|
PLATE VARIAX 2 META SLM STR 5H
|
Facility
|
IP
|
$5,180.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.26 |
| Max. Negotiated Rate |
$4,973.63 |
| Rate for Payer: Aetna Commercial |
$3,989.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,041.07
|
| Rate for Payer: Cash Price |
$2,590.43
|
| Rate for Payer: Cigna Commercial |
$4,300.11
|
| Rate for Payer: First Health Commercial |
$4,921.82
|
| Rate for Payer: Humana Commercial |
$4,403.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,248.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,823.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,559.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,885.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,144.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,507.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.79
|
| Rate for Payer: PHCS Commercial |
$4,973.63
|
| Rate for Payer: United Healthcare All Payer |
$4,559.16
|
|
|
PLATE VARIAX 2 META SLM STR 5H
|
Facility
|
OP
|
$5,180.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.26 |
| Max. Negotiated Rate |
$4,973.63 |
| Rate for Payer: Aetna Commercial |
$3,989.26
|
| Rate for Payer: Anthem Medicaid |
$1,781.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,041.07
|
| Rate for Payer: Cash Price |
$2,590.43
|
| Rate for Payer: Cigna Commercial |
$4,300.11
|
| Rate for Payer: First Health Commercial |
$4,921.82
|
| Rate for Payer: Humana Commercial |
$4,403.73
|
| Rate for Payer: Humana KY Medicaid |
$1,781.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,248.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,823.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,817.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,559.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,885.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,144.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,507.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.79
|
| Rate for Payer: PHCS Commercial |
$4,973.63
|
| Rate for Payer: United Healthcare All Payer |
$4,559.16
|
|
|
PLATE VARIAX 2 META SLM STR 6H
|
Facility
|
OP
|
$4,226.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.85 |
| Max. Negotiated Rate |
$4,057.10 |
| Rate for Payer: Aetna Commercial |
$3,254.14
|
| Rate for Payer: Anthem Medicaid |
$1,453.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,296.40
|
| Rate for Payer: Cash Price |
$2,113.07
|
| Rate for Payer: Cigna Commercial |
$3,507.70
|
| Rate for Payer: First Health Commercial |
$4,014.84
|
| Rate for Payer: Humana Commercial |
$3,592.23
|
| Rate for Payer: Humana KY Medicaid |
$1,453.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,468.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,465.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,118.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,267.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,482.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,719.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,169.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,380.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,676.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.04
|
| Rate for Payer: PHCS Commercial |
$4,057.10
|
| Rate for Payer: United Healthcare All Payer |
$3,719.01
|
|
|
PLATE VARIAX 2 META SLM STR 6H
|
Facility
|
IP
|
$4,226.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.85 |
| Max. Negotiated Rate |
$4,057.10 |
| Rate for Payer: Aetna Commercial |
$3,254.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,296.40
|
| Rate for Payer: Cash Price |
$2,113.07
|
| Rate for Payer: Cigna Commercial |
$3,507.70
|
| Rate for Payer: First Health Commercial |
$4,014.84
|
| Rate for Payer: Humana Commercial |
$3,592.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,465.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,118.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,267.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,719.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,169.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,380.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,676.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,916.04
|
| Rate for Payer: PHCS Commercial |
$4,057.10
|
| Rate for Payer: United Healthcare All Payer |
$3,719.01
|
|
|
PLATE VARIAX 2 META SLM STR 7H
|
Facility
|
IP
|
$5,180.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.26 |
| Max. Negotiated Rate |
$4,973.63 |
| Rate for Payer: Aetna Commercial |
$3,989.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,041.07
|
| Rate for Payer: Cash Price |
$2,590.43
|
| Rate for Payer: Cigna Commercial |
$4,300.11
|
| Rate for Payer: First Health Commercial |
$4,921.82
|
| Rate for Payer: Humana Commercial |
$4,403.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,248.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,823.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,559.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,885.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,144.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,507.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.79
|
| Rate for Payer: PHCS Commercial |
$4,973.63
|
| Rate for Payer: United Healthcare All Payer |
$4,559.16
|
|
|
PLATE VARIAX 2 META SLM STR 7H
|
Facility
|
OP
|
$5,180.86
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,554.26 |
| Max. Negotiated Rate |
$4,973.63 |
| Rate for Payer: Aetna Commercial |
$3,989.26
|
| Rate for Payer: Anthem Medicaid |
$1,781.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,041.07
|
| Rate for Payer: Cash Price |
$2,590.43
|
| Rate for Payer: Cigna Commercial |
$4,300.11
|
| Rate for Payer: First Health Commercial |
$4,921.82
|
| Rate for Payer: Humana Commercial |
$4,403.73
|
| Rate for Payer: Humana KY Medicaid |
$1,781.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,799.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,248.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,823.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,554.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,817.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,559.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,885.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,144.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,507.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,574.79
|
| Rate for Payer: PHCS Commercial |
$4,973.63
|
| Rate for Payer: United Healthcare All Payer |
$4,559.16
|
|
|
PLATE VARIAX 2 METATR BRD Y 2H
|
Facility
|
OP
|
$10,183.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,054.96 |
| Max. Negotiated Rate |
$9,775.87 |
| Rate for Payer: Aetna Commercial |
$7,841.06
|
| Rate for Payer: Anthem Medicaid |
$3,502.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,942.90
|
| Rate for Payer: Cash Price |
$5,091.60
|
| Rate for Payer: Cigna Commercial |
$8,452.06
|
| Rate for Payer: First Health Commercial |
$9,674.04
|
| Rate for Payer: Humana Commercial |
$8,655.72
|
| Rate for Payer: Humana KY Medicaid |
$3,502.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,537.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,350.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,515.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,054.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,572.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,637.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,146.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,859.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,026.41
|
| Rate for Payer: PHCS Commercial |
$9,775.87
|
| Rate for Payer: United Healthcare All Payer |
$8,961.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 2H
|
Facility
|
IP
|
$10,183.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,054.96 |
| Max. Negotiated Rate |
$9,775.87 |
| Rate for Payer: Aetna Commercial |
$7,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,942.90
|
| Rate for Payer: Cash Price |
$5,091.60
|
| Rate for Payer: Cigna Commercial |
$8,452.06
|
| Rate for Payer: First Health Commercial |
$9,674.04
|
| Rate for Payer: Humana Commercial |
$8,655.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,350.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,515.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,054.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,637.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,146.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,859.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,026.41
|
| Rate for Payer: PHCS Commercial |
$9,775.87
|
| Rate for Payer: United Healthcare All Payer |
$8,961.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 3H
|
Facility
|
OP
|
$7,378.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,213.42 |
| Max. Negotiated Rate |
$7,082.95 |
| Rate for Payer: Aetna Commercial |
$5,681.11
|
| Rate for Payer: Anthem Medicaid |
$2,537.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,754.89
|
| Rate for Payer: Cash Price |
$3,689.03
|
| Rate for Payer: Cigna Commercial |
$6,123.80
|
| Rate for Payer: First Health Commercial |
$7,009.17
|
| Rate for Payer: Humana Commercial |
$6,271.36
|
| Rate for Payer: Humana KY Medicaid |
$2,537.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,050.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,445.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,213.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,492.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,533.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,902.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,418.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.87
|
| Rate for Payer: PHCS Commercial |
$7,082.95
|
| Rate for Payer: United Healthcare All Payer |
$6,492.70
|
|
|
PLATE VARIAX 2 METATR BRD Y 3H
|
Facility
|
IP
|
$7,378.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,213.42 |
| Max. Negotiated Rate |
$7,082.95 |
| Rate for Payer: Aetna Commercial |
$5,681.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,754.89
|
| Rate for Payer: Cash Price |
$3,689.03
|
| Rate for Payer: Cigna Commercial |
$6,123.80
|
| Rate for Payer: First Health Commercial |
$7,009.17
|
| Rate for Payer: Humana Commercial |
$6,271.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,050.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,445.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,213.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,492.70
|
| Rate for Payer: Ohio Health Group HMO |
$5,533.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,902.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,418.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,090.87
|
| Rate for Payer: PHCS Commercial |
$7,082.95
|
| Rate for Payer: United Healthcare All Payer |
$6,492.70
|
|
|
PLATE VARIAX 2 METATR BRD Y 4H
|
Facility
|
IP
|
$5,354.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.31 |
| Max. Negotiated Rate |
$5,140.20 |
| Rate for Payer: Aetna Commercial |
$4,122.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,176.42
|
| Rate for Payer: Cash Price |
$2,677.19
|
| Rate for Payer: Cigna Commercial |
$4,444.14
|
| Rate for Payer: First Health Commercial |
$5,086.66
|
| Rate for Payer: Humana Commercial |
$4,551.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,390.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,951.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,711.85
|
| Rate for Payer: Ohio Health Group HMO |
$4,015.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,283.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,658.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,694.52
|
| Rate for Payer: PHCS Commercial |
$5,140.20
|
| Rate for Payer: United Healthcare All Payer |
$4,711.85
|
|
|
PLATE VARIAX 2 METATR BRD Y 4H
|
Facility
|
OP
|
$5,354.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.31 |
| Max. Negotiated Rate |
$5,140.20 |
| Rate for Payer: Aetna Commercial |
$4,122.87
|
| Rate for Payer: Anthem Medicaid |
$1,841.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,176.42
|
| Rate for Payer: Cash Price |
$2,677.19
|
| Rate for Payer: Cigna Commercial |
$4,444.14
|
| Rate for Payer: First Health Commercial |
$5,086.66
|
| Rate for Payer: Humana Commercial |
$4,551.22
|
| Rate for Payer: Humana KY Medicaid |
$1,841.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,390.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,951.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,711.85
|
| Rate for Payer: Ohio Health Group HMO |
$4,015.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,283.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,658.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,694.52
|
| Rate for Payer: PHCS Commercial |
$5,140.20
|
| Rate for Payer: United Healthcare All Payer |
$4,711.85
|
|
|
PLATE VARIAX 2 METATR BRD Y 6H
|
Facility
|
OP
|
$10,183.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,054.96 |
| Max. Negotiated Rate |
$9,775.87 |
| Rate for Payer: Aetna Commercial |
$7,841.06
|
| Rate for Payer: Anthem Medicaid |
$3,502.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,942.90
|
| Rate for Payer: Cash Price |
$5,091.60
|
| Rate for Payer: Cigna Commercial |
$8,452.06
|
| Rate for Payer: First Health Commercial |
$9,674.04
|
| Rate for Payer: Humana Commercial |
$8,655.72
|
| Rate for Payer: Humana KY Medicaid |
$3,502.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,537.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,350.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,515.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,054.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,572.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,637.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,146.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,859.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,026.41
|
| Rate for Payer: PHCS Commercial |
$9,775.87
|
| Rate for Payer: United Healthcare All Payer |
$8,961.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 6H
|
Facility
|
IP
|
$10,183.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,054.96 |
| Max. Negotiated Rate |
$9,775.87 |
| Rate for Payer: Aetna Commercial |
$7,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,942.90
|
| Rate for Payer: Cash Price |
$5,091.60
|
| Rate for Payer: Cigna Commercial |
$8,452.06
|
| Rate for Payer: First Health Commercial |
$9,674.04
|
| Rate for Payer: Humana Commercial |
$8,655.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,350.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,515.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,054.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,637.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,146.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,859.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,026.41
|
| Rate for Payer: PHCS Commercial |
$9,775.87
|
| Rate for Payer: United Healthcare All Payer |
$8,961.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 7H
|
Facility
|
OP
|
$10,183.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,054.96 |
| Max. Negotiated Rate |
$9,775.87 |
| Rate for Payer: Aetna Commercial |
$7,841.06
|
| Rate for Payer: Anthem Medicaid |
$3,502.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,942.90
|
| Rate for Payer: Cash Price |
$5,091.60
|
| Rate for Payer: Cigna Commercial |
$8,452.06
|
| Rate for Payer: First Health Commercial |
$9,674.04
|
| Rate for Payer: Humana Commercial |
$8,655.72
|
| Rate for Payer: Humana KY Medicaid |
$3,502.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,537.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,350.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,515.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,054.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,572.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,637.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,146.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,859.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,026.41
|
| Rate for Payer: PHCS Commercial |
$9,775.87
|
| Rate for Payer: United Healthcare All Payer |
$8,961.22
|
|
|
PLATE VARIAX 2 METATR BRD Y 7H
|
Facility
|
IP
|
$10,183.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,054.96 |
| Max. Negotiated Rate |
$9,775.87 |
| Rate for Payer: Aetna Commercial |
$7,841.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,942.90
|
| Rate for Payer: Cash Price |
$5,091.60
|
| Rate for Payer: Cigna Commercial |
$8,452.06
|
| Rate for Payer: First Health Commercial |
$9,674.04
|
| Rate for Payer: Humana Commercial |
$8,655.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,350.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,515.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,054.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,961.22
|
| Rate for Payer: Ohio Health Group HMO |
$7,637.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,146.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,859.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,026.41
|
| Rate for Payer: PHCS Commercial |
$9,775.87
|
| Rate for Payer: United Healthcare All Payer |
$8,961.22
|
|
|
PLATE VARIAX 2 METATR SLM Y 2H
|
Facility
|
IP
|
$6,729.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.86 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$5,181.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,249.03
|
| Rate for Payer: Cash Price |
$3,364.77
|
| Rate for Payer: Cigna Commercial |
$5,585.51
|
| Rate for Payer: First Health Commercial |
$6,393.05
|
| Rate for Payer: Humana Commercial |
$5,720.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.38
|
| Rate for Payer: PHCS Commercial |
$6,460.35
|
| Rate for Payer: United Healthcare All Payer |
$5,921.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 2H
|
Facility
|
OP
|
$6,729.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.86 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$5,181.74
|
| Rate for Payer: Anthem Medicaid |
$2,314.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,249.03
|
| Rate for Payer: Cash Price |
$3,364.77
|
| Rate for Payer: Cigna Commercial |
$5,585.51
|
| Rate for Payer: First Health Commercial |
$6,393.05
|
| Rate for Payer: Humana Commercial |
$5,720.10
|
| Rate for Payer: Humana KY Medicaid |
$2,314.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,337.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,360.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.38
|
| Rate for Payer: PHCS Commercial |
$6,460.35
|
| Rate for Payer: United Healthcare All Payer |
$5,921.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 3H
|
Facility
|
OP
|
$6,729.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.86 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$5,181.74
|
| Rate for Payer: Anthem Medicaid |
$2,314.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,249.03
|
| Rate for Payer: Cash Price |
$3,364.77
|
| Rate for Payer: Cigna Commercial |
$5,585.51
|
| Rate for Payer: First Health Commercial |
$6,393.05
|
| Rate for Payer: Humana Commercial |
$5,720.10
|
| Rate for Payer: Humana KY Medicaid |
$2,314.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,337.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,360.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.38
|
| Rate for Payer: PHCS Commercial |
$6,460.35
|
| Rate for Payer: United Healthcare All Payer |
$5,921.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 3H
|
Facility
|
IP
|
$6,729.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.86 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$5,181.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,249.03
|
| Rate for Payer: Cash Price |
$3,364.77
|
| Rate for Payer: Cigna Commercial |
$5,585.51
|
| Rate for Payer: First Health Commercial |
$6,393.05
|
| Rate for Payer: Humana Commercial |
$5,720.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.38
|
| Rate for Payer: PHCS Commercial |
$6,460.35
|
| Rate for Payer: United Healthcare All Payer |
$5,921.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 4H
|
Facility
|
OP
|
$4,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,457.25 |
| Max. Negotiated Rate |
$4,663.20 |
| Rate for Payer: Aetna Commercial |
$3,740.28
|
| Rate for Payer: Anthem Medicaid |
$1,670.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,788.85
|
| Rate for Payer: Cash Price |
$2,428.75
|
| Rate for Payer: Cigna Commercial |
$4,031.72
|
| Rate for Payer: First Health Commercial |
$4,614.62
|
| Rate for Payer: Humana Commercial |
$4,128.88
|
| Rate for Payer: Humana KY Medicaid |
$1,670.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,687.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,983.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,584.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,704.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,274.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,643.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,226.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,351.68
|
| Rate for Payer: PHCS Commercial |
$4,663.20
|
| Rate for Payer: United Healthcare All Payer |
$4,274.60
|
|
|
PLATE VARIAX 2 METATR SLM Y 4H
|
Facility
|
IP
|
$4,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,457.25 |
| Max. Negotiated Rate |
$4,663.20 |
| Rate for Payer: Aetna Commercial |
$3,740.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,788.85
|
| Rate for Payer: Cash Price |
$2,428.75
|
| Rate for Payer: Cigna Commercial |
$4,031.72
|
| Rate for Payer: First Health Commercial |
$4,614.62
|
| Rate for Payer: Humana Commercial |
$4,128.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,983.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,584.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,274.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,643.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,226.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,351.68
|
| Rate for Payer: PHCS Commercial |
$4,663.20
|
| Rate for Payer: United Healthcare All Payer |
$4,274.60
|
|
|
PLATE VARIAX 2 METATR SLM Y 5H
|
Facility
|
IP
|
$6,729.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.86 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$5,181.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,249.03
|
| Rate for Payer: Cash Price |
$3,364.77
|
| Rate for Payer: Cigna Commercial |
$5,585.51
|
| Rate for Payer: First Health Commercial |
$6,393.05
|
| Rate for Payer: Humana Commercial |
$5,720.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.38
|
| Rate for Payer: PHCS Commercial |
$6,460.35
|
| Rate for Payer: United Healthcare All Payer |
$5,921.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 5H
|
Facility
|
OP
|
$6,729.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,018.86 |
| Max. Negotiated Rate |
$6,460.35 |
| Rate for Payer: Aetna Commercial |
$5,181.74
|
| Rate for Payer: Anthem Medicaid |
$2,314.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,249.03
|
| Rate for Payer: Cash Price |
$3,364.77
|
| Rate for Payer: Cigna Commercial |
$5,585.51
|
| Rate for Payer: First Health Commercial |
$6,393.05
|
| Rate for Payer: Humana Commercial |
$5,720.10
|
| Rate for Payer: Humana KY Medicaid |
$2,314.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,337.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,518.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,966.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,360.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,921.99
|
| Rate for Payer: Ohio Health Group HMO |
$5,047.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,383.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,854.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,643.38
|
| Rate for Payer: PHCS Commercial |
$6,460.35
|
| Rate for Payer: United Healthcare All Payer |
$5,921.99
|
|
|
PLATE VARIAX 2 METATR SLM Y 6H
|
Facility
|
IP
|
$4,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,457.25 |
| Max. Negotiated Rate |
$4,663.20 |
| Rate for Payer: Aetna Commercial |
$3,740.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,788.85
|
| Rate for Payer: Cash Price |
$2,428.75
|
| Rate for Payer: Cigna Commercial |
$4,031.72
|
| Rate for Payer: First Health Commercial |
$4,614.62
|
| Rate for Payer: Humana Commercial |
$4,128.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,983.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,584.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,457.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,274.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,643.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,886.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,226.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,351.68
|
| Rate for Payer: PHCS Commercial |
$4,663.20
|
| Rate for Payer: United Healthcare All Payer |
$4,274.60
|
|
