|
PLATE CMF 1.7 MINI 8H
|
Facility
|
OP
|
$1,822.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$1,749.87 |
| Rate for Payer: Aetna Commercial |
$1,403.54
|
| Rate for Payer: Anthem Medicaid |
$626.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.77
|
| Rate for Payer: Cash Price |
$911.39
|
| Rate for Payer: Cigna Commercial |
$1,512.91
|
| Rate for Payer: First Health Commercial |
$1,731.64
|
| Rate for Payer: Humana Commercial |
$1,549.36
|
| Rate for Payer: Humana KY Medicaid |
$626.85
|
| Rate for Payer: Kentucky WC Medicaid |
$633.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.06
|
| Rate for Payer: PHCS Commercial |
$1,749.87
|
| Rate for Payer: United Healthcare All Payer |
$1,604.05
|
|
|
PLATE CMF 1.7 MINI 8H
|
Facility
|
IP
|
$1,822.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$1,749.87 |
| Rate for Payer: Aetna Commercial |
$1,403.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.77
|
| Rate for Payer: Cash Price |
$911.39
|
| Rate for Payer: Cigna Commercial |
$1,512.91
|
| Rate for Payer: First Health Commercial |
$1,731.64
|
| Rate for Payer: Humana Commercial |
$1,549.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.06
|
| Rate for Payer: PHCS Commercial |
$1,749.87
|
| Rate for Payer: United Healthcare All Payer |
$1,604.05
|
|
|
PLATE CMF 1.7 SQ 2*2H
|
Facility
|
OP
|
$1,730.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.93 |
| Max. Negotiated Rate |
$1,661.03 |
| Rate for Payer: Anthem Medicaid |
$595.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,349.59
|
| Rate for Payer: Cash Price |
$865.12
|
| Rate for Payer: Cigna Commercial |
$1,436.10
|
| Rate for Payer: First Health Commercial |
$1,643.73
|
| Rate for Payer: Humana Commercial |
$1,470.70
|
| Rate for Payer: Humana KY Medicaid |
$595.03
|
| Rate for Payer: Kentucky WC Medicaid |
$601.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,522.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.37
|
| Rate for Payer: PHCS Commercial |
$1,661.03
|
| Rate for Payer: United Healthcare All Payer |
$1,522.61
|
| Rate for Payer: Aetna Commercial |
$1,332.28
|
|
|
PLATE CMF 1.7 SQ 2*2H
|
Facility
|
IP
|
$1,730.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.93 |
| Max. Negotiated Rate |
$1,661.03 |
| Rate for Payer: Aetna Commercial |
$1,332.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,349.59
|
| Rate for Payer: Cash Price |
$865.12
|
| Rate for Payer: Cigna Commercial |
$1,436.10
|
| Rate for Payer: First Health Commercial |
$1,643.73
|
| Rate for Payer: Humana Commercial |
$1,470.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,522.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.37
|
| Rate for Payer: PHCS Commercial |
$1,661.03
|
| Rate for Payer: United Healthcare All Payer |
$1,522.61
|
|
|
PLATE CMF 1.7 SQ 3*2H
|
Facility
|
IP
|
$1,730.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.93 |
| Max. Negotiated Rate |
$1,661.03 |
| Rate for Payer: Aetna Commercial |
$1,332.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,349.59
|
| Rate for Payer: Cash Price |
$865.12
|
| Rate for Payer: Cigna Commercial |
$1,436.10
|
| Rate for Payer: First Health Commercial |
$1,643.73
|
| Rate for Payer: Humana Commercial |
$1,470.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,522.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.37
|
| Rate for Payer: PHCS Commercial |
$1,661.03
|
| Rate for Payer: United Healthcare All Payer |
$1,522.61
|
|
|
PLATE CMF 1.7 SQ 3*2H
|
Facility
|
OP
|
$1,730.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.93 |
| Max. Negotiated Rate |
$1,661.03 |
| Rate for Payer: Aetna Commercial |
$1,332.28
|
| Rate for Payer: Anthem Medicaid |
$595.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,349.59
|
| Rate for Payer: Cash Price |
$865.12
|
| Rate for Payer: Cigna Commercial |
$1,436.10
|
| Rate for Payer: First Health Commercial |
$1,643.73
|
| Rate for Payer: Humana Commercial |
$1,470.70
|
| Rate for Payer: Humana KY Medicaid |
$595.03
|
| Rate for Payer: Kentucky WC Medicaid |
$601.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,418.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,276.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$519.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,522.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,297.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$346.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$536.37
|
| Rate for Payer: PHCS Commercial |
$1,661.03
|
| Rate for Payer: United Healthcare All Payer |
$1,522.61
|
|
|
PLATE CMF 1.7 ST 16H
|
Facility
|
IP
|
$2,069.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.99 |
| Max. Negotiated Rate |
$1,986.41 |
| Rate for Payer: Aetna Commercial |
$1,593.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.96
|
| Rate for Payer: Cash Price |
$1,034.59
|
| Rate for Payer: Cigna Commercial |
$1,717.42
|
| Rate for Payer: First Health Commercial |
$1,965.72
|
| Rate for Payer: Humana Commercial |
$1,758.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,527.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.45
|
| Rate for Payer: PHCS Commercial |
$1,986.41
|
| Rate for Payer: United Healthcare All Payer |
$1,820.88
|
|
|
PLATE CMF 1.7 ST 16H
|
Facility
|
OP
|
$2,069.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.99 |
| Max. Negotiated Rate |
$1,986.41 |
| Rate for Payer: Aetna Commercial |
$1,593.27
|
| Rate for Payer: Anthem Medicaid |
$711.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.96
|
| Rate for Payer: Cash Price |
$1,034.59
|
| Rate for Payer: Cigna Commercial |
$1,717.42
|
| Rate for Payer: First Health Commercial |
$1,965.72
|
| Rate for Payer: Humana Commercial |
$1,758.80
|
| Rate for Payer: Humana KY Medicaid |
$711.59
|
| Rate for Payer: Kentucky WC Medicaid |
$718.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,527.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.45
|
| Rate for Payer: PHCS Commercial |
$1,986.41
|
| Rate for Payer: United Healthcare All Payer |
$1,820.88
|
|
|
PLATE CMF 1.7 ST 4H 6MM
|
Facility
|
IP
|
$1,083.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$1,040.24 |
| Rate for Payer: Aetna Commercial |
$834.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$845.19
|
| Rate for Payer: Cash Price |
$541.79
|
| Rate for Payer: Cigna Commercial |
$899.37
|
| Rate for Payer: First Health Commercial |
$1,029.40
|
| Rate for Payer: Humana Commercial |
$921.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$888.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$799.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$953.55
|
| Rate for Payer: Ohio Health Group HMO |
$812.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.91
|
| Rate for Payer: PHCS Commercial |
$1,040.24
|
| Rate for Payer: United Healthcare All Payer |
$953.55
|
|
|
PLATE CMF 1.7 ST 4H 6MM
|
Facility
|
OP
|
$1,083.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$1,040.24 |
| Rate for Payer: Aetna Commercial |
$834.36
|
| Rate for Payer: Anthem Medicaid |
$372.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$845.19
|
| Rate for Payer: Cash Price |
$541.79
|
| Rate for Payer: Cigna Commercial |
$899.37
|
| Rate for Payer: First Health Commercial |
$1,029.40
|
| Rate for Payer: Humana Commercial |
$921.04
|
| Rate for Payer: Humana KY Medicaid |
$372.64
|
| Rate for Payer: Kentucky WC Medicaid |
$376.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$888.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$799.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$325.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$380.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$953.55
|
| Rate for Payer: Ohio Health Group HMO |
$812.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.91
|
| Rate for Payer: PHCS Commercial |
$1,040.24
|
| Rate for Payer: United Healthcare All Payer |
$953.55
|
|
|
PLATE CMF 1.7 ST 4H 8MM
|
Facility
|
OP
|
$1,740.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,340.12
|
| Rate for Payer: Anthem Medicaid |
$598.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.53
|
| Rate for Payer: Cash Price |
$870.21
|
| Rate for Payer: Cigna Commercial |
$1,444.55
|
| Rate for Payer: First Health Commercial |
$1,653.40
|
| Rate for Payer: Humana Commercial |
$1,479.36
|
| Rate for Payer: Humana KY Medicaid |
$598.53
|
| Rate for Payer: Kentucky WC Medicaid |
$604.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.53
|
| Rate for Payer: PHCS Commercial |
$1,670.80
|
| Rate for Payer: United Healthcare All Payer |
$1,531.57
|
|
|
PLATE CMF 1.7 ST 4H 8MM
|
Facility
|
IP
|
$1,740.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.25 |
| Max. Negotiated Rate |
$1,670.80 |
| Rate for Payer: Aetna Commercial |
$1,340.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,357.53
|
| Rate for Payer: Cash Price |
$870.21
|
| Rate for Payer: Cigna Commercial |
$1,444.55
|
| Rate for Payer: First Health Commercial |
$1,653.40
|
| Rate for Payer: Humana Commercial |
$1,479.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,427.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,284.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$522.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,531.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,305.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$348.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.53
|
| Rate for Payer: PHCS Commercial |
$1,670.80
|
| Rate for Payer: United Healthcare All Payer |
$1,531.57
|
|
|
PLATE CMF 1.7 ST 8H REG
|
Facility
|
IP
|
$1,545.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$1,483.56 |
| Rate for Payer: Aetna Commercial |
$1,189.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.39
|
| Rate for Payer: Cash Price |
$772.68
|
| Rate for Payer: Cigna Commercial |
$1,282.66
|
| Rate for Payer: First Health Commercial |
$1,468.10
|
| Rate for Payer: Humana Commercial |
$1,313.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,267.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,359.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,159.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.06
|
| Rate for Payer: PHCS Commercial |
$1,483.56
|
| Rate for Payer: United Healthcare All Payer |
$1,359.93
|
|
|
PLATE CMF 1.7 ST 8H REG
|
Facility
|
OP
|
$1,545.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.90 |
| Max. Negotiated Rate |
$1,483.56 |
| Rate for Payer: Aetna Commercial |
$1,189.93
|
| Rate for Payer: Anthem Medicaid |
$531.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.39
|
| Rate for Payer: Cash Price |
$772.68
|
| Rate for Payer: Cigna Commercial |
$1,282.66
|
| Rate for Payer: First Health Commercial |
$1,468.10
|
| Rate for Payer: Humana Commercial |
$1,313.56
|
| Rate for Payer: Humana KY Medicaid |
$531.45
|
| Rate for Payer: Kentucky WC Medicaid |
$536.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,267.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,359.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,159.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.06
|
| Rate for Payer: PHCS Commercial |
$1,483.56
|
| Rate for Payer: United Healthcare All Payer |
$1,359.93
|
|
|
PLATE CMF 1.7 T 5H REG 10MM
|
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 T 5H REG 10MM
|
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 Y 5H 8MM
|
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: 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
|
| Rate for Payer: Humana Commercial |
$1,760.79
|
|
|
PLATE CMF 1.7 Y 5H 8MM
|
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 2.0 CRVD 6H
|
Facility
|
OP
|
$1,799.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.94 |
| Max. Negotiated Rate |
$1,727.56 |
| Rate for Payer: Aetna Commercial |
$1,385.65
|
| Rate for Payer: Anthem Medicaid |
$618.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.64
|
| Rate for Payer: Cash Price |
$899.77
|
| Rate for Payer: Cigna Commercial |
$1,493.62
|
| Rate for Payer: First Health Commercial |
$1,709.56
|
| Rate for Payer: Humana Commercial |
$1,529.61
|
| Rate for Payer: Humana KY Medicaid |
$618.86
|
| Rate for Payer: Kentucky WC Medicaid |
$625.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$631.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.86
|
| Rate for Payer: PHCS Commercial |
$1,727.56
|
| Rate for Payer: United Healthcare All Payer |
$1,583.60
|
|
|
PLATE CMF 2.0 CRVD 6H
|
Facility
|
IP
|
$1,799.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.94 |
| Max. Negotiated Rate |
$1,727.56 |
| Rate for Payer: Aetna Commercial |
$1,385.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,403.64
|
| Rate for Payer: Cash Price |
$899.77
|
| Rate for Payer: Cigna Commercial |
$1,493.62
|
| Rate for Payer: First Health Commercial |
$1,709.56
|
| Rate for Payer: Humana Commercial |
$1,529.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,475.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,328.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,583.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,349.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.86
|
| Rate for Payer: PHCS Commercial |
$1,727.56
|
| Rate for Payer: United Healthcare All Payer |
$1,583.60
|
|
|
PLATE CMF 2.0 DBL Y REG
|
Facility
|
OP
|
$3,359.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$436.70 |
| Max. Negotiated Rate |
$3,224.83 |
| Rate for Payer: Aetna Commercial |
$2,586.58
|
| Rate for Payer: Anthem Medicaid |
$1,155.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.18
|
| Rate for Payer: Cash Price |
$1,679.60
|
| Rate for Payer: Cigna Commercial |
$2,788.14
|
| Rate for Payer: First Health Commercial |
$3,191.24
|
| Rate for Payer: Humana Commercial |
$2,855.32
|
| Rate for Payer: Humana KY Medicaid |
$1,155.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,166.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,754.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,178.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.35
|
| Rate for Payer: PHCS Commercial |
$3,224.83
|
| Rate for Payer: United Healthcare All Payer |
$2,956.10
|
|
|
PLATE CMF 2.0 DBL Y REG
|
Facility
|
IP
|
$3,359.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$436.70 |
| Max. Negotiated Rate |
$3,224.83 |
| Rate for Payer: Aetna Commercial |
$2,586.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,620.18
|
| Rate for Payer: Cash Price |
$1,679.60
|
| Rate for Payer: Cigna Commercial |
$2,788.14
|
| Rate for Payer: First Health Commercial |
$3,191.24
|
| Rate for Payer: Humana Commercial |
$2,855.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,754.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,479.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,007.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,956.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,519.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$671.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$436.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,041.35
|
| Rate for Payer: PHCS Commercial |
$3,224.83
|
| Rate for Payer: United Healthcare All Payer |
$2,956.10
|
|
|
PLATE CMF 2.0 L 5H LT
|
Facility
|
IP
|
$1,876.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.97 |
| Max. Negotiated Rate |
$1,801.61 |
| Rate for Payer: Aetna Commercial |
$1,445.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.81
|
| Rate for Payer: Cash Price |
$938.34
|
| Rate for Payer: Cigna Commercial |
$1,557.64
|
| Rate for Payer: First Health Commercial |
$1,782.85
|
| Rate for Payer: Humana Commercial |
$1,595.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.77
|
| Rate for Payer: PHCS Commercial |
$1,801.61
|
| Rate for Payer: United Healthcare All Payer |
$1,651.48
|
|
|
PLATE CMF 2.0 L 5H LT
|
Facility
|
OP
|
$1,876.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.97 |
| Max. Negotiated Rate |
$1,801.61 |
| Rate for Payer: Aetna Commercial |
$1,445.04
|
| Rate for Payer: Anthem Medicaid |
$645.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,463.81
|
| Rate for Payer: Cash Price |
$938.34
|
| Rate for Payer: Cigna Commercial |
$1,557.64
|
| Rate for Payer: First Health Commercial |
$1,782.85
|
| Rate for Payer: Humana Commercial |
$1,595.18
|
| Rate for Payer: Humana KY Medicaid |
$645.39
|
| Rate for Payer: Kentucky WC Medicaid |
$651.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,538.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,384.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,651.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,407.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.77
|
| Rate for Payer: PHCS Commercial |
$1,801.61
|
| Rate for Payer: United Healthcare All Payer |
$1,651.48
|
|
|
PLATE CMF 2.0 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: 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
|
| 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
|
|
