.72
|
| Rate for Payer: Cigna Commercial |
$5,801.24
|
| Rate for Payer: First Health Commercial |
$6,639.98
|
| Rate for Payer: Humana Commercial |
$5,941.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,731.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,158.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,096.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,150.72
|
| Rate for Payer: Ohio Health Group HMO |
$5,242.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,591.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,080.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,822.72
|
| Rate for Payer: PHCS Commercial |
$6,709.87
|
| Rate for Payer: United Healthcare All Payer |
$6,150.72
|
|
