|
PLATE TIBLK 3.5M 262M 16 R 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
|
|
|
PLATE TIBLK 3.5M 262M 16 R 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 TIB LK 3.5M 73M 4 L L-P
|
Facility
|
OP
|
$7,409.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.81 |
| Max. Negotiated Rate |
$7,113.00 |
| Rate for Payer: Aetna Commercial |
$5,705.22
|
| Rate for Payer: Anthem Medicaid |
$2,548.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,779.32
|
| Rate for Payer: Cash Price |
$3,704.69
|
| Rate for Payer: Cigna Commercial |
$6,149.79
|
| Rate for Payer: First Health Commercial |
$7,038.91
|
| Rate for Payer: Humana Commercial |
$6,297.97
|
| Rate for Payer: Humana KY Medicaid |
$2,548.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,574.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,075.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,468.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,599.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,520.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,557.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,927.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,112.47
|
| Rate for Payer: PHCS Commercial |
$7,113.00
|
| Rate for Payer: United Healthcare All Payer |
$6,520.25
|
|
|
PLATE TIB LK 3.5M 73M 4 L L-P
|
Facility
|
IP
|
$7,409.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.81 |
| Max. Negotiated Rate |
$7,113.00 |
| Rate for Payer: Aetna Commercial |
$5,705.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,779.32
|
| Rate for Payer: Cash Price |
$3,704.69
|
| Rate for Payer: Cigna Commercial |
$6,149.79
|
| Rate for Payer: First Health Commercial |
$7,038.91
|
| Rate for Payer: Humana Commercial |
$6,297.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,075.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,468.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,520.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,557.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,927.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,112.47
|
| Rate for Payer: PHCS Commercial |
$7,113.00
|
| Rate for Payer: United Healthcare All Payer |
$6,520.25
|
|
|
PLATE TIB LK 3.5M 73M 4 R L-P
|
Facility
|
OP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem Medicaid |
$3,000.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Humana KY Medicaid |
$3,000.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,031.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,061.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE TIB LK 3.5M 73M 4 R L-P
|
Facility
|
IP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE TIBLK 3.5M 98M 6 L A-L-D
|
Facility
|
OP
|
$9,509.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,852.82 |
| Max. Negotiated Rate |
$9,129.03 |
| Rate for Payer: Aetna Commercial |
$7,322.25
|
| Rate for Payer: Anthem Medicaid |
$3,270.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,417.34
|
| Rate for Payer: Cash Price |
$4,754.70
|
| Rate for Payer: Cigna Commercial |
$7,892.81
|
| Rate for Payer: First Health Commercial |
$9,033.94
|
| Rate for Payer: Humana Commercial |
$8,083.00
|
| Rate for Payer: Humana KY Medicaid |
$3,270.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,303.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,797.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,017.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,852.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,335.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,132.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,607.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,273.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,561.49
|
| Rate for Payer: PHCS Commercial |
$9,129.03
|
| Rate for Payer: United Healthcare All Payer |
$8,368.28
|
|
|
PLATE TIBLK 3.5M 98M 6 L A-L-D
|
Facility
|
IP
|
$9,509.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,852.82 |
| Max. Negotiated Rate |
$9,129.03 |
| Rate for Payer: Aetna Commercial |
$7,322.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,417.34
|
| Rate for Payer: Cash Price |
$4,754.70
|
| Rate for Payer: Cigna Commercial |
$7,892.81
|
| Rate for Payer: First Health Commercial |
$9,033.94
|
| Rate for Payer: Humana Commercial |
$8,083.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,797.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,017.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,852.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,132.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,607.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,273.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,561.49
|
| Rate for Payer: PHCS Commercial |
$9,129.03
|
| Rate for Payer: United Healthcare All Payer |
$8,368.28
|
|
|
PLATE TIB LK 3.5M 98M 6 L L-P
|
Facility
|
OP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem Medicaid |
$3,000.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Humana KY Medicaid |
$3,000.91
|
| Rate for Payer: Kentucky WC Medicaid |
$3,031.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,061.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE TIB LK 3.5M 98M 6 L L-P
|
Facility
|
IP
|
$8,726.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.84 |
| Max. Negotiated Rate |
$8,377.08 |
| Rate for Payer: Aetna Commercial |
$6,719.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,806.37
|
| Rate for Payer: Cash Price |
$4,363.06
|
| Rate for Payer: Cigna Commercial |
$7,242.68
|
| Rate for Payer: First Health Commercial |
$8,289.81
|
| Rate for Payer: Humana Commercial |
$7,417.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,155.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,439.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,617.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,678.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,544.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,980.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,591.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,021.02
|
| Rate for Payer: PHCS Commercial |
$8,377.08
|
| Rate for Payer: United Healthcare All Payer |
$7,678.99
|
|
|
PLATE TIBLK 3.5M 98M 6 R A-L-D
|
Facility
|
IP
|
$9,509.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,852.82 |
| Max. Negotiated Rate |
$9,129.03 |
| Rate for Payer: Aetna Commercial |
$7,322.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,417.34
|
| Rate for Payer: Cash Price |
$4,754.70
|
| Rate for Payer: Cigna Commercial |
$7,892.81
|
| Rate for Payer: First Health Commercial |
$9,033.94
|
| Rate for Payer: Humana Commercial |
$8,083.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,797.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,017.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,852.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,132.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,607.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,273.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,561.49
|
| Rate for Payer: PHCS Commercial |
$9,129.03
|
| Rate for Payer: United Healthcare All Payer |
$8,368.28
|
|
|
PLATE TIBLK 3.5M 98M 6 R A-L-D
|
Facility
|
OP
|
$9,509.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,852.82 |
| Max. Negotiated Rate |
$9,129.03 |
| Rate for Payer: Aetna Commercial |
$7,322.25
|
| Rate for Payer: Anthem Medicaid |
$3,270.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,417.34
|
| Rate for Payer: Cash Price |
$4,754.70
|
| Rate for Payer: Cigna Commercial |
$7,892.81
|
| Rate for Payer: First Health Commercial |
$9,033.94
|
| Rate for Payer: Humana Commercial |
$8,083.00
|
| Rate for Payer: Humana KY Medicaid |
$3,270.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,303.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,797.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,017.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,852.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,335.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,368.28
|
| Rate for Payer: Ohio Health Group HMO |
$7,132.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,607.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,273.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,561.49
|
| Rate for Payer: PHCS Commercial |
$9,129.03
|
| Rate for Payer: United Healthcare All Payer |
$8,368.28
|
|
|
PLATE TIB LK 3.5M 98M 6 R L-P
|
Facility
|
OP
|
$8,696.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,609.08 |
| Max. Negotiated Rate |
$8,349.04 |
| Rate for Payer: Aetna Commercial |
$6,696.63
|
| Rate for Payer: Anthem Medicaid |
$2,990.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,783.60
|
| Rate for Payer: Cash Price |
$4,348.46
|
| Rate for Payer: Cigna Commercial |
$7,218.44
|
| Rate for Payer: First Health Commercial |
$8,262.07
|
| Rate for Payer: Humana Commercial |
$7,392.38
|
| Rate for Payer: Humana KY Medicaid |
$2,990.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,021.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,131.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,418.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,609.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,050.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,653.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,522.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,957.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,566.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,000.87
|
| Rate for Payer: PHCS Commercial |
$8,349.04
|
| Rate for Payer: United Healthcare All Payer |
$7,653.29
|
|
|
PLATE TIB LK 3.5M 98M 6 R L-P
|
Facility
|
IP
|
$8,696.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,609.08 |
| Max. Negotiated Rate |
$8,349.04 |
| Rate for Payer: Aetna Commercial |
$6,696.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,783.60
|
| Rate for Payer: Cash Price |
$4,348.46
|
| Rate for Payer: Cigna Commercial |
$7,218.44
|
| Rate for Payer: First Health Commercial |
$8,262.07
|
| Rate for Payer: Humana Commercial |
$7,392.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,131.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,418.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,609.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,653.29
|
| Rate for Payer: Ohio Health Group HMO |
$6,522.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,957.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,566.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,000.87
|
| Rate for Payer: PHCS Commercial |
$8,349.04
|
| Rate for Payer: United Healthcare All Payer |
$7,653.29
|
|
|
PLATE TIB LK 3.5M A-D 6H 107M
|
Facility
|
IP
|
$5,557.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.17 |
| Max. Negotiated Rate |
$5,334.96 |
| Rate for Payer: Aetna Commercial |
$4,279.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,334.65
|
| Rate for Payer: Cash Price |
$2,778.62
|
| Rate for Payer: Cigna Commercial |
$4,612.52
|
| Rate for Payer: First Health Commercial |
$5,279.39
|
| Rate for Payer: Humana Commercial |
$4,723.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,556.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,101.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,890.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,167.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,445.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,834.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.50
|
| Rate for Payer: PHCS Commercial |
$5,334.96
|
| Rate for Payer: United Healthcare All Payer |
$4,890.38
|
|
|
PLATE TIB LK 3.5M A-D 6H 107M
|
Facility
|
OP
|
$5,557.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,667.17 |
| Max. Negotiated Rate |
$5,334.96 |
| Rate for Payer: Aetna Commercial |
$4,279.08
|
| Rate for Payer: Anthem Medicaid |
$1,911.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,334.65
|
| Rate for Payer: Cash Price |
$2,778.62
|
| Rate for Payer: Cigna Commercial |
$4,612.52
|
| Rate for Payer: First Health Commercial |
$5,279.39
|
| Rate for Payer: Humana Commercial |
$4,723.66
|
| Rate for Payer: Humana KY Medicaid |
$1,911.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,930.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,556.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,101.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,667.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,949.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,890.38
|
| Rate for Payer: Ohio Health Group HMO |
$4,167.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,445.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,834.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,834.50
|
| Rate for Payer: PHCS Commercial |
$5,334.96
|
| Rate for Payer: United Healthcare All Payer |
$4,890.38
|
|
|
PLATE TIB LK 3.5M L-P 6H 93M R
|
Facility
|
OP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem Medicaid |
$1,948.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Humana KY Medicaid |
$1,948.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK 3.5M L-P 6H 93M R
|
Facility
|
IP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK 3.5MM A-D 3H 74MM
|
Facility
|
OP
|
$5,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.40 |
| Max. Negotiated Rate |
$5,134.08 |
| Rate for Payer: Aetna Commercial |
$4,117.96
|
| Rate for Payer: Anthem Medicaid |
$1,839.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,171.44
|
| Rate for Payer: Cash Price |
$2,674.00
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: First Health Commercial |
$5,080.60
|
| Rate for Payer: Humana Commercial |
$4,545.80
|
| Rate for Payer: Humana KY Medicaid |
$1,839.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,857.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,385.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,946.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,706.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,011.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,652.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,690.12
|
| Rate for Payer: PHCS Commercial |
$5,134.08
|
| Rate for Payer: United Healthcare All Payer |
$4,706.24
|
|
|
PLATE TIB LK 3.5MM A-D 3H 74MM
|
Facility
|
IP
|
$5,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.40 |
| Max. Negotiated Rate |
$5,134.08 |
| Rate for Payer: Aetna Commercial |
$4,117.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,171.44
|
| Rate for Payer: Cash Price |
$2,674.00
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: First Health Commercial |
$5,080.60
|
| Rate for Payer: Humana Commercial |
$4,545.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,385.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,946.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,706.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,011.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,652.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,690.12
|
| Rate for Payer: PHCS Commercial |
$5,134.08
|
| Rate for Payer: United Healthcare All Payer |
$4,706.24
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M L
|
Facility
|
IP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M L
|
Facility
|
OP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem Medicaid |
$1,901.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Humana KY Medicaid |
$1,901.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,940.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M R
|
Facility
|
OP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem Medicaid |
$1,901.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Humana KY Medicaid |
$1,901.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,940.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK 3.5M M-D 3H 89M R
|
Facility
|
IP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK 4.5M 130M 6 L L-P
|
Facility
|
OP
|
$8,651.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.55 |
| Max. Negotiated Rate |
$8,305.77 |
| Rate for Payer: Aetna Commercial |
$6,661.92
|
| Rate for Payer: Anthem Medicaid |
$2,975.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,748.44
|
| Rate for Payer: Cash Price |
$4,325.92
|
| Rate for Payer: Cigna Commercial |
$7,181.03
|
| Rate for Payer: First Health Commercial |
$8,219.25
|
| Rate for Payer: Humana Commercial |
$7,354.06
|
| Rate for Payer: Humana KY Medicaid |
$2,975.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,005.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,094.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,385.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,595.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,035.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,613.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,488.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,921.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,527.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,969.77
|
| Rate for Payer: PHCS Commercial |
$8,305.77
|
| Rate for Payer: United Healthcare All Payer |
$7,613.62
|
|
