|
PLATE TIB LK 4.5M 130M 6 L L-P
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TIB LK 4.5M 130M 6 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 TIB LK 4.5M 130M 6 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 4.5M 165M 8 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 TIB LK 4.5M 165M 8 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 4.5M 165M 8 R L-P
|
Facility
|
IP
|
$8,713.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.17 |
| Max. Negotiated Rate |
$8,365.33 |
| Rate for Payer: Aetna Commercial |
$6,709.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.83
|
| Rate for Payer: Cash Price |
$4,356.95
|
| Rate for Payer: Cigna Commercial |
$7,232.53
|
| Rate for Payer: First Health Commercial |
$8,278.20
|
| Rate for Payer: Humana Commercial |
$7,406.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,145.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,668.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,535.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,971.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,581.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,012.58
|
| Rate for Payer: PHCS Commercial |
$8,365.33
|
| Rate for Payer: United Healthcare All Payer |
$7,668.22
|
|
|
PLATE TIB LK 4.5M 165M 8 R L-P
|
Facility
|
OP
|
$8,713.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,614.17 |
| Max. Negotiated Rate |
$8,365.33 |
| Rate for Payer: Aetna Commercial |
$6,709.70
|
| Rate for Payer: Anthem Medicaid |
$2,996.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.83
|
| Rate for Payer: Cash Price |
$4,356.95
|
| Rate for Payer: Cigna Commercial |
$7,232.53
|
| Rate for Payer: First Health Commercial |
$8,278.20
|
| Rate for Payer: Humana Commercial |
$7,406.81
|
| Rate for Payer: Humana KY Medicaid |
$2,996.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,027.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,145.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,614.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,668.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,535.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,971.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,581.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,012.58
|
| Rate for Payer: PHCS Commercial |
$8,365.33
|
| Rate for Payer: United Healthcare All Payer |
$7,668.22
|
|
|
PLATE TIBLK 4.5M 201M 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 4.5M 201M 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 4.5M 201M 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 4.5M 201M 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 TIBLK 4.5M 255M 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 4.5M 255M 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 4.5M 255M 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 4.5M 255M 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 4.5M 309M 16 L L-P
|
Facility
|
OP
|
$9,009.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.92 |
| Max. Negotiated Rate |
$8,649.34 |
| Rate for Payer: Aetna Commercial |
$6,937.49
|
| Rate for Payer: Anthem Medicaid |
$3,098.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,027.59
|
| Rate for Payer: Cash Price |
$4,504.86
|
| Rate for Payer: Cigna Commercial |
$7,478.08
|
| Rate for Payer: First Health Commercial |
$8,559.24
|
| Rate for Payer: Humana Commercial |
$7,658.27
|
| Rate for Payer: Humana KY Medicaid |
$3,098.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,129.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,387.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,649.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,702.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,160.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,928.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,757.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,207.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,838.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,216.71
|
| Rate for Payer: PHCS Commercial |
$8,649.34
|
| Rate for Payer: United Healthcare All Payer |
$7,928.56
|
|
|
PLATE TIBLK 4.5M 309M 16 L L-P
|
Facility
|
IP
|
$9,009.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.92 |
| Max. Negotiated Rate |
$8,649.34 |
| Rate for Payer: Aetna Commercial |
$6,937.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,027.59
|
| Rate for Payer: Cash Price |
$4,504.86
|
| Rate for Payer: Cigna Commercial |
$7,478.08
|
| Rate for Payer: First Health Commercial |
$8,559.24
|
| Rate for Payer: Humana Commercial |
$7,658.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,387.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,649.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,702.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,928.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,757.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,207.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,838.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,216.71
|
| Rate for Payer: PHCS Commercial |
$8,649.34
|
| Rate for Payer: United Healthcare All Payer |
$7,928.56
|
|
|
PLATE TIBLK 4.5M 309M 16 R L-P
|
Facility
|
OP
|
$9,009.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.92 |
| Max. Negotiated Rate |
$8,649.34 |
| Rate for Payer: Aetna Commercial |
$6,937.49
|
| Rate for Payer: Anthem Medicaid |
$3,098.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,027.59
|
| Rate for Payer: Cash Price |
$4,504.86
|
| Rate for Payer: Cigna Commercial |
$7,478.08
|
| Rate for Payer: First Health Commercial |
$8,559.24
|
| Rate for Payer: Humana Commercial |
$7,658.27
|
| Rate for Payer: Humana KY Medicaid |
$3,098.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,129.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,387.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,649.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,702.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,160.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,928.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,757.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,207.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,838.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,216.71
|
| Rate for Payer: PHCS Commercial |
$8,649.34
|
| Rate for Payer: United Healthcare All Payer |
$7,928.56
|
|
|
PLATE TIBLK 4.5M 309M 16 R L-P
|
Facility
|
IP
|
$9,009.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,702.92 |
| Max. Negotiated Rate |
$8,649.34 |
| Rate for Payer: Aetna Commercial |
$6,937.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,027.59
|
| Rate for Payer: Cash Price |
$4,504.86
|
| Rate for Payer: Cigna Commercial |
$7,478.08
|
| Rate for Payer: First Health Commercial |
$8,559.24
|
| Rate for Payer: Humana Commercial |
$7,658.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,387.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,649.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,702.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,928.56
|
| Rate for Payer: Ohio Health Group HMO |
$6,757.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,207.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,838.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,216.71
|
| Rate for Payer: PHCS Commercial |
$8,649.34
|
| Rate for Payer: United Healthcare All Payer |
$7,928.56
|
|
|
PLATE TIB LK 4.5M 94M 4 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
|
|
|
PLATE TIB LK 4.5M 94M 4 L L-P
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TIB LK 4.5M 94M 4 R L-P
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TIB LK 4.5M 94M 4 R 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
|
|
|
PLATE TIB LK A-D 3.5MM 107MM 6
|
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 A-D 3.5MM 107MM 6
|
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
|
|
