|
PLATE POSTEROLTRL DIS TIB 3H L
|
Facility
|
IP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POSTEROLTRL DIS TIB 3H L
|
Facility
|
OP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem Medicaid |
$1,425.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Humana KY Medicaid |
$1,425.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,439.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POSTEROLTRL DIS TIB 3H R
|
Facility
|
IP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POSTEROLTRL DIS TIB 3H R
|
Facility
|
OP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem Medicaid |
$1,425.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Humana KY Medicaid |
$1,425.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,439.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POSTEROLTRL DIS TIB 4H L
|
Facility
|
OP
|
$4,242.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.75 |
| Max. Negotiated Rate |
$4,072.80 |
| Rate for Payer: Aetna Commercial |
$3,266.72
|
| Rate for Payer: Anthem Medicaid |
$1,459.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,309.15
|
| Rate for Payer: Cash Price |
$2,121.25
|
| Rate for Payer: Cigna Commercial |
$3,521.28
|
| Rate for Payer: First Health Commercial |
$4,030.38
|
| Rate for Payer: Humana Commercial |
$3,606.12
|
| Rate for Payer: Humana KY Medicaid |
$1,459.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,473.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,478.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,130.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,488.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,733.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,394.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,690.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,927.32
|
| Rate for Payer: PHCS Commercial |
$4,072.80
|
| Rate for Payer: United Healthcare All Payer |
$3,733.40
|
|
|
PLATE POSTEROLTRL DIS TIB 4H L
|
Facility
|
IP
|
$4,242.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.75 |
| Max. Negotiated Rate |
$4,072.80 |
| Rate for Payer: Aetna Commercial |
$3,266.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,309.15
|
| Rate for Payer: Cash Price |
$2,121.25
|
| Rate for Payer: Cigna Commercial |
$3,521.28
|
| Rate for Payer: First Health Commercial |
$4,030.38
|
| Rate for Payer: Humana Commercial |
$3,606.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,478.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,130.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,733.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,394.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,690.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,927.32
|
| Rate for Payer: PHCS Commercial |
$4,072.80
|
| Rate for Payer: United Healthcare All Payer |
$3,733.40
|
|
|
PLATE POSTEROLTRL DIS TIB 4H R
|
Facility
|
IP
|
$4,242.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.75 |
| Max. Negotiated Rate |
$4,072.80 |
| Rate for Payer: Aetna Commercial |
$3,266.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,309.15
|
| Rate for Payer: Cash Price |
$2,121.25
|
| Rate for Payer: Cigna Commercial |
$3,521.28
|
| Rate for Payer: First Health Commercial |
$4,030.38
|
| Rate for Payer: Humana Commercial |
$3,606.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,478.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,130.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,733.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,394.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,690.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,927.32
|
| Rate for Payer: PHCS Commercial |
$4,072.80
|
| Rate for Payer: United Healthcare All Payer |
$3,733.40
|
|
|
PLATE POSTEROLTRL DIS TIB 4H R
|
Facility
|
OP
|
$4,242.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.75 |
| Max. Negotiated Rate |
$4,072.80 |
| Rate for Payer: Aetna Commercial |
$3,266.72
|
| Rate for Payer: Anthem Medicaid |
$1,459.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,309.15
|
| Rate for Payer: Cash Price |
$2,121.25
|
| Rate for Payer: Cigna Commercial |
$3,521.28
|
| Rate for Payer: First Health Commercial |
$4,030.38
|
| Rate for Payer: Humana Commercial |
$3,606.12
|
| Rate for Payer: Humana KY Medicaid |
$1,459.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,473.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,478.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,130.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,488.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,733.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,181.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,394.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,690.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,927.32
|
| Rate for Payer: PHCS Commercial |
$4,072.80
|
| Rate for Payer: United Healthcare All Payer |
$3,733.40
|
|
|
PLATE POSTEROMEDL DIS TIB 3H L
|
Facility
|
OP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem Medicaid |
$1,425.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Humana KY Medicaid |
$1,425.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,439.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POSTEROMEDL DIS TIB 3H L
|
Facility
|
IP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POSTEROMEDL DIS TIB 3H R
|
Facility
|
IP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POSTEROMEDL DIS TIB 3H R
|
Facility
|
OP
|
$4,145.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,243.50 |
| Max. Negotiated Rate |
$3,979.20 |
| Rate for Payer: Aetna Commercial |
$3,191.65
|
| Rate for Payer: Anthem Medicaid |
$1,425.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,233.10
|
| Rate for Payer: Cash Price |
$2,072.50
|
| Rate for Payer: Cigna Commercial |
$3,440.35
|
| Rate for Payer: First Health Commercial |
$3,937.75
|
| Rate for Payer: Humana Commercial |
$3,523.25
|
| Rate for Payer: Humana KY Medicaid |
$1,425.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,439.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,398.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,059.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,243.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,454.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,647.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,108.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,316.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,606.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,860.05
|
| Rate for Payer: PHCS Commercial |
$3,979.20
|
| Rate for Payer: United Healthcare All Payer |
$3,647.60
|
|
|
PLATE POST FSN 3.5MM 80MM L
|
Facility
|
IP
|
$7,052.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.83 |
| Max. Negotiated Rate |
$6,770.67 |
| Rate for Payer: Aetna Commercial |
$5,430.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.17
|
| Rate for Payer: Cash Price |
$3,526.39
|
| Rate for Payer: Cigna Commercial |
$5,853.81
|
| Rate for Payer: First Health Commercial |
$6,700.14
|
| Rate for Payer: Humana Commercial |
$5,994.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.42
|
| Rate for Payer: PHCS Commercial |
$6,770.67
|
| Rate for Payer: United Healthcare All Payer |
$6,206.45
|
|
|
PLATE POST FSN 3.5MM 80MM L
|
Facility
|
OP
|
$7,052.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.83 |
| Max. Negotiated Rate |
$6,770.67 |
| Rate for Payer: Aetna Commercial |
$5,430.64
|
| Rate for Payer: Anthem Medicaid |
$2,425.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.17
|
| Rate for Payer: Cash Price |
$3,526.39
|
| Rate for Payer: Cigna Commercial |
$5,853.81
|
| Rate for Payer: First Health Commercial |
$6,700.14
|
| Rate for Payer: Humana Commercial |
$5,994.86
|
| Rate for Payer: Humana KY Medicaid |
$2,425.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,450.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,474.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.42
|
| Rate for Payer: PHCS Commercial |
$6,770.67
|
| Rate for Payer: United Healthcare All Payer |
$6,206.45
|
|
|
PLATE POST FSN 3.5MM 80MM R
|
Facility
|
IP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE POST FSN 3.5MM 80MM R
|
Facility
|
OP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem Medicaid |
$2,465.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Humana KY Medicaid |
$2,465.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,490.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,514.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE PRFL LK 3D REPL 1.7 4X2H
|
Facility
|
IP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PRFL LK 3D REPL 1.7 4X2H
|
Facility
|
OP
|
$4,937.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,481.10 |
| Max. Negotiated Rate |
$4,739.52 |
| Rate for Payer: Aetna Commercial |
$3,801.49
|
| Rate for Payer: Anthem Medicaid |
$1,697.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,850.86
|
| Rate for Payer: Cash Price |
$2,468.50
|
| Rate for Payer: Cigna Commercial |
$4,097.71
|
| Rate for Payer: First Health Commercial |
$4,690.15
|
| Rate for Payer: Humana Commercial |
$4,196.45
|
| Rate for Payer: Humana KY Medicaid |
$1,697.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,715.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,048.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,643.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,481.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,731.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,344.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,702.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,949.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,295.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,406.53
|
| Rate for Payer: PHCS Commercial |
$4,739.52
|
| Rate for Payer: United Healthcare All Payer |
$4,344.56
|
|
|
PLATE PRIM AK FSN 3.5M 67M 3 L
|
Facility
|
OP
|
$7,052.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.83 |
| Max. Negotiated Rate |
$6,770.67 |
| Rate for Payer: Aetna Commercial |
$5,430.64
|
| Rate for Payer: Anthem Medicaid |
$2,425.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.17
|
| Rate for Payer: Cash Price |
$3,526.39
|
| Rate for Payer: Cigna Commercial |
$5,853.81
|
| Rate for Payer: First Health Commercial |
$6,700.14
|
| Rate for Payer: Humana Commercial |
$5,994.86
|
| Rate for Payer: Humana KY Medicaid |
$2,425.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,450.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,474.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.42
|
| Rate for Payer: PHCS Commercial |
$6,770.67
|
| Rate for Payer: United Healthcare All Payer |
$6,206.45
|
|
|
PLATE PRIM AK FSN 3.5M 67M 3 L
|
Facility
|
IP
|
$7,052.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.83 |
| Max. Negotiated Rate |
$6,770.67 |
| Rate for Payer: Aetna Commercial |
$5,430.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.17
|
| Rate for Payer: Cash Price |
$3,526.39
|
| Rate for Payer: Cigna Commercial |
$5,853.81
|
| Rate for Payer: First Health Commercial |
$6,700.14
|
| Rate for Payer: Humana Commercial |
$5,994.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.42
|
| Rate for Payer: PHCS Commercial |
$6,770.67
|
| Rate for Payer: United Healthcare All Payer |
$6,206.45
|
|
|
PLATE PRIM AK FSN 3.5M 67M 3 R
|
Facility
|
OP
|
$7,052.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.83 |
| Max. Negotiated Rate |
$6,770.67 |
| Rate for Payer: Aetna Commercial |
$5,430.64
|
| Rate for Payer: Anthem Medicaid |
$2,425.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.17
|
| Rate for Payer: Cash Price |
$3,526.39
|
| Rate for Payer: Cigna Commercial |
$5,853.81
|
| Rate for Payer: First Health Commercial |
$6,700.14
|
| Rate for Payer: Humana Commercial |
$5,994.86
|
| Rate for Payer: Humana KY Medicaid |
$2,425.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,450.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,474.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.42
|
| Rate for Payer: PHCS Commercial |
$6,770.67
|
| Rate for Payer: United Healthcare All Payer |
$6,206.45
|
|
|
PLATE PRIM AK FSN 3.5M 67M 3 R
|
Facility
|
IP
|
$7,052.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.83 |
| Max. Negotiated Rate |
$6,770.67 |
| Rate for Payer: Aetna Commercial |
$5,430.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,501.17
|
| Rate for Payer: Cash Price |
$3,526.39
|
| Rate for Payer: Cigna Commercial |
$5,853.81
|
| Rate for Payer: First Health Commercial |
$6,700.14
|
| Rate for Payer: Humana Commercial |
$5,994.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,783.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,206.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,642.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.42
|
| Rate for Payer: PHCS Commercial |
$6,770.67
|
| Rate for Payer: United Healthcare All Payer |
$6,206.45
|
|
|
PLATE PRIM AK FSN 3.5M 92M 5 R
|
Facility
|
IP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE PRIM AK FSN 3.5M 92M 5 R
|
Facility
|
OP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem Medicaid |
$2,465.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Humana KY Medicaid |
$2,465.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,490.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,514.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE PRIMARY RECON 11H
|
Facility
|
OP
|
$4,057.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,217.21 |
| Max. Negotiated Rate |
$3,895.07 |
| Rate for Payer: Aetna Commercial |
$3,124.17
|
| Rate for Payer: Anthem Medicaid |
$1,395.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,164.74
|
| Rate for Payer: Cash Price |
$2,028.68
|
| Rate for Payer: Cigna Commercial |
$3,367.61
|
| Rate for Payer: First Health Commercial |
$3,854.49
|
| Rate for Payer: Humana Commercial |
$3,448.76
|
| Rate for Payer: Humana KY Medicaid |
$1,395.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,409.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,327.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,994.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,217.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,423.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,570.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,043.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,245.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,529.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,799.58
|
| Rate for Payer: PHCS Commercial |
$3,895.07
|
| Rate for Payer: United Healthcare All Payer |
$3,570.48
|
|
