|
PLATE CALC PERC SM 2.7M 55M L
|
Facility
|
IP
|
$6,727.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.52 |
| Max. Negotiated Rate |
$6,457.96 |
| Rate for Payer: Aetna Commercial |
$5,179.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,247.09
|
| Rate for Payer: Cash Price |
$3,363.52
|
| Rate for Payer: Cigna Commercial |
$5,583.44
|
| Rate for Payer: First Health Commercial |
$6,390.69
|
| Rate for Payer: Humana Commercial |
$5,717.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,516.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,964.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,919.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,045.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,085.38
|
| Rate for Payer: PHCS Commercial |
$6,457.96
|
| Rate for Payer: United Healthcare All Payer |
$5,919.80
|
|
|
PLATE CALC PERC SM 2.7M 55M R
|
Facility
|
IP
|
$6,727.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.52 |
| Max. Negotiated Rate |
$6,457.96 |
| Rate for Payer: Aetna Commercial |
$5,179.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,247.09
|
| Rate for Payer: Cash Price |
$3,363.52
|
| Rate for Payer: Cigna Commercial |
$5,583.44
|
| Rate for Payer: First Health Commercial |
$6,390.69
|
| Rate for Payer: Humana Commercial |
$5,717.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,516.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,964.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,919.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,045.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,085.38
|
| Rate for Payer: PHCS Commercial |
$6,457.96
|
| Rate for Payer: United Healthcare All Payer |
$5,919.80
|
|
|
PLATE CALC PERC SM 2.7M 55M R
|
Facility
|
OP
|
$6,727.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.52 |
| Max. Negotiated Rate |
$6,457.96 |
| Rate for Payer: Aetna Commercial |
$5,179.82
|
| Rate for Payer: Anthem Medicaid |
$2,313.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,247.09
|
| Rate for Payer: Cash Price |
$3,363.52
|
| Rate for Payer: Cigna Commercial |
$5,583.44
|
| Rate for Payer: First Health Commercial |
$6,390.69
|
| Rate for Payer: Humana Commercial |
$5,717.98
|
| Rate for Payer: Humana KY Medicaid |
$2,313.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,336.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,516.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,964.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,359.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,919.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,045.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,085.38
|
| Rate for Payer: PHCS Commercial |
$6,457.96
|
| Rate for Payer: United Healthcare All Payer |
$5,919.80
|
|
|
PLATE CALC PERC XL 2.7M 68M L
|
Facility
|
OP
|
$7,249.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.42 |
| Max. Negotiated Rate |
$6,959.38 |
| Rate for Payer: Aetna Commercial |
$5,582.00
|
| Rate for Payer: Anthem Medicaid |
$2,493.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,654.49
|
| Rate for Payer: Cash Price |
$3,624.68
|
| Rate for Payer: Cigna Commercial |
$6,016.96
|
| Rate for Payer: First Health Commercial |
$6,886.88
|
| Rate for Payer: Humana Commercial |
$6,161.95
|
| Rate for Payer: Humana KY Medicaid |
$2,493.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,518.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,944.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,350.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,379.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,437.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,247.30
|
| Rate for Payer: PHCS Commercial |
$6,959.38
|
| Rate for Payer: United Healthcare All Payer |
$6,379.43
|
|
|
PLATE CALC PERC XL 2.7M 68M L
|
Facility
|
IP
|
$7,249.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.42 |
| Max. Negotiated Rate |
$6,959.38 |
| Rate for Payer: Aetna Commercial |
$5,582.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,654.49
|
| Rate for Payer: Cash Price |
$3,624.68
|
| Rate for Payer: Cigna Commercial |
$6,016.96
|
| Rate for Payer: First Health Commercial |
$6,886.88
|
| Rate for Payer: Humana Commercial |
$6,161.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,944.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,350.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,379.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,437.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,247.30
|
| Rate for Payer: PHCS Commercial |
$6,959.38
|
| Rate for Payer: United Healthcare All Payer |
$6,379.43
|
|
|
PLATE CALC PERC XL 2.7M 68M R
|
Facility
|
IP
|
$7,249.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.42 |
| Max. Negotiated Rate |
$6,959.38 |
| Rate for Payer: Aetna Commercial |
$5,582.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,654.49
|
| Rate for Payer: Cash Price |
$3,624.68
|
| Rate for Payer: Cigna Commercial |
$6,016.96
|
| Rate for Payer: First Health Commercial |
$6,886.88
|
| Rate for Payer: Humana Commercial |
$6,161.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,944.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,350.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,379.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,437.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,247.30
|
| Rate for Payer: PHCS Commercial |
$6,959.38
|
| Rate for Payer: United Healthcare All Payer |
$6,379.43
|
|
|
PLATE CALC PERC XL 2.7M 68M R
|
Facility
|
OP
|
$7,249.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$942.42 |
| Max. Negotiated Rate |
$6,959.38 |
| Rate for Payer: Aetna Commercial |
$5,582.00
|
| Rate for Payer: Anthem Medicaid |
$2,493.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,654.49
|
| Rate for Payer: Cash Price |
$3,624.68
|
| Rate for Payer: Cigna Commercial |
$6,016.96
|
| Rate for Payer: First Health Commercial |
$6,886.88
|
| Rate for Payer: Humana Commercial |
$6,161.95
|
| Rate for Payer: Humana KY Medicaid |
$2,493.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,518.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,944.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,350.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,174.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,543.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,379.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,437.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,449.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$942.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,247.30
|
| Rate for Payer: PHCS Commercial |
$6,959.38
|
| Rate for Payer: United Healthcare All Payer |
$6,379.43
|
|
|
PLATE CHIN 6H 4MM
|
Facility
|
OP
|
$2,157.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.41 |
| Max. Negotiated Rate |
$2,070.75 |
| Rate for Payer: Aetna Commercial |
$1,660.91
|
| Rate for Payer: Anthem Medicaid |
$741.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,682.48
|
| Rate for Payer: Cash Price |
$1,078.52
|
| Rate for Payer: Cigna Commercial |
$1,790.33
|
| Rate for Payer: First Health Commercial |
$2,049.18
|
| Rate for Payer: Humana Commercial |
$1,833.48
|
| Rate for Payer: Humana KY Medicaid |
$741.80
|
| Rate for Payer: Kentucky WC Medicaid |
$749.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$756.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,898.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.68
|
| Rate for Payer: PHCS Commercial |
$2,070.75
|
| Rate for Payer: United Healthcare All Payer |
$1,898.19
|
|
|
PLATE CHIN 6H 4MM
|
Facility
|
IP
|
$2,157.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.41 |
| Max. Negotiated Rate |
$2,070.75 |
| Rate for Payer: Aetna Commercial |
$1,660.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,682.48
|
| Rate for Payer: Cash Price |
$1,078.52
|
| Rate for Payer: Cigna Commercial |
$1,790.33
|
| Rate for Payer: First Health Commercial |
$2,049.18
|
| Rate for Payer: Humana Commercial |
$1,833.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,768.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,591.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$647.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,898.19
|
| Rate for Payer: Ohio Health Group HMO |
$1,617.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.68
|
| Rate for Payer: PHCS Commercial |
$2,070.75
|
| Rate for Payer: United Healthcare All Payer |
$1,898.19
|
|
|
PLATE CHS SHORT BARREL 145^ 5H
|
Facility
|
OP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem Medicaid |
$735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Humana KY Medicaid |
$735.09
|
| Rate for Payer: Kentucky WC Medicaid |
$742.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
PLATE CHS SHORT BARREL 145^ 5H
|
Facility
|
IP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
PLATE CHS SHORT BARREL 150^ 5H
|
Facility
|
IP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
PLATE CHS SHORT BARREL 150^ 5H
|
Facility
|
OP
|
$2,137.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$277.88 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$1,645.88
|
| Rate for Payer: Anthem Medicaid |
$735.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,667.25
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cigna Commercial |
$1,774.12
|
| Rate for Payer: First Health Commercial |
$2,030.62
|
| Rate for Payer: Humana Commercial |
$1,816.88
|
| Rate for Payer: Humana KY Medicaid |
$735.09
|
| Rate for Payer: Kentucky WC Medicaid |
$742.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,752.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,577.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$641.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$749.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,881.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,603.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$427.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$277.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$662.62
|
| Rate for Payer: PHCS Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Payer |
$1,881.00
|
|
|
PLATE CLASSIC 10 SLOT 130^ 220
|
Facility
|
IP
|
$4,826.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.39 |
| Max. Negotiated Rate |
$4,633.01 |
| Rate for Payer: Aetna Commercial |
$3,716.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,764.32
|
| Rate for Payer: Cash Price |
$2,413.02
|
| Rate for Payer: Cigna Commercial |
$4,005.62
|
| Rate for Payer: First Health Commercial |
$4,584.75
|
| Rate for Payer: Humana Commercial |
$4,102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,957.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,619.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,496.08
|
| Rate for Payer: PHCS Commercial |
$4,633.01
|
| Rate for Payer: United Healthcare All Payer |
$4,246.92
|
|
|
PLATE CLASSIC 10 SLOT 130^ 220
|
Facility
|
OP
|
$4,826.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.39 |
| Max. Negotiated Rate |
$4,633.01 |
| Rate for Payer: Anthem Medicaid |
$1,659.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,764.32
|
| Rate for Payer: Cash Price |
$2,413.02
|
| Rate for Payer: Cigna Commercial |
$4,005.62
|
| Rate for Payer: First Health Commercial |
$4,584.75
|
| Rate for Payer: Humana Commercial |
$4,102.14
|
| Rate for Payer: Humana KY Medicaid |
$1,659.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,957.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,619.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,496.08
|
| Rate for Payer: PHCS Commercial |
$4,633.01
|
| Rate for Payer: United Healthcare All Payer |
$4,246.92
|
| Rate for Payer: Aetna Commercial |
$3,716.06
|
|
|
PLATE CLASSIC 10 SLOT 145^ 220
|
Facility
|
OP
|
$4,826.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.39 |
| Max. Negotiated Rate |
$4,633.01 |
| Rate for Payer: Aetna Commercial |
$3,716.06
|
| Rate for Payer: Anthem Medicaid |
$1,659.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,764.32
|
| Rate for Payer: Cash Price |
$2,413.02
|
| Rate for Payer: Cigna Commercial |
$4,005.62
|
| Rate for Payer: First Health Commercial |
$4,584.75
|
| Rate for Payer: Humana Commercial |
$4,102.14
|
| Rate for Payer: Humana KY Medicaid |
$1,659.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,957.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,619.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,496.08
|
| Rate for Payer: PHCS Commercial |
$4,633.01
|
| Rate for Payer: United Healthcare All Payer |
$4,246.92
|
|
|
PLATE CLASSIC 10 SLOT 145^ 220
|
Facility
|
IP
|
$4,826.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.39 |
| Max. Negotiated Rate |
$4,633.01 |
| Rate for Payer: Aetna Commercial |
$3,716.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,764.32
|
| Rate for Payer: Cash Price |
$2,413.02
|
| Rate for Payer: Cigna Commercial |
$4,005.62
|
| Rate for Payer: First Health Commercial |
$4,584.75
|
| Rate for Payer: Humana Commercial |
$4,102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,957.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,619.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,496.08
|
| Rate for Payer: PHCS Commercial |
$4,633.01
|
| Rate for Payer: United Healthcare All Payer |
$4,246.92
|
|
|
PLATE CLASSIC 10 SLOT 150^ 220
|
Facility
|
IP
|
$4,826.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.39 |
| Max. Negotiated Rate |
$4,633.01 |
| Rate for Payer: Aetna Commercial |
$3,716.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,764.32
|
| Rate for Payer: Cash Price |
$2,413.02
|
| Rate for Payer: Cigna Commercial |
$4,005.62
|
| Rate for Payer: First Health Commercial |
$4,584.75
|
| Rate for Payer: Humana Commercial |
$4,102.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,957.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,619.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,496.08
|
| Rate for Payer: PHCS Commercial |
$4,633.01
|
| Rate for Payer: United Healthcare All Payer |
$4,246.92
|
|
|
PLATE CLASSIC 10 SLOT 150^ 220
|
Facility
|
OP
|
$4,826.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.39 |
| Max. Negotiated Rate |
$4,633.01 |
| Rate for Payer: Aetna Commercial |
$3,716.06
|
| Rate for Payer: Anthem Medicaid |
$1,659.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,764.32
|
| Rate for Payer: Cash Price |
$2,413.02
|
| Rate for Payer: Cigna Commercial |
$4,005.62
|
| Rate for Payer: First Health Commercial |
$4,584.75
|
| Rate for Payer: Humana Commercial |
$4,102.14
|
| Rate for Payer: Humana KY Medicaid |
$1,659.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,957.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,561.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,619.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,496.08
|
| Rate for Payer: PHCS Commercial |
$4,633.01
|
| Rate for Payer: United Healthcare All Payer |
$4,246.92
|
|
|
PLATE CLASSIC 10 SLOT 90^
|
Facility
|
IP
|
$4,711.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.46 |
| Max. Negotiated Rate |
$4,522.80 |
| Rate for Payer: Aetna Commercial |
$3,627.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,674.78
|
| Rate for Payer: Cash Price |
$2,355.62
|
| Rate for Payer: Cigna Commercial |
$3,910.34
|
| Rate for Payer: First Health Commercial |
$4,475.69
|
| Rate for Payer: Humana Commercial |
$4,004.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,863.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,476.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,413.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,145.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,533.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.49
|
| Rate for Payer: PHCS Commercial |
$4,522.80
|
| Rate for Payer: United Healthcare All Payer |
$4,145.90
|
|
|
PLATE CLASSIC 10 SLOT 90^
|
Facility
|
OP
|
$4,711.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.46 |
| Max. Negotiated Rate |
$4,522.80 |
| Rate for Payer: Aetna Commercial |
$3,627.66
|
| Rate for Payer: Anthem Medicaid |
$1,620.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,674.78
|
| Rate for Payer: Cash Price |
$2,355.62
|
| Rate for Payer: Cigna Commercial |
$3,910.34
|
| Rate for Payer: First Health Commercial |
$4,475.69
|
| Rate for Payer: Humana Commercial |
$4,004.56
|
| Rate for Payer: Humana KY Medicaid |
$1,620.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,863.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,476.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,413.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,145.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,533.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.49
|
| Rate for Payer: PHCS Commercial |
$4,522.80
|
| Rate for Payer: United Healthcare All Payer |
$4,145.90
|
|
|
PLATE CLASSIC 10 SLOT 95^
|
Facility
|
IP
|
$4,711.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.46 |
| Max. Negotiated Rate |
$4,522.80 |
| Rate for Payer: Aetna Commercial |
$3,627.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,674.78
|
| Rate for Payer: Cash Price |
$2,355.62
|
| Rate for Payer: Cigna Commercial |
$3,910.34
|
| Rate for Payer: First Health Commercial |
$4,475.69
|
| Rate for Payer: Humana Commercial |
$4,004.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,863.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,476.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,413.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,145.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,533.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.49
|
| Rate for Payer: PHCS Commercial |
$4,522.80
|
| Rate for Payer: United Healthcare All Payer |
$4,145.90
|
|
|
PLATE CLASSIC 10 SLOT 95^
|
Facility
|
OP
|
$4,711.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.46 |
| Max. Negotiated Rate |
$4,522.80 |
| Rate for Payer: Aetna Commercial |
$3,627.66
|
| Rate for Payer: Anthem Medicaid |
$1,620.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,674.78
|
| Rate for Payer: Cash Price |
$2,355.62
|
| Rate for Payer: Cigna Commercial |
$3,910.34
|
| Rate for Payer: First Health Commercial |
$4,475.69
|
| Rate for Payer: Humana Commercial |
$4,004.56
|
| Rate for Payer: Humana KY Medicaid |
$1,620.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,863.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,476.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,413.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,145.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,533.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$942.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.49
|
| Rate for Payer: PHCS Commercial |
$4,522.80
|
| Rate for Payer: United Healthcare All Payer |
$4,145.90
|
|
|
PLATE CLASSIC 12 SLOT 145^ 260
|
Facility
|
IP
|
$5,005.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.70 |
| Max. Negotiated Rate |
$4,805.20 |
| Rate for Payer: Aetna Commercial |
$3,854.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,904.23
|
| Rate for Payer: Cash Price |
$2,502.71
|
| Rate for Payer: Cigna Commercial |
$4,154.50
|
| Rate for Payer: First Health Commercial |
$4,755.15
|
| Rate for Payer: Humana Commercial |
$4,254.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,104.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,694.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,404.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,754.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.68
|
| Rate for Payer: PHCS Commercial |
$4,805.20
|
| Rate for Payer: United Healthcare All Payer |
$4,404.77
|
|
|
PLATE CLASSIC 12 SLOT 145^ 260
|
Facility
|
OP
|
$5,005.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.70 |
| Max. Negotiated Rate |
$4,805.20 |
| Rate for Payer: Aetna Commercial |
$3,854.17
|
| Rate for Payer: Anthem Medicaid |
$1,721.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,904.23
|
| Rate for Payer: Cash Price |
$2,502.71
|
| Rate for Payer: Cigna Commercial |
$4,154.50
|
| Rate for Payer: First Health Commercial |
$4,755.15
|
| Rate for Payer: Humana Commercial |
$4,254.61
|
| Rate for Payer: Humana KY Medicaid |
$1,721.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,738.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,104.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,694.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,501.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,755.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,404.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,754.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,551.68
|
| Rate for Payer: PHCS Commercial |
$4,805.20
|
| Rate for Payer: United Healthcare All Payer |
$4,404.77
|
|
