|
PLATE CMF 2.3 ST 14H
|
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 ST 14H
|
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 ST 4H LONG
|
Facility
|
IP
|
$3,377.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.02 |
| Max. Negotiated Rate |
$3,241.97 |
| Rate for Payer: Aetna Commercial |
$2,600.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.10
|
| Rate for Payer: Cash Price |
$1,688.53
|
| Rate for Payer: Cigna Commercial |
$2,802.95
|
| Rate for Payer: First Health Commercial |
$3,208.20
|
| Rate for Payer: Humana Commercial |
$2,870.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.89
|
| Rate for Payer: PHCS Commercial |
$3,241.97
|
| Rate for Payer: United Healthcare All Payer |
$2,971.80
|
|
|
PLATE CMF 2.3 ST 4H LONG
|
Facility
|
OP
|
$3,377.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.02 |
| Max. Negotiated Rate |
$3,241.97 |
| Rate for Payer: Aetna Commercial |
$2,600.33
|
| Rate for Payer: Anthem Medicaid |
$1,161.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.10
|
| Rate for Payer: Cash Price |
$1,688.53
|
| Rate for Payer: Cigna Commercial |
$2,802.95
|
| Rate for Payer: First Health Commercial |
$3,208.20
|
| Rate for Payer: Humana Commercial |
$2,870.49
|
| Rate for Payer: Humana KY Medicaid |
$1,161.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.89
|
| Rate for Payer: PHCS Commercial |
$3,241.97
|
| Rate for Payer: United Healthcare All Payer |
$2,971.80
|
|
|
PLATE CMF 2.3 ST 4H MED
|
Facility
|
IP
|
$3,377.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.02 |
| Max. Negotiated Rate |
$3,241.97 |
| Rate for Payer: Aetna Commercial |
$2,600.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.10
|
| Rate for Payer: Cash Price |
$1,688.53
|
| Rate for Payer: Cigna Commercial |
$2,802.95
|
| Rate for Payer: First Health Commercial |
$3,208.20
|
| Rate for Payer: Humana Commercial |
$2,870.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.89
|
| Rate for Payer: PHCS Commercial |
$3,241.97
|
| Rate for Payer: United Healthcare All Payer |
$2,971.80
|
|
|
PLATE CMF 2.3 ST 4H MED
|
Facility
|
OP
|
$3,377.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.02 |
| Max. Negotiated Rate |
$3,241.97 |
| Rate for Payer: Aetna Commercial |
$2,600.33
|
| Rate for Payer: Anthem Medicaid |
$1,161.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.10
|
| Rate for Payer: Cash Price |
$1,688.53
|
| Rate for Payer: Cigna Commercial |
$2,802.95
|
| Rate for Payer: First Health Commercial |
$3,208.20
|
| Rate for Payer: Humana Commercial |
$2,870.49
|
| Rate for Payer: Humana KY Medicaid |
$1,161.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.89
|
| Rate for Payer: PHCS Commercial |
$3,241.97
|
| Rate for Payer: United Healthcare All Payer |
$2,971.80
|
|
|
PLATE CMF 2.3 ST 4H SHORT
|
Facility
|
OP
|
$3,377.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.02 |
| Max. Negotiated Rate |
$3,241.97 |
| Rate for Payer: Aetna Commercial |
$2,600.33
|
| Rate for Payer: Anthem Medicaid |
$1,161.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.10
|
| Rate for Payer: Cash Price |
$1,688.53
|
| Rate for Payer: Cigna Commercial |
$2,802.95
|
| Rate for Payer: First Health Commercial |
$3,208.20
|
| Rate for Payer: Humana Commercial |
$2,870.49
|
| Rate for Payer: Humana KY Medicaid |
$1,161.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,173.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,184.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.89
|
| Rate for Payer: PHCS Commercial |
$3,241.97
|
| Rate for Payer: United Healthcare All Payer |
$2,971.80
|
|
|
PLATE CMF 2.3 ST 4H SHORT
|
Facility
|
IP
|
$3,377.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$439.02 |
| Max. Negotiated Rate |
$3,241.97 |
| Rate for Payer: Aetna Commercial |
$2,600.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,634.10
|
| Rate for Payer: Cash Price |
$1,688.53
|
| Rate for Payer: Cigna Commercial |
$2,802.95
|
| Rate for Payer: First Health Commercial |
$3,208.20
|
| Rate for Payer: Humana Commercial |
$2,870.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,769.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,492.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,013.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,971.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,532.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$675.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$439.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,046.89
|
| Rate for Payer: PHCS Commercial |
$3,241.97
|
| Rate for Payer: United Healthcare All Payer |
$2,971.80
|
|
|
PLATE CMF 2.3 ST 6H LONG
|
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 ST 6H LONG
|
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 ST 6H MED
|
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: 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
|
| Rate for Payer: Aetna Commercial |
$2,467.57
|
|
|
PLATE CMF 2.3 ST 6H MED
|
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 ST 6H SHORT
|
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 ST 6H SHORT
|
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 ST 8H
|
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 ST 8H
|
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 2.7 16H 120M
|
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 2.7 16H 120M
|
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 2.7 4H 35MM
|
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 2.7 4H 35MM
|
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 2.7 6H 40MM
|
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 2.7 6H 40MM
|
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 2.7 6H 50MM
|
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 2.7 6H 50MM
|
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 2.7 8H 60MM
|
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
|
|
