|
PLATE EVS INTL 4H WDE TI 57M L
|
Facility
|
IP
|
$7,268.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.93 |
| Max. Negotiated Rate |
$6,977.95 |
| Rate for Payer: Aetna Commercial |
$5,596.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,669.59
|
| Rate for Payer: Cash Price |
$3,634.35
|
| Rate for Payer: Cigna Commercial |
$6,033.02
|
| Rate for Payer: First Health Commercial |
$6,905.26
|
| Rate for Payer: Humana Commercial |
$6,178.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,960.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,364.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,180.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,396.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,451.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,453.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$944.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,253.30
|
| Rate for Payer: PHCS Commercial |
$6,977.95
|
| Rate for Payer: United Healthcare All Payer |
$6,396.46
|
|
|
PLATE EVS VL 10H STD TI 141M R
|
Facility
|
IP
|
$8,930.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.02 |
| Max. Negotiated Rate |
$8,573.67 |
| Rate for Payer: Aetna Commercial |
$6,876.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.11
|
| Rate for Payer: Cash Price |
$4,465.45
|
| Rate for Payer: Cigna Commercial |
$7,412.66
|
| Rate for Payer: First Health Commercial |
$8,484.36
|
| Rate for Payer: Humana Commercial |
$7,591.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.58
|
| Rate for Payer: PHCS Commercial |
$8,573.67
|
| Rate for Payer: United Healthcare All Payer |
$7,859.20
|
|
|
PLATE EVS VL 10H STD TI 141M R
|
Facility
|
OP
|
$8,930.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.02 |
| Max. Negotiated Rate |
$8,573.67 |
| Rate for Payer: Anthem Medicaid |
$3,071.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,966.11
|
| Rate for Payer: Cash Price |
$4,465.45
|
| Rate for Payer: Cigna Commercial |
$7,412.66
|
| Rate for Payer: First Health Commercial |
$8,484.36
|
| Rate for Payer: Humana Commercial |
$7,591.27
|
| Rate for Payer: Humana KY Medicaid |
$3,071.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,102.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,323.35
|
| Rate for Payer: Aetna Commercial |
$6,876.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,591.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,679.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,132.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,859.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,698.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,786.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,161.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,768.58
|
| Rate for Payer: PHCS Commercial |
$8,573.67
|
| Rate for Payer: United Healthcare All Payer |
$7,859.20
|
|
|
PLATE EXT 4H GTR 4 CABLES 23*2
|
Facility
|
IP
|
$24,911.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.50 |
| Max. Negotiated Rate |
$23,915.04 |
| Rate for Payer: Aetna Commercial |
$19,181.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,430.97
|
| Rate for Payer: Cash Price |
$12,455.75
|
| Rate for Payer: Cigna Commercial |
$20,676.54
|
| Rate for Payer: First Health Commercial |
$23,665.92
|
| Rate for Payer: Humana Commercial |
$21,174.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,427.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,384.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,473.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,922.12
|
| Rate for Payer: Ohio Health Group HMO |
$18,683.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.56
|
| Rate for Payer: PHCS Commercial |
$23,915.04
|
| Rate for Payer: United Healthcare All Payer |
$21,922.12
|
|
|
PLATE EXT 4H GTR 4 CABLES 23*2
|
Facility
|
OP
|
$24,911.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,238.50 |
| Max. Negotiated Rate |
$23,915.04 |
| Rate for Payer: Aetna Commercial |
$19,181.86
|
| Rate for Payer: Anthem Medicaid |
$8,567.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$19,430.97
|
| Rate for Payer: Cash Price |
$12,455.75
|
| Rate for Payer: Cigna Commercial |
$20,676.54
|
| Rate for Payer: First Health Commercial |
$23,665.92
|
| Rate for Payer: Humana Commercial |
$21,174.78
|
| Rate for Payer: Humana KY Medicaid |
$8,567.06
|
| Rate for Payer: Kentucky WC Medicaid |
$8,654.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$20,427.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$18,384.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$7,473.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,738.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$21,922.12
|
| Rate for Payer: Ohio Health Group HMO |
$18,683.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,982.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.56
|
| Rate for Payer: PHCS Commercial |
$23,915.04
|
| Rate for Payer: United Healthcare All Payer |
$21,922.12
|
|
|
PLATE F3 T
|
Facility
|
IP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE F3 T
|
Facility
|
OP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem Medicaid |
$1,619.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Humana KY Medicaid |
$1,619.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
|
|
PLATE FB LK 3.5M L-D 11H155M L
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem Medicaid |
$1,601.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Humana KY Medicaid |
$1,601.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,633.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE FB LK 3.5M L-D 11H155M L
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE FB LK 3.5M L-D 11H155M R
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem Medicaid |
$1,601.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Humana KY Medicaid |
$1,601.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,633.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE FB LK 3.5M L-D 11H155M R
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE FB LK 3.5M L-D 7H 107M L
|
Facility
|
OP
|
$4,417.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.29 |
| Max. Negotiated Rate |
$4,240.90 |
| Rate for Payer: Anthem Medicaid |
$1,519.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,445.73
|
| Rate for Payer: Cash Price |
$2,208.80
|
| Rate for Payer: Cigna Commercial |
$3,666.61
|
| Rate for Payer: First Health Commercial |
$4,196.72
|
| Rate for Payer: Humana Commercial |
$3,754.96
|
| Rate for Payer: Humana KY Medicaid |
$1,519.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,534.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.43
|
| Rate for Payer: Aetna Commercial |
$3,401.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,549.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.46
|
| Rate for Payer: PHCS Commercial |
$4,240.90
|
| Rate for Payer: United Healthcare All Payer |
$3,887.49
|
|
|
PLATE FB LK 3.5M L-D 7H 107M L
|
Facility
|
IP
|
$4,417.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.29 |
| Max. Negotiated Rate |
$4,240.90 |
| Rate for Payer: Aetna Commercial |
$3,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,445.73
|
| Rate for Payer: Cash Price |
$2,208.80
|
| Rate for Payer: Cigna Commercial |
$3,666.61
|
| Rate for Payer: First Health Commercial |
$4,196.72
|
| Rate for Payer: Humana Commercial |
$3,754.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.46
|
| Rate for Payer: PHCS Commercial |
$4,240.90
|
| Rate for Payer: United Healthcare All Payer |
$3,887.49
|
|
|
PLATE FB LK 3.5M L-D 7H 107M R
|
Facility
|
IP
|
$4,411.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.47 |
| Max. Negotiated Rate |
$4,234.85 |
| Rate for Payer: Aetna Commercial |
$3,396.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,440.81
|
| Rate for Payer: Cash Price |
$2,205.65
|
| Rate for Payer: Cigna Commercial |
$3,661.38
|
| Rate for Payer: First Health Commercial |
$4,190.74
|
| Rate for Payer: Humana Commercial |
$3,749.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,255.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,881.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,308.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.50
|
| Rate for Payer: PHCS Commercial |
$4,234.85
|
| Rate for Payer: United Healthcare All Payer |
$3,881.94
|
|
|
PLATE FB LK 3.5M L-D 7H 107M R
|
Facility
|
OP
|
$4,411.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.47 |
| Max. Negotiated Rate |
$4,234.85 |
| Rate for Payer: Aetna Commercial |
$3,396.70
|
| Rate for Payer: Anthem Medicaid |
$1,517.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,440.81
|
| Rate for Payer: Cash Price |
$2,205.65
|
| Rate for Payer: Cigna Commercial |
$3,661.38
|
| Rate for Payer: First Health Commercial |
$4,190.74
|
| Rate for Payer: Humana Commercial |
$3,749.60
|
| Rate for Payer: Humana KY Medicaid |
$1,517.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,255.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,881.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,308.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.50
|
| Rate for Payer: PHCS Commercial |
$4,234.85
|
| Rate for Payer: United Healthcare All Payer |
$3,881.94
|
|
|
PLATE FB LK 3.5M L-D 9H 131M L
|
Facility
|
IP
|
$4,549.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.49 |
| Max. Negotiated Rate |
$4,367.90 |
| Rate for Payer: Aetna Commercial |
$3,503.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,548.92
|
| Rate for Payer: Cash Price |
$2,274.95
|
| Rate for Payer: Cigna Commercial |
$3,776.42
|
| Rate for Payer: First Health Commercial |
$4,322.40
|
| Rate for Payer: Humana Commercial |
$3,867.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,730.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,364.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,003.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.47
|
| Rate for Payer: PHCS Commercial |
$4,367.90
|
| Rate for Payer: United Healthcare All Payer |
$4,003.91
|
|
|
PLATE FB LK 3.5M L-D 9H 131M L
|
Facility
|
OP
|
$4,549.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.49 |
| Max. Negotiated Rate |
$4,367.90 |
| Rate for Payer: Aetna Commercial |
$3,503.42
|
| Rate for Payer: Anthem Medicaid |
$1,564.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,548.92
|
| Rate for Payer: Cash Price |
$2,274.95
|
| Rate for Payer: Cigna Commercial |
$3,776.42
|
| Rate for Payer: First Health Commercial |
$4,322.40
|
| Rate for Payer: Humana Commercial |
$3,867.42
|
| Rate for Payer: Humana KY Medicaid |
$1,564.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,580.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,730.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,364.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,596.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,003.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.47
|
| Rate for Payer: PHCS Commercial |
$4,367.90
|
| Rate for Payer: United Healthcare All Payer |
$4,003.91
|
|
|
PLATE FB LK 3.5M L-D 9H 131M R
|
Facility
|
OP
|
$4,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.03 |
| Max. Negotiated Rate |
$4,349.76 |
| Rate for Payer: Aetna Commercial |
$3,488.87
|
| Rate for Payer: Anthem Medicaid |
$1,558.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.18
|
| Rate for Payer: Cash Price |
$2,265.50
|
| Rate for Payer: Cigna Commercial |
$3,760.73
|
| Rate for Payer: First Health Commercial |
$4,304.45
|
| Rate for Payer: Humana Commercial |
$3,851.35
|
| Rate for Payer: Humana KY Medicaid |
$1,558.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,404.61
|
| Rate for Payer: PHCS Commercial |
$4,349.76
|
| Rate for Payer: United Healthcare All Payer |
$3,987.28
|
|
|
PLATE FB LK 3.5M L-D 9H 131M R
|
Facility
|
IP
|
$4,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.03 |
| Max. Negotiated Rate |
$4,349.76 |
| Rate for Payer: Aetna Commercial |
$3,488.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.18
|
| Rate for Payer: Cash Price |
$2,265.50
|
| Rate for Payer: Cigna Commercial |
$3,760.73
|
| Rate for Payer: First Health Commercial |
$4,304.45
|
| Rate for Payer: Humana Commercial |
$3,851.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,404.61
|
| Rate for Payer: PHCS Commercial |
$4,349.76
|
| Rate for Payer: United Healthcare All Payer |
$3,987.28
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M L
|
Facility
|
OP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem Medicaid |
$1,309.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Humana KY Medicaid |
$1,309.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M L
|
Facility
|
IP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M R
|
Facility
|
IP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M R
|
Facility
|
OP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Anthem Medicaid |
$1,309.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Humana KY Medicaid |
$1,309.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLATE FB LK 3.5M PL-D 6H 74M L
|
Facility
|
IP
|
$3,957.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$3,799.39 |
| Rate for Payer: Aetna Commercial |
$3,047.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,087.01
|
| Rate for Payer: Cash Price |
$1,978.85
|
| Rate for Payer: Cigna Commercial |
$3,284.89
|
| Rate for Payer: First Health Commercial |
$3,759.82
|
| Rate for Payer: Humana Commercial |
$3,364.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.89
|
| Rate for Payer: PHCS Commercial |
$3,799.39
|
| Rate for Payer: United Healthcare All Payer |
$3,482.78
|
|
|
PLATE FB LK 3.5M PL-D 6H 74M L
|
Facility
|
OP
|
$3,957.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$3,799.39 |
| Rate for Payer: Aetna Commercial |
$3,047.43
|
| Rate for Payer: Anthem Medicaid |
$1,361.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,087.01
|
| Rate for Payer: Cash Price |
$1,978.85
|
| Rate for Payer: Cigna Commercial |
$3,284.89
|
| Rate for Payer: First Health Commercial |
$3,759.82
|
| Rate for Payer: Humana Commercial |
$3,364.04
|
| Rate for Payer: Humana KY Medicaid |
$1,361.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,388.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.89
|
| Rate for Payer: PHCS Commercial |
$3,799.39
|
| Rate for Payer: United Healthcare All Payer |
$3,482.78
|
|
