|
PLATE TI LCP PRX HM 5H 3.5*114
|
Facility
|
OP
|
$8,278.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.26 |
| Max. Negotiated Rate |
$7,947.75 |
| Rate for Payer: Aetna Commercial |
$6,374.76
|
| Rate for Payer: Anthem Medicaid |
$2,847.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,457.55
|
| Rate for Payer: Cash Price |
$4,139.45
|
| Rate for Payer: Cigna Commercial |
$6,871.50
|
| Rate for Payer: First Health Commercial |
$7,864.96
|
| Rate for Payer: Humana Commercial |
$7,037.07
|
| Rate for Payer: Humana KY Medicaid |
$2,847.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,876.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,788.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,109.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,483.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,904.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,285.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,209.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,566.46
|
| Rate for Payer: PHCS Commercial |
$7,947.75
|
| Rate for Payer: United Healthcare All Payer |
$7,285.44
|
|
|
PLATE TI LCP PRX HM 5H 3.5*114
|
Facility
|
IP
|
$8,278.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.26 |
| Max. Negotiated Rate |
$7,947.75 |
| Rate for Payer: Aetna Commercial |
$6,374.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,457.55
|
| Rate for Payer: Cash Price |
$4,139.45
|
| Rate for Payer: Cigna Commercial |
$6,871.50
|
| Rate for Payer: First Health Commercial |
$7,864.96
|
| Rate for Payer: Humana Commercial |
$7,037.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,788.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,109.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,483.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,285.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,209.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,655.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,076.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,566.46
|
| Rate for Payer: PHCS Commercial |
$7,947.75
|
| Rate for Payer: United Healthcare All Payer |
$7,285.44
|
|
|
PLATE TI LCP RECON 3.5*112 8H
|
Facility
|
IP
|
$4,248.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.34 |
| Max. Negotiated Rate |
$4,078.81 |
| Rate for Payer: Aetna Commercial |
$3,271.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.03
|
| Rate for Payer: Cash Price |
$2,124.38
|
| Rate for Payer: Cigna Commercial |
$3,526.47
|
| Rate for Payer: First Health Commercial |
$4,036.32
|
| Rate for Payer: Humana Commercial |
$3,611.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.12
|
| Rate for Payer: PHCS Commercial |
$4,078.81
|
| Rate for Payer: United Healthcare All Payer |
$3,738.91
|
|
|
PLATE TI LCP RECON 3.5*112 8H
|
Facility
|
OP
|
$4,248.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.34 |
| Max. Negotiated Rate |
$4,078.81 |
| Rate for Payer: Aetna Commercial |
$3,271.55
|
| Rate for Payer: Anthem Medicaid |
$1,461.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.03
|
| Rate for Payer: Cash Price |
$2,124.38
|
| Rate for Payer: Cigna Commercial |
$3,526.47
|
| Rate for Payer: First Health Commercial |
$4,036.32
|
| Rate for Payer: Humana Commercial |
$3,611.45
|
| Rate for Payer: Humana KY Medicaid |
$1,461.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,483.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,738.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.12
|
| Rate for Payer: PHCS Commercial |
$4,078.81
|
| Rate for Payer: United Healthcare All Payer |
$3,738.91
|
|
|
PLATE TI LCP RECON 3.5*140 10H
|
Facility
|
IP
|
$4,408.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.06 |
| Max. Negotiated Rate |
$4,231.80 |
| Rate for Payer: Aetna Commercial |
$3,394.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,438.33
|
| Rate for Payer: Cash Price |
$2,204.06
|
| Rate for Payer: Cigna Commercial |
$3,658.74
|
| Rate for Payer: First Health Commercial |
$4,187.71
|
| Rate for Payer: Humana Commercial |
$3,746.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,614.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,253.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,322.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,879.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,306.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.52
|
| Rate for Payer: PHCS Commercial |
$4,231.80
|
| Rate for Payer: United Healthcare All Payer |
$3,879.15
|
|
|
PLATE TI LCP RECON 3.5*140 10H
|
Facility
|
OP
|
$4,408.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.06 |
| Max. Negotiated Rate |
$4,231.80 |
| Rate for Payer: Aetna Commercial |
$3,394.25
|
| Rate for Payer: Anthem Medicaid |
$1,515.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,438.33
|
| Rate for Payer: Cash Price |
$2,204.06
|
| Rate for Payer: Cigna Commercial |
$3,658.74
|
| Rate for Payer: First Health Commercial |
$4,187.71
|
| Rate for Payer: Humana Commercial |
$3,746.90
|
| Rate for Payer: Humana KY Medicaid |
$1,515.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,531.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,614.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,253.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,322.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,546.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,879.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,306.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,366.52
|
| Rate for Payer: PHCS Commercial |
$4,231.80
|
| Rate for Payer: United Healthcare All Payer |
$3,879.15
|
|
|
PLATE TI LCP RECON 3.5*154 11H
|
Facility
|
IP
|
$4,325.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.32 |
| Max. Negotiated Rate |
$4,152.53 |
| Rate for Payer: Aetna Commercial |
$3,330.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.93
|
| Rate for Payer: Cash Price |
$2,162.78
|
| Rate for Payer: Cigna Commercial |
$3,590.21
|
| Rate for Payer: First Health Commercial |
$4,109.27
|
| Rate for Payer: Humana Commercial |
$3,676.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,192.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,297.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,244.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.92
|
| Rate for Payer: PHCS Commercial |
$4,152.53
|
| Rate for Payer: United Healthcare All Payer |
$3,806.48
|
|
|
PLATE TI LCP RECON 3.5*154 11H
|
Facility
|
OP
|
$4,325.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.32 |
| Max. Negotiated Rate |
$4,152.53 |
| Rate for Payer: Aetna Commercial |
$3,330.67
|
| Rate for Payer: Anthem Medicaid |
$1,487.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.93
|
| Rate for Payer: Cash Price |
$2,162.78
|
| Rate for Payer: Cigna Commercial |
$3,590.21
|
| Rate for Payer: First Health Commercial |
$4,109.27
|
| Rate for Payer: Humana Commercial |
$3,676.72
|
| Rate for Payer: Humana KY Medicaid |
$1,487.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,502.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,192.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,297.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,517.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,244.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$865.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.92
|
| Rate for Payer: PHCS Commercial |
$4,152.53
|
| Rate for Payer: United Healthcare All Payer |
$3,806.48
|
|
|
PLATE TI LCP RECON 3.5*168 12H
|
Facility
|
IP
|
$4,498.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.87 |
| Max. Negotiated Rate |
$4,319.02 |
| Rate for Payer: Aetna Commercial |
$3,464.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.20
|
| Rate for Payer: Cash Price |
$2,249.49
|
| Rate for Payer: Cigna Commercial |
$3,734.15
|
| Rate for Payer: First Health Commercial |
$4,274.03
|
| Rate for Payer: Humana Commercial |
$3,824.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.68
|
| Rate for Payer: PHCS Commercial |
$4,319.02
|
| Rate for Payer: United Healthcare All Payer |
$3,959.10
|
|
|
PLATE TI LCP RECON 3.5*168 12H
|
Facility
|
OP
|
$4,498.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.87 |
| Max. Negotiated Rate |
$4,319.02 |
| Rate for Payer: Aetna Commercial |
$3,464.21
|
| Rate for Payer: Anthem Medicaid |
$1,547.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,509.20
|
| Rate for Payer: Cash Price |
$2,249.49
|
| Rate for Payer: Cigna Commercial |
$3,734.15
|
| Rate for Payer: First Health Commercial |
$4,274.03
|
| Rate for Payer: Humana Commercial |
$3,824.13
|
| Rate for Payer: Humana KY Medicaid |
$1,547.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,689.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,320.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,959.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,374.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.68
|
| Rate for Payer: PHCS Commercial |
$4,319.02
|
| Rate for Payer: United Healthcare All Payer |
$3,959.10
|
|
|
PLATE TI LCP RECON 3.5*70 5H
|
Facility
|
OP
|
$3,743.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.62 |
| Max. Negotiated Rate |
$3,593.49 |
| Rate for Payer: Aetna Commercial |
$2,882.28
|
| Rate for Payer: Anthem Medicaid |
$1,287.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.71
|
| Rate for Payer: Cash Price |
$1,871.61
|
| Rate for Payer: Cigna Commercial |
$3,106.87
|
| Rate for Payer: First Health Commercial |
$3,556.06
|
| Rate for Payer: Humana Commercial |
$3,181.74
|
| Rate for Payer: Humana KY Medicaid |
$1,287.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,300.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,069.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,313.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,294.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,807.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.40
|
| Rate for Payer: PHCS Commercial |
$3,593.49
|
| Rate for Payer: United Healthcare All Payer |
$3,294.03
|
|
|
PLATE TI LCP RECON 3.5*70 5H
|
Facility
|
IP
|
$3,743.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.62 |
| Max. Negotiated Rate |
$3,593.49 |
| Rate for Payer: Aetna Commercial |
$2,882.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.71
|
| Rate for Payer: Cash Price |
$1,871.61
|
| Rate for Payer: Cigna Commercial |
$3,106.87
|
| Rate for Payer: First Health Commercial |
$3,556.06
|
| Rate for Payer: Humana Commercial |
$3,181.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,069.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,294.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,807.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.40
|
| Rate for Payer: PHCS Commercial |
$3,593.49
|
| Rate for Payer: United Healthcare All Payer |
$3,294.03
|
|
|
PLATE TI LCP RECON 3.5*84 6H
|
Facility
|
IP
|
$4,157.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.44 |
| Max. Negotiated Rate |
$3,990.91 |
| Rate for Payer: Aetna Commercial |
$3,201.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,242.62
|
| Rate for Payer: Cash Price |
$2,078.60
|
| Rate for Payer: Cigna Commercial |
$3,450.48
|
| Rate for Payer: First Health Commercial |
$3,949.34
|
| Rate for Payer: Humana Commercial |
$3,533.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,068.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,658.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.73
|
| Rate for Payer: PHCS Commercial |
$3,990.91
|
| Rate for Payer: United Healthcare All Payer |
$3,658.34
|
|
|
PLATE TI LCP RECON 3.5*84 6H
|
Facility
|
OP
|
$4,157.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.44 |
| Max. Negotiated Rate |
$3,990.91 |
| Rate for Payer: Aetna Commercial |
$3,201.04
|
| Rate for Payer: Anthem Medicaid |
$1,429.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,242.62
|
| Rate for Payer: Cash Price |
$2,078.60
|
| Rate for Payer: Cigna Commercial |
$3,450.48
|
| Rate for Payer: First Health Commercial |
$3,949.34
|
| Rate for Payer: Humana Commercial |
$3,533.62
|
| Rate for Payer: Humana KY Medicaid |
$1,429.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,408.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,068.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,658.34
|
| Rate for Payer: Ohio Health Group HMO |
$3,117.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.73
|
| Rate for Payer: PHCS Commercial |
$3,990.91
|
| Rate for Payer: United Healthcare All Payer |
$3,658.34
|
|
|
PLATE TI LCP RECON 3.5*98 7H
|
Facility
|
IP
|
$4,249.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.38 |
| Max. Negotiated Rate |
$4,079.15 |
| Rate for Payer: Aetna Commercial |
$3,271.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.31
|
| Rate for Payer: Cash Price |
$2,124.55
|
| Rate for Payer: Cigna Commercial |
$3,526.76
|
| Rate for Payer: First Health Commercial |
$4,036.65
|
| Rate for Payer: Humana Commercial |
$3,611.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.22
|
| Rate for Payer: PHCS Commercial |
$4,079.15
|
| Rate for Payer: United Healthcare All Payer |
$3,739.22
|
|
|
PLATE TI LCP RECON 3.5*98 7H
|
Facility
|
OP
|
$4,249.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.38 |
| Max. Negotiated Rate |
$4,079.15 |
| Rate for Payer: Aetna Commercial |
$3,271.81
|
| Rate for Payer: Anthem Medicaid |
$1,461.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.31
|
| Rate for Payer: Cash Price |
$2,124.55
|
| Rate for Payer: Cigna Commercial |
$3,526.76
|
| Rate for Payer: First Health Commercial |
$4,036.65
|
| Rate for Payer: Humana Commercial |
$3,611.74
|
| Rate for Payer: Humana KY Medicaid |
$1,461.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.22
|
| Rate for Payer: PHCS Commercial |
$4,079.15
|
| Rate for Payer: United Healthcare All Payer |
$3,739.22
|
|
|
PLATE TI RECON 10H 118MM
|
Facility
|
OP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Anthem Medicaid |
$1,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Humana KY Medicaid |
$1,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
| Rate for Payer: Aetna Commercial |
$2,673.98
|
|
|
PLATE TI RECON 10H 118MM
|
Facility
|
IP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 5H 58MM
|
Facility
|
OP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem Medicaid |
$1,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Humana KY Medicaid |
$1,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 5H 58MM
|
Facility
|
IP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 6H 70MM
|
Facility
|
IP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 6H 70MM
|
Facility
|
OP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem Medicaid |
$1,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Humana KY Medicaid |
$1,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 7H 82MM
|
Facility
|
OP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem Medicaid |
$1,194.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Humana KY Medicaid |
$1,194.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,206.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,218.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 7H 82MM
|
Facility
|
IP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
|
PLATE TI RECON 8H 94MM
|
Facility
|
IP
|
$3,472.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.45 |
| Max. Negotiated Rate |
$3,333.79 |
| Rate for Payer: Aetna Commercial |
$2,673.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,708.71
|
| Rate for Payer: Cash Price |
$1,736.35
|
| Rate for Payer: Cigna Commercial |
$2,882.34
|
| Rate for Payer: First Health Commercial |
$3,299.06
|
| Rate for Payer: Humana Commercial |
$2,951.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,847.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,562.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,041.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,055.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,604.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$694.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$451.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,076.54
|
| Rate for Payer: PHCS Commercial |
$3,333.79
|
| Rate for Payer: United Healthcare All Payer |
$3,055.98
|
|
