|
PLATE FEM MID LCK 4.5 14H
|
Facility
|
OP
|
$5,718.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,715.55 |
| Max. Negotiated Rate |
$5,489.76 |
| Rate for Payer: Aetna Commercial |
$4,403.24
|
| Rate for Payer: Anthem Medicaid |
$1,966.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,460.43
|
| Rate for Payer: Cash Price |
$2,859.25
|
| Rate for Payer: Cigna Commercial |
$4,746.35
|
| Rate for Payer: First Health Commercial |
$5,432.57
|
| Rate for Payer: Humana Commercial |
$4,860.73
|
| Rate for Payer: Humana KY Medicaid |
$1,966.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,986.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,689.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,220.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,715.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,006.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,032.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,288.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,975.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,945.76
|
| Rate for Payer: PHCS Commercial |
$5,489.76
|
| Rate for Payer: United Healthcare All Payer |
$5,032.28
|
|
|
PLATE FEM MID LCK 4.5 16H
|
Facility
|
IP
|
$5,718.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,715.55 |
| Max. Negotiated Rate |
$5,489.76 |
| Rate for Payer: Aetna Commercial |
$4,403.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,460.43
|
| Rate for Payer: Cash Price |
$2,859.25
|
| Rate for Payer: Cigna Commercial |
$4,746.35
|
| Rate for Payer: First Health Commercial |
$5,432.57
|
| Rate for Payer: Humana Commercial |
$4,860.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,689.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,220.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,715.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,032.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,288.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,975.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,945.76
|
| Rate for Payer: PHCS Commercial |
$5,489.76
|
| Rate for Payer: United Healthcare All Payer |
$5,032.28
|
|
|
PLATE FEM MID LCK 4.5 16H
|
Facility
|
OP
|
$5,718.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,715.55 |
| Max. Negotiated Rate |
$5,489.76 |
| Rate for Payer: Aetna Commercial |
$4,403.24
|
| Rate for Payer: Anthem Medicaid |
$1,966.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,460.43
|
| Rate for Payer: Cash Price |
$2,859.25
|
| Rate for Payer: Cigna Commercial |
$4,746.35
|
| Rate for Payer: First Health Commercial |
$5,432.57
|
| Rate for Payer: Humana Commercial |
$4,860.73
|
| Rate for Payer: Humana KY Medicaid |
$1,966.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,986.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,689.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,220.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,715.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,006.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,032.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,288.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,975.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,945.76
|
| Rate for Payer: PHCS Commercial |
$5,489.76
|
| Rate for Payer: United Healthcare All Payer |
$5,032.28
|
|
|
PLATE FEM MID LCK 4.5 18H
|
Facility
|
IP
|
$5,718.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,715.55 |
| Max. Negotiated Rate |
$5,489.76 |
| Rate for Payer: Aetna Commercial |
$4,403.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,460.43
|
| Rate for Payer: Cash Price |
$2,859.25
|
| Rate for Payer: Cigna Commercial |
$4,746.35
|
| Rate for Payer: First Health Commercial |
$5,432.57
|
| Rate for Payer: Humana Commercial |
$4,860.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,689.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,220.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,715.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,032.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,288.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,975.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,945.76
|
| Rate for Payer: PHCS Commercial |
$5,489.76
|
| Rate for Payer: United Healthcare All Payer |
$5,032.28
|
|
|
PLATE FEM MID LCK 4.5 18H
|
Facility
|
OP
|
$5,718.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,715.55 |
| Max. Negotiated Rate |
$5,489.76 |
| Rate for Payer: Aetna Commercial |
$4,403.24
|
| Rate for Payer: Anthem Medicaid |
$1,966.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,460.43
|
| Rate for Payer: Cash Price |
$2,859.25
|
| Rate for Payer: Cigna Commercial |
$4,746.35
|
| Rate for Payer: First Health Commercial |
$5,432.57
|
| Rate for Payer: Humana Commercial |
$4,860.73
|
| Rate for Payer: Humana KY Medicaid |
$1,966.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,986.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,689.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,220.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,715.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,006.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,032.28
|
| Rate for Payer: Ohio Health Group HMO |
$4,288.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,574.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,975.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,945.76
|
| Rate for Payer: PHCS Commercial |
$5,489.76
|
| Rate for Payer: United Healthcare All Payer |
$5,032.28
|
|
|
PLATE FIB LK 3.5M L-D 3H 59M L
|
Facility
|
IP
|
$4,011.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.45 |
| Max. Negotiated Rate |
$3,851.04 |
| Rate for Payer: Aetna Commercial |
$3,088.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,128.97
|
| Rate for Payer: Cash Price |
$2,005.75
|
| Rate for Payer: Cigna Commercial |
$3,329.55
|
| Rate for Payer: First Health Commercial |
$3,810.93
|
| Rate for Payer: Humana Commercial |
$3,409.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,289.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,960.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,203.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,530.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,008.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,209.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,490.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,767.93
|
| Rate for Payer: PHCS Commercial |
$3,851.04
|
| Rate for Payer: United Healthcare All Payer |
$3,530.12
|
|
|
PLATE FIB LK 3.5M L-D 3H 59M L
|
Facility
|
OP
|
$4,011.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.45 |
| Max. Negotiated Rate |
$3,851.04 |
| Rate for Payer: Aetna Commercial |
$3,088.86
|
| Rate for Payer: Anthem Medicaid |
$1,379.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,128.97
|
| Rate for Payer: Cash Price |
$2,005.75
|
| Rate for Payer: Cigna Commercial |
$3,329.55
|
| Rate for Payer: First Health Commercial |
$3,810.93
|
| Rate for Payer: Humana Commercial |
$3,409.78
|
| Rate for Payer: Humana KY Medicaid |
$1,379.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,393.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,289.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,960.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,203.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,407.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,530.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,008.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,209.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,490.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,767.93
|
| Rate for Payer: PHCS Commercial |
$3,851.04
|
| Rate for Payer: United Healthcare All Payer |
$3,530.12
|
|
|
PLATE FIB LK 3.5M L-D 3H 59M R
|
Facility
|
IP
|
$3,984.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.35 |
| Max. Negotiated Rate |
$3,825.12 |
| Rate for Payer: Aetna Commercial |
$3,068.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,107.91
|
| Rate for Payer: Cash Price |
$1,992.25
|
| Rate for Payer: Cigna Commercial |
$3,307.14
|
| Rate for Payer: First Health Commercial |
$3,785.28
|
| Rate for Payer: Humana Commercial |
$3,386.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,267.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,940.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,506.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,988.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,187.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,466.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.30
|
| Rate for Payer: PHCS Commercial |
$3,825.12
|
| Rate for Payer: United Healthcare All Payer |
$3,506.36
|
|
|
PLATE FIB LK 3.5M L-D 3H 59M R
|
Facility
|
OP
|
$3,984.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.35 |
| Max. Negotiated Rate |
$3,825.12 |
| Rate for Payer: Aetna Commercial |
$3,068.07
|
| Rate for Payer: Anthem Medicaid |
$1,370.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,107.91
|
| Rate for Payer: Cash Price |
$1,992.25
|
| Rate for Payer: Cigna Commercial |
$3,307.14
|
| Rate for Payer: First Health Commercial |
$3,785.28
|
| Rate for Payer: Humana Commercial |
$3,386.82
|
| Rate for Payer: Humana KY Medicaid |
$1,370.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,384.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,267.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,940.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,397.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,506.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,988.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,187.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,466.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.30
|
| Rate for Payer: PHCS Commercial |
$3,825.12
|
| Rate for Payer: United Healthcare All Payer |
$3,506.36
|
|
|
PLATE FIB LK 3.5M L-D 4H 71M L
|
Facility
|
IP
|
$4,133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.90 |
| Max. Negotiated Rate |
$3,967.68 |
| Rate for Payer: Aetna Commercial |
$3,182.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.74
|
| Rate for Payer: Cash Price |
$2,066.50
|
| Rate for Payer: Cigna Commercial |
$3,430.39
|
| Rate for Payer: First Health Commercial |
$3,926.35
|
| Rate for Payer: Humana Commercial |
$3,513.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.77
|
| Rate for Payer: PHCS Commercial |
$3,967.68
|
| Rate for Payer: United Healthcare All Payer |
$3,637.04
|
|
|
PLATE FIB LK 3.5M L-D 4H 71M L
|
Facility
|
OP
|
$4,133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.90 |
| Max. Negotiated Rate |
$3,967.68 |
| Rate for Payer: Aetna Commercial |
$3,182.41
|
| Rate for Payer: Anthem Medicaid |
$1,421.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.74
|
| Rate for Payer: Cash Price |
$2,066.50
|
| Rate for Payer: Cigna Commercial |
$3,430.39
|
| Rate for Payer: First Health Commercial |
$3,926.35
|
| Rate for Payer: Humana Commercial |
$3,513.05
|
| Rate for Payer: Humana KY Medicaid |
$1,421.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,435.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,449.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.77
|
| Rate for Payer: PHCS Commercial |
$3,967.68
|
| Rate for Payer: United Healthcare All Payer |
$3,637.04
|
|
|
PLATE FIB LK 3.5M L-D 4H 71M R
|
Facility
|
IP
|
$4,119.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.85 |
| Max. Negotiated Rate |
$3,954.72 |
| Rate for Payer: Aetna Commercial |
$3,172.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,213.21
|
| Rate for Payer: Cash Price |
$2,059.75
|
| Rate for Payer: Cigna Commercial |
$3,419.18
|
| Rate for Payer: First Health Commercial |
$3,913.53
|
| Rate for Payer: Humana Commercial |
$3,501.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,040.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,625.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.45
|
| Rate for Payer: PHCS Commercial |
$3,954.72
|
| Rate for Payer: United Healthcare All Payer |
$3,625.16
|
|
|
PLATE FIB LK 3.5M L-D 4H 71M R
|
Facility
|
OP
|
$4,119.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.85 |
| Max. Negotiated Rate |
$3,954.72 |
| Rate for Payer: Aetna Commercial |
$3,172.01
|
| Rate for Payer: Anthem Medicaid |
$1,416.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,213.21
|
| Rate for Payer: Cash Price |
$2,059.75
|
| Rate for Payer: Cigna Commercial |
$3,419.18
|
| Rate for Payer: First Health Commercial |
$3,913.53
|
| Rate for Payer: Humana Commercial |
$3,501.57
|
| Rate for Payer: Humana KY Medicaid |
$1,416.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,431.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,040.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,445.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,625.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.45
|
| Rate for Payer: PHCS Commercial |
$3,954.72
|
| Rate for Payer: United Healthcare All Payer |
$3,625.16
|
|
|
PLATE FIB LK 3.5M L-D 5H 83M L
|
Facility
|
OP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem Medicaid |
$1,463.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Humana KY Medicaid |
$1,463.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,478.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,492.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE FIB LK 3.5M L-D 5H 83M L
|
Facility
|
IP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE FIB LK 3.5M L-D 5H 83M R
|
Facility
|
OP
|
$4,241.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.30 |
| Max. Negotiated Rate |
$4,071.36 |
| Rate for Payer: Aetna Commercial |
$3,265.57
|
| Rate for Payer: Anthem Medicaid |
$1,458.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,307.98
|
| Rate for Payer: Cash Price |
$2,120.50
|
| Rate for Payer: Cigna Commercial |
$3,520.03
|
| Rate for Payer: First Health Commercial |
$4,028.95
|
| Rate for Payer: Humana Commercial |
$3,604.85
|
| Rate for Payer: Humana KY Medicaid |
$1,458.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,473.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,477.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,129.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,487.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,732.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,689.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,926.29
|
| Rate for Payer: PHCS Commercial |
$4,071.36
|
| Rate for Payer: United Healthcare All Payer |
$3,732.08
|
|
|
PLATE FIB LK 3.5M L-D 5H 83M R
|
Facility
|
IP
|
$4,241.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.30 |
| Max. Negotiated Rate |
$4,071.36 |
| Rate for Payer: Aetna Commercial |
$3,265.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,307.98
|
| Rate for Payer: Cash Price |
$2,120.50
|
| Rate for Payer: Cigna Commercial |
$3,520.03
|
| Rate for Payer: First Health Commercial |
$4,028.95
|
| Rate for Payer: Humana Commercial |
$3,604.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,477.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,129.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,732.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,689.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,926.29
|
| Rate for Payer: PHCS Commercial |
$4,071.36
|
| Rate for Payer: United Healthcare All Payer |
$3,732.08
|
|
|
PLATE FIB LK PL LD 3.5*07 7 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 FIB LK PL LD 3.5*07 7 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 FIB LK PL LD 3.5*131 9 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 FIB LK PL LD 3.5*131 9 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 FIB LK PL LD 3.5*155 11R
|
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 FIB LK PL LD 3.5*155 11R
|
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 FIB LK PL LD 3.5*59 3 R
|
Facility
|
OP
|
$3,984.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.35 |
| Max. Negotiated Rate |
$3,825.12 |
| Rate for Payer: Aetna Commercial |
$3,068.07
|
| Rate for Payer: Anthem Medicaid |
$1,370.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,107.91
|
| Rate for Payer: Cash Price |
$1,992.25
|
| Rate for Payer: Cigna Commercial |
$3,307.14
|
| Rate for Payer: First Health Commercial |
$3,785.28
|
| Rate for Payer: Humana Commercial |
$3,386.82
|
| Rate for Payer: Humana KY Medicaid |
$1,370.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,384.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,267.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,940.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,397.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,506.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,988.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,187.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,466.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.30
|
| Rate for Payer: PHCS Commercial |
$3,825.12
|
| Rate for Payer: United Healthcare All Payer |
$3,506.36
|
|
|
PLATE FIB LK PL LD 3.5*59 3 R
|
Facility
|
IP
|
$3,984.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,195.35 |
| Max. Negotiated Rate |
$3,825.12 |
| Rate for Payer: Aetna Commercial |
$3,068.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,107.91
|
| Rate for Payer: Cash Price |
$1,992.25
|
| Rate for Payer: Cigna Commercial |
$3,307.14
|
| Rate for Payer: First Health Commercial |
$3,785.28
|
| Rate for Payer: Humana Commercial |
$3,386.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,267.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,940.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,506.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,988.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,187.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,466.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,749.30
|
| Rate for Payer: PHCS Commercial |
$3,825.12
|
| Rate for Payer: United Healthcare All Payer |
$3,506.36
|
|
