|
PLATE CMF 2.0 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 2.0 L 9H LT
|
Facility
|
OP
|
$1,739.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.15 |
| Max. Negotiated Rate |
$1,670.04 |
| Rate for Payer: Aetna Commercial |
$1,339.51
|
| Rate for Payer: Anthem Medicaid |
$598.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.90
|
| Rate for Payer: Cash Price |
$869.81
|
| Rate for Payer: Cigna Commercial |
$1,443.88
|
| Rate for Payer: First Health Commercial |
$1,652.64
|
| Rate for Payer: Humana Commercial |
$1,478.68
|
| Rate for Payer: Humana KY Medicaid |
$598.26
|
| Rate for Payer: Kentucky WC Medicaid |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.28
|
| Rate for Payer: PHCS Commercial |
$1,670.04
|
| Rate for Payer: United Healthcare All Payer |
$1,530.87
|
|
|
PLATE CMF 2.0 L 9H LT
|
Facility
|
IP
|
$1,739.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.15 |
| Max. Negotiated Rate |
$1,670.04 |
| Rate for Payer: Aetna Commercial |
$1,339.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.90
|
| Rate for Payer: Cash Price |
$869.81
|
| Rate for Payer: Cigna Commercial |
$1,443.88
|
| Rate for Payer: First Health Commercial |
$1,652.64
|
| Rate for Payer: Humana Commercial |
$1,478.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.28
|
| Rate for Payer: PHCS Commercial |
$1,670.04
|
| Rate for Payer: United Healthcare All Payer |
$1,530.87
|
|
|
PLATE CMF 2.0 L 9H RT
|
Facility
|
IP
|
$1,739.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.15 |
| Max. Negotiated Rate |
$1,670.04 |
| Rate for Payer: Aetna Commercial |
$1,339.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.90
|
| Rate for Payer: Cash Price |
$869.81
|
| Rate for Payer: Cigna Commercial |
$1,443.88
|
| Rate for Payer: First Health Commercial |
$1,652.64
|
| Rate for Payer: Humana Commercial |
$1,478.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.28
|
| Rate for Payer: PHCS Commercial |
$1,670.04
|
| Rate for Payer: United Healthcare All Payer |
$1,530.87
|
|
|
PLATE CMF 2.0 L 9H RT
|
Facility
|
OP
|
$1,739.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.15 |
| Max. Negotiated Rate |
$1,670.04 |
| Rate for Payer: Aetna Commercial |
$1,339.51
|
| Rate for Payer: Anthem Medicaid |
$598.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.90
|
| Rate for Payer: Cash Price |
$869.81
|
| Rate for Payer: Cigna Commercial |
$1,443.88
|
| Rate for Payer: First Health Commercial |
$1,652.64
|
| Rate for Payer: Humana Commercial |
$1,478.68
|
| Rate for Payer: Humana KY Medicaid |
$598.26
|
| Rate for Payer: Kentucky WC Medicaid |
$604.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.28
|
| Rate for Payer: PHCS Commercial |
$1,670.04
|
| Rate for Payer: United Healthcare All Payer |
$1,530.87
|
|
|
PLATE CMF 2.0 L LT LONG
|
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 L LT LONG
|
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 RT LONG
|
Facility
|
OP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem Medicaid |
$390.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Humana KY Medicaid |
$390.27
|
| Rate for Payer: Kentucky WC Medicaid |
$394.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
|
|
PLATE CMF 2.0 L RT LONG
|
Facility
|
IP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
|
|
PLATE CMF 2.0 SQ 3*2H
|
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 SQ 3*2H
|
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: 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
|
| 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
|
|
|
PLATE CMF 2.0 ST 16H REG
|
Facility
|
OP
|
$1,763.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.23 |
| Max. Negotiated Rate |
$1,692.75 |
| Rate for Payer: Aetna Commercial |
$1,357.73
|
| Rate for Payer: Anthem Medicaid |
$606.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.36
|
| Rate for Payer: Cash Price |
$881.64
|
| Rate for Payer: Cigna Commercial |
$1,463.52
|
| Rate for Payer: First Health Commercial |
$1,675.12
|
| Rate for Payer: Humana Commercial |
$1,498.79
|
| Rate for Payer: Humana KY Medicaid |
$606.39
|
| Rate for Payer: Kentucky WC Medicaid |
$612.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$618.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$546.62
|
| Rate for Payer: PHCS Commercial |
$1,692.75
|
| Rate for Payer: United Healthcare All Payer |
$1,551.69
|
|
|
PLATE CMF 2.0 ST 16H REG
|
Facility
|
IP
|
$1,763.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.23 |
| Max. Negotiated Rate |
$1,692.75 |
| Rate for Payer: Aetna Commercial |
$1,357.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,375.36
|
| Rate for Payer: Cash Price |
$881.64
|
| Rate for Payer: Cigna Commercial |
$1,463.52
|
| Rate for Payer: First Health Commercial |
$1,675.12
|
| Rate for Payer: Humana Commercial |
$1,498.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,445.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,301.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$528.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,551.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,322.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$352.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$546.62
|
| Rate for Payer: PHCS Commercial |
$1,692.75
|
| Rate for Payer: United Healthcare All Payer |
$1,551.69
|
|
|
PLATE CMF 2.0 ST 4H MED
|
Facility
|
IP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
|
|
PLATE CMF 2.0 ST 4H MED
|
Facility
|
OP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem Medicaid |
$390.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Humana KY Medicaid |
$390.27
|
| Rate for Payer: Kentucky WC Medicaid |
$394.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
|
|
PLATE CMF 2.0 ST 4H REG
|
Facility
|
IP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
|
|
PLATE CMF 2.0 ST 4H REG
|
Facility
|
OP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem Medicaid |
$390.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Humana KY Medicaid |
$390.27
|
| Rate for Payer: Kentucky WC Medicaid |
$394.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
|
|
PLATE CMF 2.0 ST 6H REG
|
Facility
|
IP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
|
|
PLATE CMF 2.0 ST 6H REG
|
Facility
|
OP
|
$1,134.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.53 |
| Max. Negotiated Rate |
$1,089.44 |
| Rate for Payer: Humana Commercial |
$964.61
|
| Rate for Payer: Humana KY Medicaid |
$390.27
|
| Rate for Payer: Kentucky WC Medicaid |
$394.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$930.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$837.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$998.65
|
| Rate for Payer: Ohio Health Group HMO |
$851.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$226.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$351.80
|
| Rate for Payer: PHCS Commercial |
$1,089.44
|
| Rate for Payer: United Healthcare All Payer |
$998.65
|
| Rate for Payer: Aetna Commercial |
$873.82
|
| Rate for Payer: Anthem Medicaid |
$390.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$885.17
|
| Rate for Payer: Cash Price |
$567.42
|
| Rate for Payer: Cigna Commercial |
$941.91
|
| Rate for Payer: First Health Commercial |
$1,078.09
|
|
|
PLATE CMF 2.0 Y 8H
|
Facility
|
IP
|
$1,710.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.38 |
| Max. Negotiated Rate |
$1,642.21 |
| Rate for Payer: Aetna Commercial |
$1,317.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.30
|
| Rate for Payer: Cash Price |
$855.32
|
| Rate for Payer: Cigna Commercial |
$1,419.83
|
| Rate for Payer: First Health Commercial |
$1,625.11
|
| Rate for Payer: Humana Commercial |
$1,454.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,402.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.30
|
| Rate for Payer: PHCS Commercial |
$1,642.21
|
| Rate for Payer: United Healthcare All Payer |
$1,505.36
|
|
|
PLATE CMF 2.0 Y 8H
|
Facility
|
OP
|
$1,710.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.38 |
| Max. Negotiated Rate |
$1,642.21 |
| Rate for Payer: Aetna Commercial |
$1,317.19
|
| Rate for Payer: Anthem Medicaid |
$588.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,334.30
|
| Rate for Payer: Cash Price |
$855.32
|
| Rate for Payer: Cigna Commercial |
$1,419.83
|
| Rate for Payer: First Health Commercial |
$1,625.11
|
| Rate for Payer: Humana Commercial |
$1,454.04
|
| Rate for Payer: Humana KY Medicaid |
$588.29
|
| Rate for Payer: Kentucky WC Medicaid |
$594.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,402.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,262.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$600.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,505.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$530.30
|
| Rate for Payer: PHCS Commercial |
$1,642.21
|
| Rate for Payer: United Healthcare All Payer |
$1,505.36
|
|
|
PLATE CMF 2.3 ANGLE 6H
|
Facility
|
IP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.3 ANGLE 6H
|
Facility
|
OP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem Medicaid |
$1,102.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Humana KY Medicaid |
$1,102.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,124.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.3 C 4H
|
Facility
|
IP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
|
PLATE CMF 2.3 C 4H
|
Facility
|
OP
|
$3,204.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$416.60 |
| Max. Negotiated Rate |
$3,076.45 |
| Rate for Payer: Aetna Commercial |
$2,467.57
|
| Rate for Payer: Anthem Medicaid |
$1,102.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,499.62
|
| Rate for Payer: Cash Price |
$1,602.32
|
| Rate for Payer: Cigna Commercial |
$2,659.85
|
| Rate for Payer: First Health Commercial |
$3,044.41
|
| Rate for Payer: Humana Commercial |
$2,723.94
|
| Rate for Payer: Humana KY Medicaid |
$1,102.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,113.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,627.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,365.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$961.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,124.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,820.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,403.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$640.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$416.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$993.44
|
| Rate for Payer: PHCS Commercial |
$3,076.45
|
| Rate for Payer: United Healthcare All Payer |
$2,820.08
|
|
