|
PLATE VARIAX 2 META BRD STR 5H
|
Facility
|
IP
|
$6,486.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$843.24 |
| Max. Negotiated Rate |
$6,227.00 |
| Rate for Payer: Aetna Commercial |
$4,994.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,059.44
|
| Rate for Payer: Cash Price |
$3,243.23
|
| Rate for Payer: Cigna Commercial |
$5,383.76
|
| Rate for Payer: First Health Commercial |
$6,162.14
|
| Rate for Payer: Humana Commercial |
$5,513.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,318.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,787.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,945.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,708.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,864.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,297.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$843.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,010.80
|
| Rate for Payer: PHCS Commercial |
$6,227.00
|
| Rate for Payer: United Healthcare All Payer |
$5,708.08
|
|
|
PLATE VARIAX 2 META BRD STR 6H
|
Facility
|
IP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
|
|
PLATE VARIAX 2 META BRD STR 6H
|
Facility
|
OP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem Medicaid |
$3,249.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Humana KY Medicaid |
$3,249.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,283.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,315.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
|
|
PLATE VARIAX 2 META BRD STR 7H
|
Facility
|
OP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem Medicaid |
$3,249.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Humana KY Medicaid |
$3,249.96
|
| Rate for Payer: Kentucky WC Medicaid |
$3,283.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,315.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
|
|
PLATE VARIAX 2 META BRD STR 7H
|
Facility
|
IP
|
$9,450.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.54 |
| Max. Negotiated Rate |
$9,072.29 |
| Rate for Payer: Aetna Commercial |
$7,276.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,371.23
|
| Rate for Payer: Cash Price |
$4,725.15
|
| Rate for Payer: Cigna Commercial |
$7,843.75
|
| Rate for Payer: First Health Commercial |
$8,977.78
|
| Rate for Payer: Humana Commercial |
$8,032.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,749.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,974.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,835.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,316.26
|
| Rate for Payer: Ohio Health Group HMO |
$7,087.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,890.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,228.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,929.59
|
| Rate for Payer: PHCS Commercial |
$9,072.29
|
| Rate for Payer: United Healthcare All Payer |
$8,316.26
|
|
|
PLATE VARIAX 2 META SLM STR 2H
|
Facility
|
OP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem Medicaid |
$2,883.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Humana KY Medicaid |
$2,883.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE VARIAX 2 META SLM STR 2H
|
Facility
|
IP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE VARIAX 2 META SLM STR 3H
|
Facility
|
IP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE VARIAX 2 META SLM STR 3H
|
Facility
|
OP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem Medicaid |
$2,883.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Humana KY Medicaid |
$2,883.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE VARIAX 2 META SLM STR 4H
|
Facility
|
OP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem Medicaid |
$2,883.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Humana KY Medicaid |
$2,883.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE VARIAX 2 META SLM STR 4H
|
Facility
|
IP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE VARIAX 2 META SLM STR 5H
|
Facility
|
IP
|
$5,168.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.94 |
| Max. Negotiated Rate |
$4,962.05 |
| Rate for Payer: Aetna Commercial |
$3,979.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.66
|
| Rate for Payer: Cash Price |
$2,584.40
|
| Rate for Payer: Cigna Commercial |
$4,290.10
|
| Rate for Payer: First Health Commercial |
$4,910.36
|
| Rate for Payer: Humana Commercial |
$4,393.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,602.33
|
| Rate for Payer: PHCS Commercial |
$4,962.05
|
| Rate for Payer: United Healthcare All Payer |
$4,548.54
|
|
|
PLATE VARIAX 2 META SLM STR 5H
|
Facility
|
OP
|
$5,168.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.94 |
| Max. Negotiated Rate |
$4,962.05 |
| Rate for Payer: Anthem Medicaid |
$1,777.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.66
|
| Rate for Payer: Cash Price |
$2,584.40
|
| Rate for Payer: Cigna Commercial |
$4,290.10
|
| Rate for Payer: First Health Commercial |
$4,910.36
|
| Rate for Payer: Humana Commercial |
$4,393.48
|
| Rate for Payer: Humana KY Medicaid |
$1,777.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,795.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,813.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,602.33
|
| Rate for Payer: PHCS Commercial |
$4,962.05
|
| Rate for Payer: United Healthcare All Payer |
$4,548.54
|
| Rate for Payer: Aetna Commercial |
$3,979.98
|
|
|
PLATE VARIAX 2 META SLM STR 6H
|
Facility
|
IP
|
$4,277.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.11 |
| Max. Negotiated Rate |
$4,106.63 |
| Rate for Payer: Aetna Commercial |
$3,293.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,336.64
|
| Rate for Payer: Cash Price |
$2,138.87
|
| Rate for Payer: Cigna Commercial |
$3,550.52
|
| Rate for Payer: First Health Commercial |
$4,063.85
|
| Rate for Payer: Humana Commercial |
$3,636.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,507.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,156.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,764.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,208.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,326.10
|
| Rate for Payer: PHCS Commercial |
$4,106.63
|
| Rate for Payer: United Healthcare All Payer |
$3,764.41
|
|
|
PLATE VARIAX 2 META SLM STR 6H
|
Facility
|
OP
|
$4,277.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.11 |
| Max. Negotiated Rate |
$4,106.63 |
| Rate for Payer: Aetna Commercial |
$3,293.86
|
| Rate for Payer: Anthem Medicaid |
$1,471.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,336.64
|
| Rate for Payer: Cash Price |
$2,138.87
|
| Rate for Payer: Cigna Commercial |
$3,550.52
|
| Rate for Payer: First Health Commercial |
$4,063.85
|
| Rate for Payer: Humana Commercial |
$3,636.08
|
| Rate for Payer: Humana KY Medicaid |
$1,471.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,486.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,507.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,156.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,283.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,500.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,764.41
|
| Rate for Payer: Ohio Health Group HMO |
$3,208.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$855.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,326.10
|
| Rate for Payer: PHCS Commercial |
$4,106.63
|
| Rate for Payer: United Healthcare All Payer |
$3,764.41
|
|
|
PLATE VARIAX 2 META SLM STR 7H
|
Facility
|
OP
|
$5,168.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.94 |
| Max. Negotiated Rate |
$4,962.05 |
| Rate for Payer: Aetna Commercial |
$3,979.98
|
| Rate for Payer: Anthem Medicaid |
$1,777.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.66
|
| Rate for Payer: Cash Price |
$2,584.40
|
| Rate for Payer: Cigna Commercial |
$4,290.10
|
| Rate for Payer: First Health Commercial |
$4,910.36
|
| Rate for Payer: Humana Commercial |
$4,393.48
|
| Rate for Payer: Humana KY Medicaid |
$1,777.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,795.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,813.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,602.33
|
| Rate for Payer: PHCS Commercial |
$4,962.05
|
| Rate for Payer: United Healthcare All Payer |
$4,548.54
|
|
|
PLATE VARIAX 2 META SLM STR 7H
|
Facility
|
IP
|
$5,168.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.94 |
| Max. Negotiated Rate |
$4,962.05 |
| Rate for Payer: Aetna Commercial |
$3,979.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.66
|
| Rate for Payer: Cash Price |
$2,584.40
|
| Rate for Payer: Cigna Commercial |
$4,290.10
|
| Rate for Payer: First Health Commercial |
$4,910.36
|
| Rate for Payer: Humana Commercial |
$4,393.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.54
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,033.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$671.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,602.33
|
| Rate for Payer: PHCS Commercial |
$4,962.05
|
| Rate for Payer: United Healthcare All Payer |
$4,548.54
|
|
|
PLATE VARIAX 2 METATR BRD Y 2H
|
Facility
|
OP
|
$9,983.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.82 |
| Max. Negotiated Rate |
$9,583.87 |
| Rate for Payer: Aetna Commercial |
$7,687.06
|
| Rate for Payer: Anthem Medicaid |
$3,433.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,786.90
|
| Rate for Payer: Cash Price |
$4,991.60
|
| Rate for Payer: Cigna Commercial |
$8,286.06
|
| Rate for Payer: First Health Commercial |
$9,484.04
|
| Rate for Payer: Humana Commercial |
$8,485.72
|
| Rate for Payer: Humana KY Medicaid |
$3,433.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,468.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,367.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,994.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,502.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,996.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,094.79
|
| Rate for Payer: PHCS Commercial |
$9,583.87
|
| Rate for Payer: United Healthcare All Payer |
$8,785.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 2H
|
Facility
|
IP
|
$9,983.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.82 |
| Max. Negotiated Rate |
$9,583.87 |
| Rate for Payer: Aetna Commercial |
$7,687.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,786.90
|
| Rate for Payer: Cash Price |
$4,991.60
|
| Rate for Payer: Cigna Commercial |
$8,286.06
|
| Rate for Payer: First Health Commercial |
$9,484.04
|
| Rate for Payer: Humana Commercial |
$8,485.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,367.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,994.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,996.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,094.79
|
| Rate for Payer: PHCS Commercial |
$9,583.87
|
| Rate for Payer: United Healthcare All Payer |
$8,785.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 3H
|
Facility
|
IP
|
$7,178.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.15 |
| Max. Negotiated Rate |
$6,890.95 |
| Rate for Payer: Aetna Commercial |
$5,527.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,598.89
|
| Rate for Payer: Cash Price |
$3,589.03
|
| Rate for Payer: Cigna Commercial |
$5,957.80
|
| Rate for Payer: First Health Commercial |
$6,819.17
|
| Rate for Payer: Humana Commercial |
$6,101.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,886.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,297.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,316.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,383.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.20
|
| Rate for Payer: PHCS Commercial |
$6,890.95
|
| Rate for Payer: United Healthcare All Payer |
$6,316.70
|
|
|
PLATE VARIAX 2 METATR BRD Y 3H
|
Facility
|
OP
|
$7,178.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.15 |
| Max. Negotiated Rate |
$6,890.95 |
| Rate for Payer: Aetna Commercial |
$5,527.11
|
| Rate for Payer: Anthem Medicaid |
$2,468.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,598.89
|
| Rate for Payer: Cash Price |
$3,589.03
|
| Rate for Payer: Cigna Commercial |
$5,957.80
|
| Rate for Payer: First Health Commercial |
$6,819.17
|
| Rate for Payer: Humana Commercial |
$6,101.36
|
| Rate for Payer: Humana KY Medicaid |
$2,468.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,493.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,886.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,297.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,153.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,316.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,383.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,435.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.20
|
| Rate for Payer: PHCS Commercial |
$6,890.95
|
| Rate for Payer: United Healthcare All Payer |
$6,316.70
|
|
|
PLATE VARIAX 2 METATR BRD Y 4H
|
Facility
|
OP
|
$5,330.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$5,117.52 |
| Rate for Payer: Aetna Commercial |
$4,104.68
|
| Rate for Payer: Anthem Medicaid |
$1,833.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,157.98
|
| Rate for Payer: Cash Price |
$2,665.38
|
| Rate for Payer: Cigna Commercial |
$4,424.52
|
| Rate for Payer: First Health Commercial |
$5,064.21
|
| Rate for Payer: Humana Commercial |
$4,531.14
|
| Rate for Payer: Humana KY Medicaid |
$1,833.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,851.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,371.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,934.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,691.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,998.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,652.53
|
| Rate for Payer: PHCS Commercial |
$5,117.52
|
| Rate for Payer: United Healthcare All Payer |
$4,691.06
|
|
|
PLATE VARIAX 2 METATR BRD Y 4H
|
Facility
|
IP
|
$5,330.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$5,117.52 |
| Rate for Payer: Aetna Commercial |
$4,104.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,157.98
|
| Rate for Payer: Cash Price |
$2,665.38
|
| Rate for Payer: Cigna Commercial |
$4,424.52
|
| Rate for Payer: First Health Commercial |
$5,064.21
|
| Rate for Payer: Humana Commercial |
$4,531.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,371.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,934.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,691.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,998.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,652.53
|
| Rate for Payer: PHCS Commercial |
$5,117.52
|
| Rate for Payer: United Healthcare All Payer |
$4,691.06
|
|
|
PLATE VARIAX 2 METATR BRD Y 6H
|
Facility
|
OP
|
$9,983.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.82 |
| Max. Negotiated Rate |
$9,583.87 |
| Rate for Payer: Aetna Commercial |
$7,687.06
|
| Rate for Payer: Anthem Medicaid |
$3,433.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,786.90
|
| Rate for Payer: Cash Price |
$4,991.60
|
| Rate for Payer: Cigna Commercial |
$8,286.06
|
| Rate for Payer: First Health Commercial |
$9,484.04
|
| Rate for Payer: Humana Commercial |
$8,485.72
|
| Rate for Payer: Humana KY Medicaid |
$3,433.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,468.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,367.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,994.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,502.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,996.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,094.79
|
| Rate for Payer: PHCS Commercial |
$9,583.87
|
| Rate for Payer: United Healthcare All Payer |
$8,785.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 6H
|
Facility
|
IP
|
$9,983.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.82 |
| Max. Negotiated Rate |
$9,583.87 |
| Rate for Payer: Aetna Commercial |
$7,687.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,786.90
|
| Rate for Payer: Cash Price |
$4,991.60
|
| Rate for Payer: Cigna Commercial |
$8,286.06
|
| Rate for Payer: First Health Commercial |
$9,484.04
|
| Rate for Payer: Humana Commercial |
$8,485.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,186.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,367.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,994.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,785.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,487.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,996.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,297.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,094.79
|
| Rate for Payer: PHCS Commercial |
$9,583.87
|
| Rate for Payer: United Healthcare All Payer |
$8,785.22
|
|
