|
PLATE CMF 1.2 Y 6H
|
Facility
|
OP
|
$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 Medicaid |
$587.18
|
| 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: Humana KY Medicaid |
$587.18
|
| Rate for Payer: Kentucky WC Medicaid |
$593.16
|
| 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: Molina Healthcare Medicaid |
$598.96
|
| 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
|
|
|
PLATE CMF 1.7 DBL Y 6H REG
|
Facility
|
OP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem Medicaid |
$712.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Humana KY Medicaid |
$712.40
|
| Rate for Payer: Kentucky WC Medicaid |
$719.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
|
|
PLATE CMF 1.7 DBL Y 6H REG
|
Facility
|
IP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
|
|
PLATE CMF 1.7 DBL Y 7H REG
|
Facility
|
OP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem Medicaid |
$712.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Humana KY Medicaid |
$712.40
|
| Rate for Payer: Kentucky WC Medicaid |
$719.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
|
|
PLATE CMF 1.7 DBL Y 7H REG
|
Facility
|
IP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
|
|
PLATE CMF 1.7 L 90^ 10MM LT
|
Facility
|
OP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem Medicaid |
$702.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Humana KY Medicaid |
$702.11
|
| Rate for Payer: Kentucky WC Medicaid |
$709.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$716.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 L 90^ 10MM LT
|
Facility
|
IP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 L 90^ 10MM RT
|
Facility
|
IP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 L 90^ 10MM RT
|
Facility
|
OP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem Medicaid |
$702.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Humana KY Medicaid |
$702.11
|
| Rate for Payer: Kentucky WC Medicaid |
$709.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$716.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 L 90^ 12MM LT
|
Facility
|
IP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
|
|
PLATE CMF 1.7 L 90^ 12MM LT
|
Facility
|
OP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Humana KY Medicaid |
$712.40
|
| Rate for Payer: Kentucky WC Medicaid |
$719.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem Medicaid |
$712.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
|
|
PLATE CMF 1.7 L 90^ 12MM RT
|
Facility
|
IP
|
$1,842.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.56 |
| Max. Negotiated Rate |
$1,769.09 |
| Rate for Payer: Aetna Commercial |
$1,418.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,437.38
|
| Rate for Payer: Cash Price |
$921.40
|
| Rate for Payer: Cigna Commercial |
$1,529.52
|
| Rate for Payer: First Health Commercial |
$1,750.66
|
| Rate for Payer: Humana Commercial |
$1,566.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,511.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,359.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,621.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,382.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.27
|
| Rate for Payer: PHCS Commercial |
$1,769.09
|
| Rate for Payer: United Healthcare All Payer |
$1,621.66
|
|
|
PLATE CMF 1.7 L 90^ 12MM RT
|
Facility
|
OP
|
$1,842.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.56 |
| Max. Negotiated Rate |
$1,769.09 |
| Rate for Payer: Aetna Commercial |
$1,418.96
|
| Rate for Payer: Anthem Medicaid |
$633.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,437.38
|
| Rate for Payer: Cash Price |
$921.40
|
| Rate for Payer: Cigna Commercial |
$1,529.52
|
| Rate for Payer: First Health Commercial |
$1,750.66
|
| Rate for Payer: Humana Commercial |
$1,566.38
|
| Rate for Payer: Humana KY Medicaid |
$633.74
|
| Rate for Payer: Kentucky WC Medicaid |
$640.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,511.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,359.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$646.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,621.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,382.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$571.27
|
| Rate for Payer: PHCS Commercial |
$1,769.09
|
| Rate for Payer: United Healthcare All Payer |
$1,621.66
|
|
|
PLATE CMF 1.7 L 90^ 6MM LT
|
Facility
|
OP
|
$1,819.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.56 |
| Max. Negotiated Rate |
$1,746.91 |
| Rate for Payer: Aetna Commercial |
$1,401.17
|
| Rate for Payer: Anthem Medicaid |
$625.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.37
|
| Rate for Payer: Cash Price |
$909.85
|
| Rate for Payer: Cigna Commercial |
$1,510.35
|
| Rate for Payer: First Health Commercial |
$1,728.72
|
| Rate for Payer: Humana Commercial |
$1,546.74
|
| Rate for Payer: Humana KY Medicaid |
$625.79
|
| Rate for Payer: Kentucky WC Medicaid |
$632.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,342.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$638.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,364.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.11
|
| Rate for Payer: PHCS Commercial |
$1,746.91
|
| Rate for Payer: United Healthcare All Payer |
$1,601.34
|
|
|
PLATE CMF 1.7 L 90^ 6MM LT
|
Facility
|
IP
|
$1,819.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.56 |
| Max. Negotiated Rate |
$1,746.91 |
| Rate for Payer: Aetna Commercial |
$1,401.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,419.37
|
| Rate for Payer: Cash Price |
$909.85
|
| Rate for Payer: Cigna Commercial |
$1,510.35
|
| Rate for Payer: First Health Commercial |
$1,728.72
|
| Rate for Payer: Humana Commercial |
$1,546.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,492.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,342.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$545.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,601.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,364.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.11
|
| Rate for Payer: PHCS Commercial |
$1,746.91
|
| Rate for Payer: United Healthcare All Payer |
$1,601.34
|
|
|
PLATE CMF 1.7 L 90^ 6MM RT
|
Facility
|
OP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem Medicaid |
$712.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Humana KY Medicaid |
$712.40
|
| Rate for Payer: Kentucky WC Medicaid |
$719.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
|
|
PLATE CMF 1.7 L 90^ 6MM RT
|
Facility
|
IP
|
$2,071.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$1,988.66 |
| Rate for Payer: Aetna Commercial |
$1,595.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.79
|
| Rate for Payer: Cash Price |
$1,035.76
|
| Rate for Payer: Cigna Commercial |
$1,719.36
|
| Rate for Payer: First Health Commercial |
$1,967.94
|
| Rate for Payer: Humana Commercial |
$1,760.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$414.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$269.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$642.17
|
| Rate for Payer: PHCS Commercial |
$1,988.66
|
| Rate for Payer: United Healthcare All Payer |
$1,822.94
|
|
|
PLATE CMF 1.7 L 90^ 8MM LT
|
Facility
|
IP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 L 90^ 8MM LT
|
Facility
|
OP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem Medicaid |
$702.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Humana KY Medicaid |
$702.11
|
| Rate for Payer: Kentucky WC Medicaid |
$709.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$716.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 L 90^ 8MM RT
|
Facility
|
IP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 L 90^ 8MM RT
|
Facility
|
OP
|
$2,041.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.41 |
| Max. Negotiated Rate |
$1,959.94 |
| Rate for Payer: Aetna Commercial |
$1,572.03
|
| Rate for Payer: Anthem Medicaid |
$702.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,592.45
|
| Rate for Payer: Cash Price |
$1,020.80
|
| Rate for Payer: Cigna Commercial |
$1,694.53
|
| Rate for Payer: First Health Commercial |
$1,939.52
|
| Rate for Payer: Humana Commercial |
$1,735.36
|
| Rate for Payer: Humana KY Medicaid |
$702.11
|
| Rate for Payer: Kentucky WC Medicaid |
$709.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,674.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,506.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$716.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,796.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,531.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$408.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.90
|
| Rate for Payer: PHCS Commercial |
$1,959.94
|
| Rate for Payer: United Healthcare All Payer |
$1,796.61
|
|
|
PLATE CMF 1.7 MINI 4H 6MM
|
Facility
|
IP
|
$1,868.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.93 |
| Max. Negotiated Rate |
$1,793.95 |
| Rate for Payer: Aetna Commercial |
$1,438.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,457.59
|
| Rate for Payer: Cash Price |
$934.35
|
| Rate for Payer: Cigna Commercial |
$1,551.02
|
| Rate for Payer: First Health Commercial |
$1,775.26
|
| Rate for Payer: Humana Commercial |
$1,588.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,532.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,644.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,401.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.30
|
| Rate for Payer: PHCS Commercial |
$1,793.95
|
| Rate for Payer: United Healthcare All Payer |
$1,644.46
|
|
|
PLATE CMF 1.7 MINI 4H 6MM
|
Facility
|
OP
|
$1,868.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.93 |
| Max. Negotiated Rate |
$1,793.95 |
| Rate for Payer: Aetna Commercial |
$1,438.90
|
| Rate for Payer: Anthem Medicaid |
$642.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,457.59
|
| Rate for Payer: Cash Price |
$934.35
|
| Rate for Payer: Cigna Commercial |
$1,551.02
|
| Rate for Payer: First Health Commercial |
$1,775.26
|
| Rate for Payer: Humana Commercial |
$1,588.40
|
| Rate for Payer: Humana KY Medicaid |
$642.65
|
| Rate for Payer: Kentucky WC Medicaid |
$649.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,532.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,379.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$655.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,644.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,401.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$579.30
|
| Rate for Payer: PHCS Commercial |
$1,793.95
|
| Rate for Payer: United Healthcare All Payer |
$1,644.46
|
|
|
PLATE CMF 1.7 MINI 6H 8MM
|
Facility
|
OP
|
$1,975.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$1,896.10 |
| Rate for Payer: Aetna Commercial |
$1,520.83
|
| Rate for Payer: Anthem Medicaid |
$679.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,540.58
|
| Rate for Payer: Cash Price |
$987.55
|
| Rate for Payer: Cigna Commercial |
$1,639.33
|
| Rate for Payer: First Health Commercial |
$1,876.34
|
| Rate for Payer: Humana Commercial |
$1,678.84
|
| Rate for Payer: Humana KY Medicaid |
$679.24
|
| Rate for Payer: Kentucky WC Medicaid |
$686.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,619.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,457.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,738.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,481.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.28
|
| Rate for Payer: PHCS Commercial |
$1,896.10
|
| Rate for Payer: United Healthcare All Payer |
$1,738.09
|
|
|
PLATE CMF 1.7 MINI 6H 8MM
|
Facility
|
IP
|
$1,975.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$1,896.10 |
| Rate for Payer: Aetna Commercial |
$1,520.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,540.58
|
| Rate for Payer: Cash Price |
$987.55
|
| Rate for Payer: Cigna Commercial |
$1,639.33
|
| Rate for Payer: First Health Commercial |
$1,876.34
|
| Rate for Payer: Humana Commercial |
$1,678.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,619.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,457.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,738.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,481.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$395.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.28
|
| Rate for Payer: PHCS Commercial |
$1,896.10
|
| Rate for Payer: United Healthcare All Payer |
$1,738.09
|
|
