|
PLATE CLOVERLEAF 3X88MM
|
Facility
|
IP
|
$3,319.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.51 |
| Max. Negotiated Rate |
$3,186.53 |
| Rate for Payer: Aetna Commercial |
$2,555.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.05
|
| Rate for Payer: Cash Price |
$1,659.65
|
| Rate for Payer: Cigna Commercial |
$2,755.02
|
| Rate for Payer: First Health Commercial |
$3,153.34
|
| Rate for Payer: Humana Commercial |
$2,821.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,721.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,449.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,920.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,489.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.98
|
| Rate for Payer: PHCS Commercial |
$3,186.53
|
| Rate for Payer: United Healthcare All Payer |
$2,920.98
|
|
|
PLATE CLOVERLEAF 4X104MM
|
Facility
|
OP
|
$3,405.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.70 |
| Max. Negotiated Rate |
$3,269.18 |
| Rate for Payer: Humana Commercial |
$2,894.59
|
| Rate for Payer: Humana KY Medicaid |
$1,171.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,792.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,996.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.67
|
| Rate for Payer: PHCS Commercial |
$3,269.18
|
| Rate for Payer: United Healthcare All Payer |
$2,996.75
|
| Rate for Payer: Aetna Commercial |
$2,622.16
|
| Rate for Payer: Anthem Medicaid |
$1,171.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.21
|
| Rate for Payer: Cash Price |
$1,702.70
|
| Rate for Payer: Cigna Commercial |
$2,826.48
|
| Rate for Payer: First Health Commercial |
$3,235.13
|
|
|
PLATE CLOVERLEAF 4X104MM
|
Facility
|
IP
|
$3,405.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.70 |
| Max. Negotiated Rate |
$3,269.18 |
| Rate for Payer: Aetna Commercial |
$2,622.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.21
|
| Rate for Payer: Cash Price |
$1,702.70
|
| Rate for Payer: Cigna Commercial |
$2,826.48
|
| Rate for Payer: First Health Commercial |
$3,235.13
|
| Rate for Payer: Humana Commercial |
$2,894.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,792.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,996.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.67
|
| Rate for Payer: PHCS Commercial |
$3,269.18
|
| Rate for Payer: United Healthcare All Payer |
$2,996.75
|
|
|
PLATE CLOVERLEAF 5 H 120MM
|
Facility
|
OP
|
$3,728.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.68 |
| Max. Negotiated Rate |
$3,579.15 |
| Rate for Payer: Aetna Commercial |
$2,870.78
|
| Rate for Payer: Anthem Medicaid |
$1,282.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.06
|
| Rate for Payer: Cash Price |
$1,864.14
|
| Rate for Payer: Cigna Commercial |
$3,094.47
|
| Rate for Payer: First Health Commercial |
$3,541.87
|
| Rate for Payer: Humana Commercial |
$3,169.04
|
| Rate for Payer: Humana KY Medicaid |
$1,282.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,307.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,280.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,155.77
|
| Rate for Payer: PHCS Commercial |
$3,579.15
|
| Rate for Payer: United Healthcare All Payer |
$3,280.89
|
|
|
PLATE CLOVERLEAF 5 H 120MM
|
Facility
|
IP
|
$3,728.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$484.68 |
| Max. Negotiated Rate |
$3,579.15 |
| Rate for Payer: Aetna Commercial |
$2,870.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,908.06
|
| Rate for Payer: Cash Price |
$1,864.14
|
| Rate for Payer: Cigna Commercial |
$3,094.47
|
| Rate for Payer: First Health Commercial |
$3,541.87
|
| Rate for Payer: Humana Commercial |
$3,169.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,057.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,280.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,796.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$745.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$484.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,155.77
|
| Rate for Payer: PHCS Commercial |
$3,579.15
|
| Rate for Payer: United Healthcare All Payer |
$3,280.89
|
|
|
PLATE CLOVERLEAF 6 H 136MM
|
Facility
|
IP
|
$3,878.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.26 |
| Max. Negotiated Rate |
$3,723.79 |
| Rate for Payer: Aetna Commercial |
$2,986.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,025.58
|
| Rate for Payer: Cash Price |
$1,939.47
|
| Rate for Payer: Cigna Commercial |
$3,219.53
|
| Rate for Payer: First Health Commercial |
$3,685.00
|
| Rate for Payer: Humana Commercial |
$3,297.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,180.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,862.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,163.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,413.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,909.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.47
|
| Rate for Payer: PHCS Commercial |
$3,723.79
|
| Rate for Payer: United Healthcare All Payer |
$3,413.48
|
|
|
PLATE CLOVERLEAF 6 H 136MM
|
Facility
|
OP
|
$3,878.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.26 |
| Max. Negotiated Rate |
$3,723.79 |
| Rate for Payer: Aetna Commercial |
$2,986.79
|
| Rate for Payer: Anthem Medicaid |
$1,333.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,025.58
|
| Rate for Payer: Cash Price |
$1,939.47
|
| Rate for Payer: Cigna Commercial |
$3,219.53
|
| Rate for Payer: First Health Commercial |
$3,685.00
|
| Rate for Payer: Humana Commercial |
$3,297.11
|
| Rate for Payer: Humana KY Medicaid |
$1,333.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,180.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,862.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,163.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,360.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,413.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,909.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.47
|
| Rate for Payer: PHCS Commercial |
$3,723.79
|
| Rate for Payer: United Healthcare All Payer |
$3,413.48
|
|
|
PLATE CLOVERLEAF 7 H 152MM
|
Facility
|
IP
|
$3,986.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$3,827.11 |
| Rate for Payer: Aetna Commercial |
$3,069.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.52
|
| Rate for Payer: Cash Price |
$1,993.29
|
| Rate for Payer: Cigna Commercial |
$3,308.85
|
| Rate for Payer: First Health Commercial |
$3,787.24
|
| Rate for Payer: Humana Commercial |
$3,388.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,268.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.84
|
| Rate for Payer: PHCS Commercial |
$3,827.11
|
| Rate for Payer: United Healthcare All Payer |
$3,508.18
|
|
|
PLATE CLOVERLEAF 7 H 152MM
|
Facility
|
OP
|
$3,986.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$518.25 |
| Max. Negotiated Rate |
$3,827.11 |
| Rate for Payer: Aetna Commercial |
$3,069.66
|
| Rate for Payer: Anthem Medicaid |
$1,370.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,109.52
|
| Rate for Payer: Cash Price |
$1,993.29
|
| Rate for Payer: Cigna Commercial |
$3,308.85
|
| Rate for Payer: First Health Commercial |
$3,787.24
|
| Rate for Payer: Humana Commercial |
$3,388.58
|
| Rate for Payer: Humana KY Medicaid |
$1,370.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,384.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,268.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,195.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,508.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,989.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$797.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$518.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,235.84
|
| Rate for Payer: PHCS Commercial |
$3,827.11
|
| Rate for Payer: United Healthcare All Payer |
$3,508.18
|
|
|
PLATE CLOVERLEAF 8 H 168MM
|
Facility
|
IP
|
$4,101.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.18 |
| Max. Negotiated Rate |
$3,937.32 |
| Rate for Payer: Aetna Commercial |
$3,158.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,199.08
|
| Rate for Payer: Cash Price |
$2,050.69
|
| Rate for Payer: Cigna Commercial |
$3,404.15
|
| Rate for Payer: First Health Commercial |
$3,896.31
|
| Rate for Payer: Humana Commercial |
$3,486.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,363.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,026.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,609.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.43
|
| Rate for Payer: PHCS Commercial |
$3,937.32
|
| Rate for Payer: United Healthcare All Payer |
$3,609.21
|
|
|
PLATE CLOVERLEAF 8 H 168MM
|
Facility
|
OP
|
$4,101.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.18 |
| Max. Negotiated Rate |
$3,937.32 |
| Rate for Payer: Aetna Commercial |
$3,158.06
|
| Rate for Payer: Anthem Medicaid |
$1,410.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,199.08
|
| Rate for Payer: Cash Price |
$2,050.69
|
| Rate for Payer: Cigna Commercial |
$3,404.15
|
| Rate for Payer: First Health Commercial |
$3,896.31
|
| Rate for Payer: Humana Commercial |
$3,486.17
|
| Rate for Payer: Humana KY Medicaid |
$1,410.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,363.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,026.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,609.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.43
|
| Rate for Payer: PHCS Commercial |
$3,937.32
|
| Rate for Payer: United Healthcare All Payer |
$3,609.21
|
|
|
PLATE CLOVERLEAF 9 H 184MM
|
Facility
|
OP
|
$4,259.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$4,088.86 |
| Rate for Payer: Aetna Commercial |
$3,279.61
|
| Rate for Payer: Anthem Medicaid |
$1,464.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.20
|
| Rate for Payer: Cash Price |
$2,129.61
|
| Rate for Payer: Cigna Commercial |
$3,535.16
|
| Rate for Payer: First Health Commercial |
$4,046.27
|
| Rate for Payer: Humana Commercial |
$3,620.35
|
| Rate for Payer: Humana KY Medicaid |
$1,464.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.36
|
| Rate for Payer: PHCS Commercial |
$4,088.86
|
| Rate for Payer: United Healthcare All Payer |
$3,748.12
|
|
|
PLATE CLOVERLEAF 9 H 184MM
|
Facility
|
IP
|
$4,259.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$4,088.86 |
| Rate for Payer: Aetna Commercial |
$3,279.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.20
|
| Rate for Payer: Cash Price |
$2,129.61
|
| Rate for Payer: Cigna Commercial |
$3,535.16
|
| Rate for Payer: First Health Commercial |
$4,046.27
|
| Rate for Payer: Humana Commercial |
$3,620.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.36
|
| Rate for Payer: PHCS Commercial |
$4,088.86
|
| Rate for Payer: United Healthcare All Payer |
$3,748.12
|
|
|
PLATE CLOVERLEAF W/PF 3H
|
Facility
|
IP
|
$3,434.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.43 |
| Max. Negotiated Rate |
$3,296.74 |
| Rate for Payer: Aetna Commercial |
$2,644.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.60
|
| Rate for Payer: Cash Price |
$1,717.05
|
| Rate for Payer: Cigna Commercial |
$2,850.30
|
| Rate for Payer: First Health Commercial |
$3,262.40
|
| Rate for Payer: Humana Commercial |
$2,918.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.57
|
| Rate for Payer: PHCS Commercial |
$3,296.74
|
| Rate for Payer: United Healthcare All Payer |
$3,022.01
|
|
|
PLATE CLOVERLEAF W/PF 3H
|
Facility
|
OP
|
$3,434.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$446.43 |
| Max. Negotiated Rate |
$3,296.74 |
| Rate for Payer: Aetna Commercial |
$2,644.26
|
| Rate for Payer: Anthem Medicaid |
$1,180.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,678.60
|
| Rate for Payer: Cash Price |
$1,717.05
|
| Rate for Payer: Cigna Commercial |
$2,850.30
|
| Rate for Payer: First Health Commercial |
$3,262.40
|
| Rate for Payer: Humana Commercial |
$2,918.98
|
| Rate for Payer: Humana KY Medicaid |
$1,180.99
|
| Rate for Payer: Kentucky WC Medicaid |
$1,193.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,815.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,534.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,030.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,204.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,022.01
|
| Rate for Payer: Ohio Health Group HMO |
$2,575.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$686.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$446.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.57
|
| Rate for Payer: PHCS Commercial |
$3,296.74
|
| Rate for Payer: United Healthcare All Payer |
$3,022.01
|
|
|
PLATE CLOVERLEAF W/PF 4H
|
Facility
|
IP
|
$3,534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.49 |
| Max. Negotiated Rate |
$3,393.17 |
| Rate for Payer: Aetna Commercial |
$2,721.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,756.95
|
| Rate for Payer: Cash Price |
$1,767.28
|
| Rate for Payer: Cigna Commercial |
$2,933.68
|
| Rate for Payer: First Health Commercial |
$3,357.82
|
| Rate for Payer: Humana Commercial |
$3,004.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,650.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.71
|
| Rate for Payer: PHCS Commercial |
$3,393.17
|
| Rate for Payer: United Healthcare All Payer |
$3,110.40
|
|
|
PLATE CLOVERLEAF W/PF 4H
|
Facility
|
OP
|
$3,534.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.49 |
| Max. Negotiated Rate |
$3,393.17 |
| Rate for Payer: Aetna Commercial |
$2,721.60
|
| Rate for Payer: Anthem Medicaid |
$1,215.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,756.95
|
| Rate for Payer: Cash Price |
$1,767.28
|
| Rate for Payer: Cigna Commercial |
$2,933.68
|
| Rate for Payer: First Health Commercial |
$3,357.82
|
| Rate for Payer: Humana Commercial |
$3,004.37
|
| Rate for Payer: Humana KY Medicaid |
$1,215.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,227.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,898.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,608.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,060.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,239.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,110.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,650.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$706.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$459.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,095.71
|
| Rate for Payer: PHCS Commercial |
$3,393.17
|
| Rate for Payer: United Healthcare All Payer |
$3,110.40
|
|
|
PLATE CLUSTER 11-HI
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
PLATE CLUSTER 11-HI
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
PLATE CMF 1.2 24H
|
Facility
|
OP
|
$3,181.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.55 |
| Max. Negotiated Rate |
$3,053.91 |
| Rate for Payer: Anthem Medicaid |
$1,094.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.30
|
| Rate for Payer: Cash Price |
$1,590.58
|
| Rate for Payer: Cigna Commercial |
$2,640.36
|
| Rate for Payer: First Health Commercial |
$3,022.10
|
| Rate for Payer: Humana Commercial |
$2,703.99
|
| Rate for Payer: Humana KY Medicaid |
$1,094.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,105.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.16
|
| Rate for Payer: PHCS Commercial |
$3,053.91
|
| Rate for Payer: United Healthcare All Payer |
$2,799.42
|
| Rate for Payer: Aetna Commercial |
$2,449.49
|
|
|
PLATE CMF 1.2 24H
|
Facility
|
IP
|
$3,181.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.55 |
| Max. Negotiated Rate |
$3,053.91 |
| Rate for Payer: Aetna Commercial |
$2,449.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,481.30
|
| Rate for Payer: Cash Price |
$1,590.58
|
| Rate for Payer: Cigna Commercial |
$2,640.36
|
| Rate for Payer: First Health Commercial |
$3,022.10
|
| Rate for Payer: Humana Commercial |
$2,703.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,799.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.16
|
| Rate for Payer: PHCS Commercial |
$3,053.91
|
| Rate for Payer: United Healthcare All Payer |
$2,799.42
|
|
|
PLATE CMF 1.2 CRVD 8H
|
Facility
|
OP
|
$1,831.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.15 |
| Max. Negotiated Rate |
$1,758.67 |
| Rate for Payer: Aetna Commercial |
$1,410.60
|
| Rate for Payer: Anthem Medicaid |
$630.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.92
|
| Rate for Payer: Cash Price |
$915.98
|
| Rate for Payer: Cigna Commercial |
$1,520.52
|
| Rate for Payer: First Health Commercial |
$1,740.35
|
| Rate for Payer: Humana Commercial |
$1,557.16
|
| Rate for Payer: Humana KY Medicaid |
$630.01
|
| Rate for Payer: Kentucky WC Medicaid |
$636.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,351.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,373.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.90
|
| Rate for Payer: PHCS Commercial |
$1,758.67
|
| Rate for Payer: United Healthcare All Payer |
$1,612.12
|
|
|
PLATE CMF 1.2 CRVD 8H
|
Facility
|
IP
|
$1,831.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.15 |
| Max. Negotiated Rate |
$1,758.67 |
| Rate for Payer: Aetna Commercial |
$1,410.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.92
|
| Rate for Payer: Cash Price |
$915.98
|
| Rate for Payer: Cigna Commercial |
$1,520.52
|
| Rate for Payer: First Health Commercial |
$1,740.35
|
| Rate for Payer: Humana Commercial |
$1,557.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,351.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,373.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$366.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$567.90
|
| Rate for Payer: PHCS Commercial |
$1,758.67
|
| Rate for Payer: United Healthcare All Payer |
$1,612.12
|
|
|
PLATE CMF 1.2 DBL T 9H
|
Facility
|
OP
|
$1,779.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.39 |
| Max. Negotiated Rate |
$1,708.70 |
| Rate for Payer: Aetna Commercial |
$1,370.52
|
| Rate for Payer: Anthem Medicaid |
$612.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,388.32
|
| Rate for Payer: Cash Price |
$889.95
|
| Rate for Payer: Cigna Commercial |
$1,477.32
|
| Rate for Payer: First Health Commercial |
$1,690.90
|
| Rate for Payer: Humana Commercial |
$1,512.92
|
| Rate for Payer: Humana KY Medicaid |
$612.11
|
| Rate for Payer: Kentucky WC Medicaid |
$618.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,459.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,313.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$624.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,566.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,334.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$551.77
|
| Rate for Payer: PHCS Commercial |
$1,708.70
|
| Rate for Payer: United Healthcare All Payer |
$1,566.31
|
|
|
PLATE CMF 1.2 DBL T 9H
|
Facility
|
IP
|
$1,779.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.39 |
| Max. Negotiated Rate |
$1,708.70 |
| Rate for Payer: Aetna Commercial |
$1,370.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,388.32
|
| Rate for Payer: Cash Price |
$889.95
|
| Rate for Payer: Cigna Commercial |
$1,477.32
|
| Rate for Payer: First Health Commercial |
$1,690.90
|
| Rate for Payer: Humana Commercial |
$1,512.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,459.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,313.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$533.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,566.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,334.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$355.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$551.77
|
| Rate for Payer: PHCS Commercial |
$1,708.70
|
| Rate for Payer: United Healthcare All Payer |
$1,566.31
|
|
