|
PLATE TIB LK 3.5M 134M 6 L M-D
|
Facility
|
OP
|
$9,408.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.44 |
| Max. Negotiated Rate |
$9,031.80 |
| Rate for Payer: Aetna Commercial |
$7,244.25
|
| Rate for Payer: Anthem Medicaid |
$3,235.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,338.33
|
| Rate for Payer: Cash Price |
$4,704.06
|
| Rate for Payer: Cigna Commercial |
$7,808.74
|
| Rate for Payer: First Health Commercial |
$8,937.71
|
| Rate for Payer: Humana Commercial |
$7,996.90
|
| Rate for Payer: Humana KY Medicaid |
$3,235.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,268.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,714.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,943.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,822.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,300.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,279.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,056.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,526.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,185.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,491.60
|
| Rate for Payer: PHCS Commercial |
$9,031.80
|
| Rate for Payer: United Healthcare All Payer |
$8,279.15
|
|
|
PLATE TIB LK 3.5M 134M 6 R M-D
|
Facility
|
OP
|
$9,408.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.44 |
| Max. Negotiated Rate |
$9,031.80 |
| Rate for Payer: Aetna Commercial |
$7,244.25
|
| Rate for Payer: Anthem Medicaid |
$3,235.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,338.33
|
| Rate for Payer: Cash Price |
$4,704.06
|
| Rate for Payer: Cigna Commercial |
$7,808.74
|
| Rate for Payer: First Health Commercial |
$8,937.71
|
| Rate for Payer: Humana Commercial |
$7,996.90
|
| Rate for Payer: Humana KY Medicaid |
$3,235.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,268.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,714.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,943.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,822.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,300.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,279.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,056.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,526.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,185.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,491.60
|
| Rate for Payer: PHCS Commercial |
$9,031.80
|
| Rate for Payer: United Healthcare All Payer |
$8,279.15
|
|
|
PLATE TIB LK 3.5M 134M 6 R M-D
|
Facility
|
IP
|
$9,408.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.44 |
| Max. Negotiated Rate |
$9,031.80 |
| Rate for Payer: Aetna Commercial |
$7,244.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,338.33
|
| Rate for Payer: Cash Price |
$4,704.06
|
| Rate for Payer: Cigna Commercial |
$7,808.74
|
| Rate for Payer: First Health Commercial |
$8,937.71
|
| Rate for Payer: Humana Commercial |
$7,996.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,714.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,943.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,822.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,279.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,056.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,526.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,185.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,491.60
|
| Rate for Payer: PHCS Commercial |
$9,031.80
|
| Rate for Payer: United Healthcare All Payer |
$8,279.15
|
|
|
PLATE TIBLK 3.5M 149M 10 L L-P
|
Facility
|
IP
|
$8,847.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.30 |
| Max. Negotiated Rate |
$8,493.76 |
| Rate for Payer: Aetna Commercial |
$6,812.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,901.18
|
| Rate for Payer: Cash Price |
$4,423.83
|
| Rate for Payer: Cigna Commercial |
$7,343.57
|
| Rate for Payer: First Health Commercial |
$8,405.29
|
| Rate for Payer: Humana Commercial |
$7,520.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,255.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,529.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,785.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,078.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,697.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,104.89
|
| Rate for Payer: PHCS Commercial |
$8,493.76
|
| Rate for Payer: United Healthcare All Payer |
$7,785.95
|
|
|
PLATE TIBLK 3.5M 149M 10 L L-P
|
Facility
|
OP
|
$8,847.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.30 |
| Max. Negotiated Rate |
$8,493.76 |
| Rate for Payer: Aetna Commercial |
$6,812.71
|
| Rate for Payer: Anthem Medicaid |
$3,042.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,901.18
|
| Rate for Payer: Cash Price |
$4,423.83
|
| Rate for Payer: Cigna Commercial |
$7,343.57
|
| Rate for Payer: First Health Commercial |
$8,405.29
|
| Rate for Payer: Humana Commercial |
$7,520.52
|
| Rate for Payer: Humana KY Medicaid |
$3,042.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,073.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,255.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,529.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,103.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,785.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,078.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,697.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,104.89
|
| Rate for Payer: PHCS Commercial |
$8,493.76
|
| Rate for Payer: United Healthcare All Payer |
$7,785.95
|
|
|
PLATE TIBLK 3.5M 149M 10 R L-P
|
Facility
|
IP
|
$8,847.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.30 |
| Max. Negotiated Rate |
$8,493.76 |
| Rate for Payer: Aetna Commercial |
$6,812.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,901.18
|
| Rate for Payer: Cash Price |
$4,423.83
|
| Rate for Payer: Cigna Commercial |
$7,343.57
|
| Rate for Payer: First Health Commercial |
$8,405.29
|
| Rate for Payer: Humana Commercial |
$7,520.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,255.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,529.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,785.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,078.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,697.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,104.89
|
| Rate for Payer: PHCS Commercial |
$8,493.76
|
| Rate for Payer: United Healthcare All Payer |
$7,785.95
|
|
|
PLATE TIBLK 3.5M 149M 10 R L-P
|
Facility
|
OP
|
$8,847.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,654.30 |
| Max. Negotiated Rate |
$8,493.76 |
| Rate for Payer: Aetna Commercial |
$6,812.71
|
| Rate for Payer: Anthem Medicaid |
$3,042.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,901.18
|
| Rate for Payer: Cash Price |
$4,423.83
|
| Rate for Payer: Cigna Commercial |
$7,343.57
|
| Rate for Payer: First Health Commercial |
$8,405.29
|
| Rate for Payer: Humana Commercial |
$7,520.52
|
| Rate for Payer: Humana KY Medicaid |
$3,042.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,073.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,255.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,529.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,654.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,103.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,785.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,635.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,078.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,697.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,104.89
|
| Rate for Payer: PHCS Commercial |
$8,493.76
|
| Rate for Payer: United Healthcare All Payer |
$7,785.95
|
|
|
PLATE TIB LK 3.5M 160M 8 L M-D
|
Facility
|
IP
|
$10,029.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,008.80 |
| Max. Negotiated Rate |
$9,628.18 |
| Rate for Payer: Aetna Commercial |
$7,722.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,822.89
|
| Rate for Payer: Cash Price |
$5,014.68
|
| Rate for Payer: Cigna Commercial |
$8,324.36
|
| Rate for Payer: First Health Commercial |
$9,527.88
|
| Rate for Payer: Humana Commercial |
$8,524.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,224.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,401.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,825.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,522.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,023.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,725.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,920.25
|
| Rate for Payer: PHCS Commercial |
$9,628.18
|
| Rate for Payer: United Healthcare All Payer |
$8,825.83
|
|
|
PLATE TIB LK 3.5M 160M 8 L M-D
|
Facility
|
OP
|
$10,029.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,008.80 |
| Max. Negotiated Rate |
$9,628.18 |
| Rate for Payer: Aetna Commercial |
$7,722.60
|
| Rate for Payer: Anthem Medicaid |
$3,449.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,822.89
|
| Rate for Payer: Cash Price |
$5,014.68
|
| Rate for Payer: Cigna Commercial |
$8,324.36
|
| Rate for Payer: First Health Commercial |
$9,527.88
|
| Rate for Payer: Humana Commercial |
$8,524.95
|
| Rate for Payer: Humana KY Medicaid |
$3,449.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,224.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,401.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,518.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,825.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,522.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,023.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,725.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,920.25
|
| Rate for Payer: PHCS Commercial |
$9,628.18
|
| Rate for Payer: United Healthcare All Payer |
$8,825.83
|
|
|
PLATE TIB LK 3.5M 160M 8 R M-D
|
Facility
|
OP
|
$10,029.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,008.80 |
| Max. Negotiated Rate |
$9,628.18 |
| Rate for Payer: Aetna Commercial |
$7,722.60
|
| Rate for Payer: Anthem Medicaid |
$3,449.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,822.89
|
| Rate for Payer: Cash Price |
$5,014.68
|
| Rate for Payer: Cigna Commercial |
$8,324.36
|
| Rate for Payer: First Health Commercial |
$9,527.88
|
| Rate for Payer: Humana Commercial |
$8,524.95
|
| Rate for Payer: Humana KY Medicaid |
$3,449.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,484.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,224.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,401.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,518.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,825.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,522.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,023.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,725.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,920.25
|
| Rate for Payer: PHCS Commercial |
$9,628.18
|
| Rate for Payer: United Healthcare All Payer |
$8,825.83
|
|
|
PLATE TIB LK 3.5M 160M 8 R M-D
|
Facility
|
IP
|
$10,029.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,008.80 |
| Max. Negotiated Rate |
$9,628.18 |
| Rate for Payer: Aetna Commercial |
$7,722.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,822.89
|
| Rate for Payer: Cash Price |
$5,014.68
|
| Rate for Payer: Cigna Commercial |
$8,324.36
|
| Rate for Payer: First Health Commercial |
$9,527.88
|
| Rate for Payer: Humana Commercial |
$8,524.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,224.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,401.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,008.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,825.83
|
| Rate for Payer: Ohio Health Group HMO |
$7,522.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,023.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,725.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,920.25
|
| Rate for Payer: PHCS Commercial |
$9,628.18
|
| Rate for Payer: United Healthcare All Payer |
$8,825.83
|
|
|
PLATE TIBLK 3.5M 185M 10 L M-D
|
Facility
|
OP
|
$9,518.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.62 |
| Max. Negotiated Rate |
$9,137.97 |
| Rate for Payer: Aetna Commercial |
$7,329.41
|
| Rate for Payer: Anthem Medicaid |
$3,273.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,424.60
|
| Rate for Payer: Cash Price |
$4,759.36
|
| Rate for Payer: Cigna Commercial |
$7,900.54
|
| Rate for Payer: First Health Commercial |
$9,042.78
|
| Rate for Payer: Humana Commercial |
$8,090.91
|
| Rate for Payer: Humana KY Medicaid |
$3,273.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,306.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,805.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,024.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,855.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,339.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,376.47
|
| Rate for Payer: Ohio Health Group HMO |
$7,139.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,614.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,281.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,567.92
|
| Rate for Payer: PHCS Commercial |
$9,137.97
|
| Rate for Payer: United Healthcare All Payer |
$8,376.47
|
|
|
PLATE TIBLK 3.5M 185M 10 L M-D
|
Facility
|
IP
|
$9,518.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.62 |
| Max. Negotiated Rate |
$9,137.97 |
| Rate for Payer: Aetna Commercial |
$7,329.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,424.60
|
| Rate for Payer: Cash Price |
$4,759.36
|
| Rate for Payer: Cigna Commercial |
$7,900.54
|
| Rate for Payer: First Health Commercial |
$9,042.78
|
| Rate for Payer: Humana Commercial |
$8,090.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,805.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,024.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,855.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,376.47
|
| Rate for Payer: Ohio Health Group HMO |
$7,139.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,614.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,281.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,567.92
|
| Rate for Payer: PHCS Commercial |
$9,137.97
|
| Rate for Payer: United Healthcare All Payer |
$8,376.47
|
|
|
PLATE TIBLK 3.5M 185M 10 R M-D
|
Facility
|
IP
|
$9,518.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.62 |
| Max. Negotiated Rate |
$9,137.97 |
| Rate for Payer: Aetna Commercial |
$7,329.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,424.60
|
| Rate for Payer: Cash Price |
$4,759.36
|
| Rate for Payer: Cigna Commercial |
$7,900.54
|
| Rate for Payer: First Health Commercial |
$9,042.78
|
| Rate for Payer: Humana Commercial |
$8,090.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,805.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,024.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,855.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,376.47
|
| Rate for Payer: Ohio Health Group HMO |
$7,139.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,614.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,281.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,567.92
|
| Rate for Payer: PHCS Commercial |
$9,137.97
|
| Rate for Payer: United Healthcare All Payer |
$8,376.47
|
|
|
PLATE TIBLK 3.5M 185M 10 R M-D
|
Facility
|
OP
|
$9,518.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,855.62 |
| Max. Negotiated Rate |
$9,137.97 |
| Rate for Payer: Aetna Commercial |
$7,329.41
|
| Rate for Payer: Anthem Medicaid |
$3,273.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,424.60
|
| Rate for Payer: Cash Price |
$4,759.36
|
| Rate for Payer: Cigna Commercial |
$7,900.54
|
| Rate for Payer: First Health Commercial |
$9,042.78
|
| Rate for Payer: Humana Commercial |
$8,090.91
|
| Rate for Payer: Humana KY Medicaid |
$3,273.49
|
| Rate for Payer: Kentucky WC Medicaid |
$3,306.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,805.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,024.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,855.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,339.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,376.47
|
| Rate for Payer: Ohio Health Group HMO |
$7,139.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,614.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,281.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,567.92
|
| Rate for Payer: PHCS Commercial |
$9,137.97
|
| Rate for Payer: United Healthcare All Payer |
$8,376.47
|
|
|
PLATE TIBLK 3.5M 187M 13 L L-P
|
Facility
|
OP
|
$8,942.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.66 |
| Max. Negotiated Rate |
$8,584.51 |
| Rate for Payer: Aetna Commercial |
$6,885.49
|
| Rate for Payer: Anthem Medicaid |
$3,075.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,974.92
|
| Rate for Payer: Cash Price |
$4,471.10
|
| Rate for Payer: Cigna Commercial |
$7,422.03
|
| Rate for Payer: First Health Commercial |
$8,495.09
|
| Rate for Payer: Humana Commercial |
$7,600.87
|
| Rate for Payer: Humana KY Medicaid |
$3,075.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,106.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,332.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,599.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,682.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,136.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,869.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,706.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,153.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,779.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,170.12
|
| Rate for Payer: PHCS Commercial |
$8,584.51
|
| Rate for Payer: United Healthcare All Payer |
$7,869.14
|
|
|
PLATE TIBLK 3.5M 187M 13 L L-P
|
Facility
|
IP
|
$8,942.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.66 |
| Max. Negotiated Rate |
$8,584.51 |
| Rate for Payer: Aetna Commercial |
$6,885.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,974.92
|
| Rate for Payer: Cash Price |
$4,471.10
|
| Rate for Payer: Cigna Commercial |
$7,422.03
|
| Rate for Payer: First Health Commercial |
$8,495.09
|
| Rate for Payer: Humana Commercial |
$7,600.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,332.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,599.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,869.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,706.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,153.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,779.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,170.12
|
| Rate for Payer: PHCS Commercial |
$8,584.51
|
| Rate for Payer: United Healthcare All Payer |
$7,869.14
|
|
|
PLATE TIBLK 3.5M 187M 13 R L-P
|
Facility
|
IP
|
$8,942.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.66 |
| Max. Negotiated Rate |
$8,584.51 |
| Rate for Payer: Aetna Commercial |
$6,885.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,974.92
|
| Rate for Payer: Cash Price |
$4,471.10
|
| Rate for Payer: Cigna Commercial |
$7,422.03
|
| Rate for Payer: First Health Commercial |
$8,495.09
|
| Rate for Payer: Humana Commercial |
$7,600.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,332.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,599.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,869.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,706.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,153.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,779.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,170.12
|
| Rate for Payer: PHCS Commercial |
$8,584.51
|
| Rate for Payer: United Healthcare All Payer |
$7,869.14
|
|
|
PLATE TIBLK 3.5M 187M 13 R L-P
|
Facility
|
OP
|
$8,942.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.66 |
| Max. Negotiated Rate |
$8,584.51 |
| Rate for Payer: Aetna Commercial |
$6,885.49
|
| Rate for Payer: Anthem Medicaid |
$3,075.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,974.92
|
| Rate for Payer: Cash Price |
$4,471.10
|
| Rate for Payer: Cigna Commercial |
$7,422.03
|
| Rate for Payer: First Health Commercial |
$8,495.09
|
| Rate for Payer: Humana Commercial |
$7,600.87
|
| Rate for Payer: Humana KY Medicaid |
$3,075.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,106.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,332.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,599.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,682.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,136.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,869.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,706.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,153.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,779.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,170.12
|
| Rate for Payer: PHCS Commercial |
$8,584.51
|
| Rate for Payer: United Healthcare All Payer |
$7,869.14
|
|
|
PLATE TIBLK 3.5M 223M 13 L M-D
|
Facility
|
OP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem Medicaid |
$3,305.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Humana KY Medicaid |
$3,305.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,338.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,371.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TIBLK 3.5M 223M 13 L M-D
|
Facility
|
IP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TIBLK 3.5M 223M 13 R M-D
|
Facility
|
IP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TIBLK 3.5M 223M 13 R M-D
|
Facility
|
OP
|
$9,610.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,883.21 |
| Max. Negotiated Rate |
$9,226.27 |
| Rate for Payer: Aetna Commercial |
$7,400.24
|
| Rate for Payer: Anthem Medicaid |
$3,305.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,496.35
|
| Rate for Payer: Cash Price |
$4,805.35
|
| Rate for Payer: Cigna Commercial |
$7,976.88
|
| Rate for Payer: First Health Commercial |
$9,130.17
|
| Rate for Payer: Humana Commercial |
$8,169.10
|
| Rate for Payer: Humana KY Medicaid |
$3,305.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,338.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,880.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,092.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,883.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,371.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,457.42
|
| Rate for Payer: Ohio Health Group HMO |
$7,208.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,688.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,631.38
|
| Rate for Payer: PHCS Commercial |
$9,226.27
|
| Rate for Payer: United Healthcare All Payer |
$8,457.42
|
|
|
PLATE TIBLK 3.5M 262M 16 L M-D
|
Facility
|
OP
|
$9,711.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,913.60 |
| Max. Negotiated Rate |
$9,323.51 |
| Rate for Payer: Aetna Commercial |
$7,478.23
|
| Rate for Payer: Anthem Medicaid |
$3,339.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,575.35
|
| Rate for Payer: Cash Price |
$4,855.99
|
| Rate for Payer: Cigna Commercial |
$8,060.95
|
| Rate for Payer: First Health Commercial |
$9,226.39
|
| Rate for Payer: Humana Commercial |
$8,255.19
|
| Rate for Payer: Humana KY Medicaid |
$3,339.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,373.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,963.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,167.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,406.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,546.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,283.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,769.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,449.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,701.27
|
| Rate for Payer: PHCS Commercial |
$9,323.51
|
| Rate for Payer: United Healthcare All Payer |
$8,546.55
|
|
|
PLATE TIBLK 3.5M 262M 16 L M-D
|
Facility
|
IP
|
$9,711.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,913.60 |
| Max. Negotiated Rate |
$9,323.51 |
| Rate for Payer: Aetna Commercial |
$7,478.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,575.35
|
| Rate for Payer: Cash Price |
$4,855.99
|
| Rate for Payer: Cigna Commercial |
$8,060.95
|
| Rate for Payer: First Health Commercial |
$9,226.39
|
| Rate for Payer: Humana Commercial |
$8,255.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,963.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,167.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,913.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,546.55
|
| Rate for Payer: Ohio Health Group HMO |
$7,283.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,769.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,449.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,701.27
|
| Rate for Payer: PHCS Commercial |
$9,323.51
|
| Rate for Payer: United Healthcare All Payer |
$8,546.55
|
|
