|
PLATE FB LK 3.5M PL-D 6H 74M R
|
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 R
|
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
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M L
|
Facility
|
IP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M L
|
Facility
|
OP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem Medicaid |
$1,410.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Humana KY Medicaid |
$1,410.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M R
|
Facility
|
OP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem Medicaid |
$1,410.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Humana KY Medicaid |
$1,410.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M R
|
Facility
|
IP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE FEM LK 4.5M 155M 6 L L-D
|
Facility
|
OP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Anthem Medicaid |
$2,679.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Humana KY Medicaid |
$2,679.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,706.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Aetna Commercial |
$5,998.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,732.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
|
|
PLATE FEM LK 4.5M 155M 6 L L-D
|
Facility
|
IP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Aetna Commercial |
$5,998.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
|
|
PLATE FEM LK 4.5M 155M 6 R L-D
|
Facility
|
IP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Aetna Commercial |
$5,998.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
|
|
PLATE FEM LK 4.5M 155M 6 R L-D
|
Facility
|
OP
|
$7,790.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.71 |
| Max. Negotiated Rate |
$7,478.50 |
| Rate for Payer: Aetna Commercial |
$5,998.38
|
| Rate for Payer: Anthem Medicaid |
$2,679.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,076.28
|
| Rate for Payer: Cash Price |
$3,895.05
|
| Rate for Payer: Cigna Commercial |
$6,465.78
|
| Rate for Payer: First Health Commercial |
$7,400.60
|
| Rate for Payer: Humana Commercial |
$6,621.58
|
| Rate for Payer: Humana KY Medicaid |
$2,679.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,706.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,387.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,749.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,337.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,732.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,855.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,842.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,558.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,012.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,414.93
|
| Rate for Payer: PHCS Commercial |
$7,478.50
|
| Rate for Payer: United Healthcare All Payer |
$6,855.29
|
|
|
PLATE FEM LK 4.5M 193M 8 L L-D
|
Facility
|
IP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATE FEM LK 4.5M 193M 8 L L-D
|
Facility
|
OP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem Medicaid |
$2,778.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Humana KY Medicaid |
$2,778.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,807.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,834.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATE FEM LK 4.5M 193M 8 R L-D
|
Facility
|
IP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATE FEM LK 4.5M 193M 8 R L-D
|
Facility
|
OP
|
$8,080.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,050.46 |
| Max. Negotiated Rate |
$7,757.24 |
| Rate for Payer: Aetna Commercial |
$6,221.95
|
| Rate for Payer: Anthem Medicaid |
$2,778.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,302.76
|
| Rate for Payer: Cash Price |
$4,040.23
|
| Rate for Payer: Cigna Commercial |
$6,706.78
|
| Rate for Payer: First Health Commercial |
$7,676.44
|
| Rate for Payer: Humana Commercial |
$6,868.39
|
| Rate for Payer: Humana KY Medicaid |
$2,778.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,807.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,625.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,963.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,424.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,834.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,110.80
|
| Rate for Payer: Ohio Health Group HMO |
$6,060.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,616.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,050.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.94
|
| Rate for Payer: PHCS Commercial |
$7,757.24
|
| Rate for Payer: United Healthcare All Payer |
$7,110.80
|
|
|
PLATE FEMLK 4.5M 230M 10 L L-D
|
Facility
|
OP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem Medicaid |
$2,809.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Humana KY Medicaid |
$2,809.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,837.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,865.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE FEMLK 4.5M 230M 10 L L-D
|
Facility
|
IP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE FEMLK 4.5M 230M 10 R L-D
|
Facility
|
IP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE FEMLK 4.5M 230M 10 R L-D
|
Facility
|
OP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Anthem Medicaid |
$2,809.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Humana KY Medicaid |
$2,809.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,837.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,865.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE FEMLK 4.5M 230M 13 R L-D
|
Facility
|
IP
|
$8,424.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.23 |
| Max. Negotiated Rate |
$8,087.84 |
| Rate for Payer: Aetna Commercial |
$6,487.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,571.37
|
| Rate for Payer: Cash Price |
$4,212.42
|
| Rate for Payer: Cigna Commercial |
$6,992.61
|
| Rate for Payer: First Health Commercial |
$8,003.59
|
| Rate for Payer: Humana Commercial |
$7,161.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,217.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,527.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,413.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.70
|
| Rate for Payer: PHCS Commercial |
$8,087.84
|
| Rate for Payer: United Healthcare All Payer |
$7,413.85
|
|
|
PLATE FEMLK 4.5M 230M 13 R L-D
|
Facility
|
OP
|
$8,424.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.23 |
| Max. Negotiated Rate |
$8,087.84 |
| Rate for Payer: Aetna Commercial |
$6,487.12
|
| Rate for Payer: Anthem Medicaid |
$2,897.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,571.37
|
| Rate for Payer: Cash Price |
$4,212.42
|
| Rate for Payer: Cigna Commercial |
$6,992.61
|
| Rate for Payer: First Health Commercial |
$8,003.59
|
| Rate for Payer: Humana Commercial |
$7,161.11
|
| Rate for Payer: Humana KY Medicaid |
$2,897.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,926.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,217.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,527.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,955.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,413.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.70
|
| Rate for Payer: PHCS Commercial |
$8,087.84
|
| Rate for Payer: United Healthcare All Payer |
$7,413.85
|
|
|
PLATE FEMLK 4.5M 286M 13 L L-D
|
Facility
|
OP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem Medicaid |
$2,809.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Humana KY Medicaid |
$2,809.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,837.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,865.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE FEMLK 4.5M 286M 13 L L-D
|
Facility
|
IP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE FEMLK 4.5M 342M 16 L L-D
|
Facility
|
IP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE FEMLK 4.5M 342M 16 L L-D
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
|
PLATE FEMLK 4.5M 342M 16 R L-D
|
Facility
|
OP
|
$8,526.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,108.40 |
| Max. Negotiated Rate |
$8,185.08 |
| Rate for Payer: Aetna Commercial |
$6,565.11
|
| Rate for Payer: Anthem Medicaid |
$2,932.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,650.37
|
| Rate for Payer: Cash Price |
$4,263.06
|
| Rate for Payer: Cigna Commercial |
$7,076.68
|
| Rate for Payer: First Health Commercial |
$8,099.81
|
| Rate for Payer: Humana Commercial |
$7,247.20
|
| Rate for Payer: Humana KY Medicaid |
$2,932.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,961.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,991.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,292.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,557.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,990.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,502.99
|
| Rate for Payer: Ohio Health Group HMO |
$6,394.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,705.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,108.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,643.10
|
| Rate for Payer: PHCS Commercial |
$8,185.08
|
| Rate for Payer: United Healthcare All Payer |
$7,502.99
|
|
