|
PLATE CLASSIC 12 SLOT 95^
|
Facility
|
OP
|
$5,026.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.50 |
| Max. Negotiated Rate |
$4,825.87 |
| Rate for Payer: Aetna Commercial |
$3,870.75
|
| Rate for Payer: Anthem Medicaid |
$1,728.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,921.02
|
| Rate for Payer: Cash Price |
$2,513.48
|
| Rate for Payer: Cigna Commercial |
$4,172.37
|
| Rate for Payer: First Health Commercial |
$4,775.60
|
| Rate for Payer: Humana Commercial |
$4,272.91
|
| Rate for Payer: Humana KY Medicaid |
$1,728.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,746.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,122.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,709.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,508.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,763.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,423.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,770.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,005.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,558.35
|
| Rate for Payer: PHCS Commercial |
$4,825.87
|
| Rate for Payer: United Healthcare All Payer |
$4,423.72
|
|
|
PLATE CLASSIC 12 SLOT 95^
|
Facility
|
IP
|
$5,026.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$653.50 |
| Max. Negotiated Rate |
$4,825.87 |
| Rate for Payer: Aetna Commercial |
$3,870.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,921.02
|
| Rate for Payer: Cash Price |
$2,513.48
|
| Rate for Payer: Cigna Commercial |
$4,172.37
|
| Rate for Payer: First Health Commercial |
$4,775.60
|
| Rate for Payer: Humana Commercial |
$4,272.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,122.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,709.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,508.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,423.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,770.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,005.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$653.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,558.35
|
| Rate for Payer: PHCS Commercial |
$4,825.87
|
| Rate for Payer: United Healthcare All Payer |
$4,423.72
|
|
|
PLATE CLASSIC 14 SLOT 145^ 300
|
Facility
|
IP
|
$4,008.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.05 |
| Max. Negotiated Rate |
$3,847.78 |
| Rate for Payer: Humana Commercial |
$3,406.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,286.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,957.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,202.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,527.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,006.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.51
|
| Rate for Payer: PHCS Commercial |
$3,847.78
|
| Rate for Payer: United Healthcare All Payer |
$3,527.13
|
| Rate for Payer: Aetna Commercial |
$3,086.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,126.32
|
| Rate for Payer: Cash Price |
$2,004.05
|
| Rate for Payer: Cigna Commercial |
$3,326.72
|
| Rate for Payer: First Health Commercial |
$3,807.70
|
|
|
PLATE CLASSIC 14 SLOT 145^ 300
|
Facility
|
OP
|
$4,008.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$521.05 |
| Max. Negotiated Rate |
$3,847.78 |
| Rate for Payer: Aetna Commercial |
$3,086.24
|
| Rate for Payer: Anthem Medicaid |
$1,378.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,126.32
|
| Rate for Payer: Cash Price |
$2,004.05
|
| Rate for Payer: Cigna Commercial |
$3,326.72
|
| Rate for Payer: First Health Commercial |
$3,807.70
|
| Rate for Payer: Humana Commercial |
$3,406.88
|
| Rate for Payer: Humana KY Medicaid |
$1,378.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,392.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,286.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,957.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,202.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,406.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,527.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,006.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$521.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,242.51
|
| Rate for Payer: PHCS Commercial |
$3,847.78
|
| Rate for Payer: United Healthcare All Payer |
$3,527.13
|
|
|
PLATE CLASSIC 2 SLOT 130^
|
Facility
|
IP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 130^
|
Facility
|
OP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem Medicaid |
$1,309.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Humana KY Medicaid |
$1,309.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 135^
|
Facility
|
IP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 135^
|
Facility
|
OP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem Medicaid |
$1,309.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Humana KY Medicaid |
$1,309.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 140^
|
Facility
|
IP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 140^
|
Facility
|
OP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem Medicaid |
$1,309.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Humana KY Medicaid |
$1,309.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 145^
|
Facility
|
OP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Humana KY Medicaid |
$1,309.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem Medicaid |
$1,309.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
|
|
PLATE CLASSIC 2 SLOT 145^
|
Facility
|
IP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 150^
|
Facility
|
IP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 2 SLOT 150^
|
Facility
|
OP
|
$3,807.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.94 |
| Max. Negotiated Rate |
$3,654.91 |
| Rate for Payer: Aetna Commercial |
$2,931.54
|
| Rate for Payer: Anthem Medicaid |
$1,309.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.62
|
| Rate for Payer: Cash Price |
$1,903.60
|
| Rate for Payer: Cigna Commercial |
$3,159.98
|
| Rate for Payer: First Health Commercial |
$3,616.84
|
| Rate for Payer: Humana Commercial |
$3,236.12
|
| Rate for Payer: Humana KY Medicaid |
$1,309.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,142.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,350.34
|
| Rate for Payer: Ohio Health Group HMO |
$2,855.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.23
|
| Rate for Payer: PHCS Commercial |
$3,654.91
|
| Rate for Payer: United Healthcare All Payer |
$3,350.34
|
|
|
PLATE CLASSIC 4 SLOT 130^ 100
|
Facility
|
IP
|
$3,972.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$3,813.33 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.33
|
| Rate for Payer: Cash Price |
$1,986.11
|
| Rate for Payer: Cigna Commercial |
$3,296.94
|
| Rate for Payer: First Health Commercial |
$3,773.61
|
| Rate for Payer: Humana Commercial |
$3,376.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,931.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,495.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.39
|
| Rate for Payer: PHCS Commercial |
$3,813.33
|
| Rate for Payer: United Healthcare All Payer |
$3,495.55
|
|
|
PLATE CLASSIC 4 SLOT 130^ 100
|
Facility
|
OP
|
$3,972.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$3,813.33 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: Anthem Medicaid |
$1,366.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.33
|
| Rate for Payer: Cash Price |
$1,986.11
|
| Rate for Payer: Cigna Commercial |
$3,296.94
|
| Rate for Payer: First Health Commercial |
$3,773.61
|
| Rate for Payer: Humana Commercial |
$3,376.39
|
| Rate for Payer: Humana KY Medicaid |
$1,366.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,379.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,931.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,495.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.39
|
| Rate for Payer: PHCS Commercial |
$3,813.33
|
| Rate for Payer: United Healthcare All Payer |
$3,495.55
|
|
|
PLATE CLASSIC 5 SLOT 140^ 120
|
Facility
|
OP
|
$3,972.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$3,813.33 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: Anthem Medicaid |
$1,366.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.33
|
| Rate for Payer: Cash Price |
$1,986.11
|
| Rate for Payer: Cigna Commercial |
$3,296.94
|
| Rate for Payer: First Health Commercial |
$3,773.61
|
| Rate for Payer: Humana Commercial |
$3,376.39
|
| Rate for Payer: Humana KY Medicaid |
$1,366.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,379.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,931.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,393.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,495.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.39
|
| Rate for Payer: PHCS Commercial |
$3,813.33
|
| Rate for Payer: United Healthcare All Payer |
$3,495.55
|
|
|
PLATE CLASSIC 5 SLOT 140^ 120
|
Facility
|
IP
|
$3,972.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.39 |
| Max. Negotiated Rate |
$3,813.33 |
| Rate for Payer: Aetna Commercial |
$3,058.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,098.33
|
| Rate for Payer: Cash Price |
$1,986.11
|
| Rate for Payer: Cigna Commercial |
$3,296.94
|
| Rate for Payer: First Health Commercial |
$3,773.61
|
| Rate for Payer: Humana Commercial |
$3,376.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,257.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,931.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,191.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,495.55
|
| Rate for Payer: Ohio Health Group HMO |
$2,979.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.39
|
| Rate for Payer: PHCS Commercial |
$3,813.33
|
| Rate for Payer: United Healthcare All Payer |
$3,495.55
|
|
|
PLATE CLASSIC 6 SLOT 90^
|
Facility
|
OP
|
$4,567.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.81 |
| Max. Negotiated Rate |
$4,385.04 |
| Rate for Payer: Aetna Commercial |
$3,517.17
|
| Rate for Payer: Anthem Medicaid |
$1,570.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,562.84
|
| Rate for Payer: Cash Price |
$2,283.88
|
| Rate for Payer: Cigna Commercial |
$3,791.23
|
| Rate for Payer: First Health Commercial |
$4,339.36
|
| Rate for Payer: Humana Commercial |
$3,882.59
|
| Rate for Payer: Humana KY Medicaid |
$1,570.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,586.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,602.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,425.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.00
|
| Rate for Payer: PHCS Commercial |
$4,385.04
|
| Rate for Payer: United Healthcare All Payer |
$4,019.62
|
|
|
PLATE CLASSIC 6 SLOT 90^
|
Facility
|
IP
|
$4,567.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.81 |
| Max. Negotiated Rate |
$4,385.04 |
| Rate for Payer: Aetna Commercial |
$3,517.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,562.84
|
| Rate for Payer: Cash Price |
$2,283.88
|
| Rate for Payer: Cigna Commercial |
$3,791.23
|
| Rate for Payer: First Health Commercial |
$4,339.36
|
| Rate for Payer: Humana Commercial |
$3,882.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,425.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.00
|
| Rate for Payer: PHCS Commercial |
$4,385.04
|
| Rate for Payer: United Healthcare All Payer |
$4,019.62
|
|
|
PLATE CLASSIC 6 SLOT 95^
|
Facility
|
IP
|
$4,567.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.81 |
| Max. Negotiated Rate |
$4,385.04 |
| Rate for Payer: Aetna Commercial |
$3,517.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,562.84
|
| Rate for Payer: Cash Price |
$2,283.88
|
| Rate for Payer: Cigna Commercial |
$3,791.23
|
| Rate for Payer: First Health Commercial |
$4,339.36
|
| Rate for Payer: Humana Commercial |
$3,882.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,425.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.00
|
| Rate for Payer: PHCS Commercial |
$4,385.04
|
| Rate for Payer: United Healthcare All Payer |
$4,019.62
|
|
|
PLATE CLASSIC 6 SLOT 95^
|
Facility
|
OP
|
$4,567.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.81 |
| Max. Negotiated Rate |
$4,385.04 |
| Rate for Payer: Aetna Commercial |
$3,517.17
|
| Rate for Payer: Anthem Medicaid |
$1,570.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,562.84
|
| Rate for Payer: Cash Price |
$2,283.88
|
| Rate for Payer: Cigna Commercial |
$3,791.23
|
| Rate for Payer: First Health Commercial |
$4,339.36
|
| Rate for Payer: Humana Commercial |
$3,882.59
|
| Rate for Payer: Humana KY Medicaid |
$1,570.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,586.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,745.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,371.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,370.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,602.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,019.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,425.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$913.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$593.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,416.00
|
| Rate for Payer: PHCS Commercial |
$4,385.04
|
| Rate for Payer: United Healthcare All Payer |
$4,019.62
|
|
|
PLATE CLASSIC 8 SLOT 130*180
|
Facility
|
IP
|
$4,452.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.88 |
| Max. Negotiated Rate |
$4,274.83 |
| Rate for Payer: Aetna Commercial |
$3,428.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,473.30
|
| Rate for Payer: Cash Price |
$2,226.48
|
| Rate for Payer: Cigna Commercial |
$3,695.95
|
| Rate for Payer: First Health Commercial |
$4,230.30
|
| Rate for Payer: Humana Commercial |
$3,785.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,651.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,286.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,335.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,918.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,339.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$890.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$578.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.41
|
| Rate for Payer: PHCS Commercial |
$4,274.83
|
| Rate for Payer: United Healthcare All Payer |
$3,918.60
|
|
|
PLATE CLASSIC 8 SLOT 130*180
|
Facility
|
OP
|
$4,452.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.88 |
| Max. Negotiated Rate |
$4,274.83 |
| Rate for Payer: Aetna Commercial |
$3,428.77
|
| Rate for Payer: Anthem Medicaid |
$1,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,473.30
|
| Rate for Payer: Cash Price |
$2,226.48
|
| Rate for Payer: Cigna Commercial |
$3,695.95
|
| Rate for Payer: First Health Commercial |
$4,230.30
|
| Rate for Payer: Humana Commercial |
$3,785.01
|
| Rate for Payer: Humana KY Medicaid |
$1,531.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,546.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,651.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,286.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,335.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,562.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,918.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,339.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$890.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$578.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.41
|
| Rate for Payer: PHCS Commercial |
$4,274.83
|
| Rate for Payer: United Healthcare All Payer |
$3,918.60
|
|
|
PLATE CLASSIC 8 SLOT 145^ 180
|
Facility
|
OP
|
$4,452.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.88 |
| Max. Negotiated Rate |
$4,274.83 |
| Rate for Payer: Aetna Commercial |
$3,428.77
|
| Rate for Payer: Anthem Medicaid |
$1,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,473.30
|
| Rate for Payer: Cash Price |
$2,226.48
|
| Rate for Payer: Cigna Commercial |
$3,695.95
|
| Rate for Payer: First Health Commercial |
$4,230.30
|
| Rate for Payer: Humana Commercial |
$3,785.01
|
| Rate for Payer: Humana KY Medicaid |
$1,531.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,546.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,651.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,286.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,335.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,562.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,918.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,339.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$890.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$578.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.41
|
| Rate for Payer: PHCS Commercial |
$4,274.83
|
| Rate for Payer: United Healthcare All Payer |
$3,918.60
|
|
