|
PLATE FB LK 3.5M L-D 11H155M L
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.75 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.03
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.97
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,030.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,196.43
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE FB LK 3.5M L-D 11H155M R
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.75 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.03
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.97
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,030.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,196.43
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE FB LK 3.5M L-D 11H155M R
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,389.75 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.97
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,706.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,030.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,196.43
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE FB LK 3.5M L-D 7H 107M L
|
Facility
|
OP
|
$4,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$4,200.96 |
| Rate for Payer: Aetna Commercial |
$3,369.52
|
| Rate for Payer: Anthem Medicaid |
$1,504.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.28
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cigna Commercial |
$3,632.08
|
| Rate for Payer: First Health Commercial |
$4,157.20
|
| Rate for Payer: Humana Commercial |
$3,719.60
|
| Rate for Payer: Humana KY Medicaid |
$1,504.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,520.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,312.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,535.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,850.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.44
|
| Rate for Payer: PHCS Commercial |
$4,200.96
|
| Rate for Payer: United Healthcare All Payer |
$3,850.88
|
|
|
PLATE FB LK 3.5M L-D 7H 107M L
|
Facility
|
IP
|
$4,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$4,200.96 |
| Rate for Payer: Aetna Commercial |
$3,369.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.28
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cigna Commercial |
$3,632.08
|
| Rate for Payer: First Health Commercial |
$4,157.20
|
| Rate for Payer: Humana Commercial |
$3,719.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,312.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,850.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.44
|
| Rate for Payer: PHCS Commercial |
$4,200.96
|
| Rate for Payer: United Healthcare All Payer |
$3,850.88
|
|
|
PLATE FB LK 3.5M L-D 7H 107M R
|
Facility
|
IP
|
$4,369.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.78 |
| Max. Negotiated Rate |
$4,194.48 |
| Rate for Payer: Aetna Commercial |
$3,364.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.01
|
| Rate for Payer: Cash Price |
$2,184.62
|
| Rate for Payer: Cigna Commercial |
$3,626.48
|
| Rate for Payer: First Health Commercial |
$4,150.79
|
| Rate for Payer: Humana Commercial |
$3,713.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,582.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,224.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,310.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,844.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,276.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,495.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.78
|
| Rate for Payer: PHCS Commercial |
$4,194.48
|
| Rate for Payer: United Healthcare All Payer |
$3,844.94
|
|
|
PLATE FB LK 3.5M L-D 7H 107M R
|
Facility
|
OP
|
$4,369.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.78 |
| Max. Negotiated Rate |
$4,194.48 |
| Rate for Payer: Aetna Commercial |
$3,364.32
|
| Rate for Payer: Anthem Medicaid |
$1,502.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.01
|
| Rate for Payer: Cash Price |
$2,184.62
|
| Rate for Payer: Cigna Commercial |
$3,626.48
|
| Rate for Payer: First Health Commercial |
$4,150.79
|
| Rate for Payer: Humana Commercial |
$3,713.86
|
| Rate for Payer: Humana KY Medicaid |
$1,502.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,517.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,582.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,224.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,310.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,532.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,844.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,276.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,495.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,801.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,014.78
|
| Rate for Payer: PHCS Commercial |
$4,194.48
|
| Rate for Payer: United Healthcare All Payer |
$3,844.94
|
|
|
PLATE FB LK 3.5M L-D 9H 131M L
|
Facility
|
IP
|
$4,517.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,355.33 |
| Max. Negotiated Rate |
$4,337.04 |
| Rate for Payer: Aetna Commercial |
$3,478.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,523.84
|
| Rate for Payer: Cash Price |
$2,258.88
|
| Rate for Payer: Cigna Commercial |
$3,749.73
|
| Rate for Payer: First Health Commercial |
$4,291.86
|
| Rate for Payer: Humana Commercial |
$3,840.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,704.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,334.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,355.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,975.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,388.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,614.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,930.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,117.25
|
| Rate for Payer: PHCS Commercial |
$4,337.04
|
| Rate for Payer: United Healthcare All Payer |
$3,975.62
|
|
|
PLATE FB LK 3.5M L-D 9H 131M L
|
Facility
|
OP
|
$4,517.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,355.33 |
| Max. Negotiated Rate |
$4,337.04 |
| Rate for Payer: Aetna Commercial |
$3,478.67
|
| Rate for Payer: Anthem Medicaid |
$1,553.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,523.84
|
| Rate for Payer: Cash Price |
$2,258.88
|
| Rate for Payer: Cigna Commercial |
$3,749.73
|
| Rate for Payer: First Health Commercial |
$4,291.86
|
| Rate for Payer: Humana Commercial |
$3,840.09
|
| Rate for Payer: Humana KY Medicaid |
$1,553.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,569.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,704.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,334.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,355.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,584.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,975.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,388.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,614.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,930.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,117.25
|
| Rate for Payer: PHCS Commercial |
$4,337.04
|
| Rate for Payer: United Healthcare All Payer |
$3,975.62
|
|
|
PLATE FB LK 3.5M L-D 9H 131M R
|
Facility
|
IP
|
$4,497.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.25 |
| Max. Negotiated Rate |
$4,317.60 |
| Rate for Payer: Aetna Commercial |
$3,463.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.05
|
| Rate for Payer: Cash Price |
$2,248.75
|
| Rate for Payer: Cigna Commercial |
$3,732.93
|
| Rate for Payer: First Health Commercial |
$4,272.62
|
| Rate for Payer: Humana Commercial |
$3,822.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,912.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.28
|
| Rate for Payer: PHCS Commercial |
$4,317.60
|
| Rate for Payer: United Healthcare All Payer |
$3,957.80
|
|
|
PLATE FB LK 3.5M L-D 9H 131M R
|
Facility
|
OP
|
$4,497.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.25 |
| Max. Negotiated Rate |
$4,317.60 |
| Rate for Payer: Aetna Commercial |
$3,463.07
|
| Rate for Payer: Anthem Medicaid |
$1,546.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.05
|
| Rate for Payer: Cash Price |
$2,248.75
|
| Rate for Payer: Cigna Commercial |
$3,732.93
|
| Rate for Payer: First Health Commercial |
$4,272.62
|
| Rate for Payer: Humana Commercial |
$3,822.88
|
| Rate for Payer: Humana KY Medicaid |
$1,546.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,687.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,577.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,957.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,598.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,912.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,103.28
|
| Rate for Payer: PHCS Commercial |
$4,317.60
|
| Rate for Payer: United Healthcare All Payer |
$3,957.80
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M L
|
Facility
|
OP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem Medicaid |
$1,279.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Humana KY Medicaid |
$1,279.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M L
|
Facility
|
IP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M R
|
Facility
|
OP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem Medicaid |
$1,279.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Humana KY Medicaid |
$1,279.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE FB LK 3.5M PL-D 5H 62M R
|
Facility
|
IP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE FB LK 3.5M PL-D 6H 74M L
|
Facility
|
IP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE FB LK 3.5M PL-D 6H 74M L
|
Facility
|
OP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem Medicaid |
$1,335.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Humana KY Medicaid |
$1,335.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE FB LK 3.5M PL-D 6H 74M R
|
Facility
|
OP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem Medicaid |
$1,335.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Humana KY Medicaid |
$1,335.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE FB LK 3.5M PL-D 6H 74M R
|
Facility
|
IP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M L
|
Facility
|
IP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M L
|
Facility
|
OP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem Medicaid |
$1,388.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Humana KY Medicaid |
$1,388.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M R
|
Facility
|
IP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE FB LK 3.5M PL-D 7H 86M R
|
Facility
|
OP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem Medicaid |
$1,388.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Humana KY Medicaid |
$1,388.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE FEM LK 4.5M 155M 6 L L-D
|
Facility
|
IP
|
$7,990.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.03 |
| Max. Negotiated Rate |
$7,670.50 |
| Rate for Payer: Aetna Commercial |
$6,152.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.28
|
| Rate for Payer: Cash Price |
$3,995.05
|
| Rate for Payer: Cigna Commercial |
$6,631.78
|
| Rate for Payer: First Health Commercial |
$7,590.60
|
| Rate for Payer: Humana Commercial |
$6,791.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,031.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,951.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.17
|
| Rate for Payer: PHCS Commercial |
$7,670.50
|
| Rate for Payer: United Healthcare All Payer |
$7,031.29
|
|
|
PLATE FEM LK 4.5M 155M 6 L L-D
|
Facility
|
OP
|
$7,990.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,397.03 |
| Max. Negotiated Rate |
$7,670.50 |
| Rate for Payer: Aetna Commercial |
$6,152.38
|
| Rate for Payer: Anthem Medicaid |
$2,747.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,232.28
|
| Rate for Payer: Cash Price |
$3,995.05
|
| Rate for Payer: Cigna Commercial |
$6,631.78
|
| Rate for Payer: First Health Commercial |
$7,590.60
|
| Rate for Payer: Humana Commercial |
$6,791.59
|
| Rate for Payer: Humana KY Medicaid |
$2,747.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,775.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,551.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,896.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,397.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,802.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,031.29
|
| Rate for Payer: Ohio Health Group HMO |
$5,992.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,392.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,951.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,513.17
|
| Rate for Payer: PHCS Commercial |
$7,670.50
|
| Rate for Payer: United Healthcare All Payer |
$7,031.29
|
|
