|
PLATE CMF 1.2 DBL Y 6H
|
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 Y 6H
|
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
|
|
|
PLATE CMF 1.2 DBL Y 7H
|
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
|
|
|
PLATE CMF 1.2 DBL Y 7H
|
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 L 5H LT
|
Facility
|
IP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 L 5H LT
|
Facility
|
OP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem Medicaid |
$585.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Humana KY Medicaid |
$585.69
|
| Rate for Payer: Kentucky WC Medicaid |
$591.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 L 5H RT
|
Facility
|
OP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem Medicaid |
$585.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Humana KY Medicaid |
$585.69
|
| Rate for Payer: Kentucky WC Medicaid |
$591.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 L 5H RT
|
Facility
|
IP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 L 8H LT
|
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: 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
|
| 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
|
|
|
PLATE CMF 1.2 L 8H LT
|
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 L 8H RT
|
Facility
|
OP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem Medicaid |
$585.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Humana KY Medicaid |
$585.69
|
| Rate for Payer: Kentucky WC Medicaid |
$591.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 L 8H RT
|
Facility
|
IP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 SQ 2*2H
|
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 SQ 2*2H
|
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 SQ 3*2H
|
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 SQ 3*2H
|
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 SQ 4*2H
|
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 SQ 4*2H
|
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: 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
|
| 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
|
|
|
PLATE CMF 1.2 ST 8H
|
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 ST 8H
|
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
|
|
|
PLATE CMF 1.2 T 5H 90^
|
Facility
|
OP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem Medicaid |
$585.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Humana KY Medicaid |
$585.69
|
| Rate for Payer: Kentucky WC Medicaid |
$591.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 T 5H 90^
|
Facility
|
IP
|
$1,703.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$1,634.96 |
| Rate for Payer: Aetna Commercial |
$1,311.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.40
|
| Rate for Payer: Cash Price |
$851.54
|
| Rate for Payer: Cigna Commercial |
$1,413.56
|
| Rate for Payer: First Health Commercial |
$1,617.93
|
| Rate for Payer: Humana Commercial |
$1,447.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.95
|
| Rate for Payer: PHCS Commercial |
$1,634.96
|
| Rate for Payer: United Healthcare All Payer |
$1,498.71
|
|
|
PLATE CMF 1.2 T 7H 90^
|
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 T 7H 90^
|
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
|
|
|
PLATE CMF 1.2 Y 6H
|
Facility
|
IP
|
$1,707.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.96 |
| Max. Negotiated Rate |
$1,639.12 |
| Rate for Payer: Aetna Commercial |
$1,314.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,331.79
|
| Rate for Payer: Cash Price |
$853.71
|
| Rate for Payer: Cigna Commercial |
$1,417.16
|
| Rate for Payer: First Health Commercial |
$1,622.05
|
| Rate for Payer: Humana Commercial |
$1,451.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,400.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,260.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,502.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,280.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.30
|
| Rate for Payer: PHCS Commercial |
$1,639.12
|
| Rate for Payer: United Healthcare All Payer |
$1,502.53
|
|
