|
PLATE COMP 3.5*145 10H
|
Facility
|
IP
|
$1,945.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.94 |
| Max. Negotiated Rate |
$1,867.87 |
| Rate for Payer: Aetna Commercial |
$1,498.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.65
|
| Rate for Payer: Cash Price |
$972.85
|
| Rate for Payer: Cigna Commercial |
$1,614.93
|
| Rate for Payer: First Health Commercial |
$1,848.42
|
| Rate for Payer: Humana Commercial |
$1,653.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.17
|
| Rate for Payer: PHCS Commercial |
$1,867.87
|
| Rate for Payer: United Healthcare All Payer |
$1,712.22
|
|
|
PLATE COMP 3.5*145 10H
|
Facility
|
OP
|
$1,945.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.94 |
| Max. Negotiated Rate |
$1,867.87 |
| Rate for Payer: Aetna Commercial |
$1,498.19
|
| Rate for Payer: Anthem Medicaid |
$669.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.65
|
| Rate for Payer: Cash Price |
$972.85
|
| Rate for Payer: Cigna Commercial |
$1,614.93
|
| Rate for Payer: First Health Commercial |
$1,848.42
|
| Rate for Payer: Humana Commercial |
$1,653.84
|
| Rate for Payer: Humana KY Medicaid |
$669.13
|
| Rate for Payer: Kentucky WC Medicaid |
$675.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.17
|
| Rate for Payer: PHCS Commercial |
$1,867.87
|
| Rate for Payer: United Healthcare All Payer |
$1,712.22
|
|
|
PLATE COMP 3.5*158 11H
|
Facility
|
OP
|
$1,971.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.31 |
| Max. Negotiated Rate |
$1,892.74 |
| Rate for Payer: Aetna Commercial |
$1,518.13
|
| Rate for Payer: Anthem Medicaid |
$678.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,537.85
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna Commercial |
$1,636.43
|
| Rate for Payer: First Health Commercial |
$1,873.02
|
| Rate for Payer: Humana Commercial |
$1,675.86
|
| Rate for Payer: Humana KY Medicaid |
$678.03
|
| Rate for Payer: Kentucky WC Medicaid |
$684.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.20
|
| Rate for Payer: PHCS Commercial |
$1,892.74
|
| Rate for Payer: United Healthcare All Payer |
$1,735.01
|
|
|
PLATE COMP 3.5*158 11H
|
Facility
|
IP
|
$1,971.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.31 |
| Max. Negotiated Rate |
$1,892.74 |
| Rate for Payer: Aetna Commercial |
$1,518.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,537.85
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna Commercial |
$1,636.43
|
| Rate for Payer: First Health Commercial |
$1,873.02
|
| Rate for Payer: Humana Commercial |
$1,675.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.20
|
| Rate for Payer: PHCS Commercial |
$1,892.74
|
| Rate for Payer: United Healthcare All Payer |
$1,735.01
|
|
|
PLATE COMP 3.5*171 12H
|
Facility
|
OP
|
$1,971.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.31 |
| Max. Negotiated Rate |
$1,892.74 |
| Rate for Payer: Aetna Commercial |
$1,518.13
|
| Rate for Payer: Anthem Medicaid |
$678.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,537.85
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna Commercial |
$1,636.43
|
| Rate for Payer: First Health Commercial |
$1,873.02
|
| Rate for Payer: Humana Commercial |
$1,675.86
|
| Rate for Payer: Humana KY Medicaid |
$678.03
|
| Rate for Payer: Kentucky WC Medicaid |
$684.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.20
|
| Rate for Payer: PHCS Commercial |
$1,892.74
|
| Rate for Payer: United Healthcare All Payer |
$1,735.01
|
|
|
PLATE COMP 3.5*171 12H
|
Facility
|
IP
|
$1,971.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.31 |
| Max. Negotiated Rate |
$1,892.74 |
| Rate for Payer: Aetna Commercial |
$1,518.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,537.85
|
| Rate for Payer: Cash Price |
$985.80
|
| Rate for Payer: Cigna Commercial |
$1,636.43
|
| Rate for Payer: First Health Commercial |
$1,873.02
|
| Rate for Payer: Humana Commercial |
$1,675.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.01
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$611.20
|
| Rate for Payer: PHCS Commercial |
$1,892.74
|
| Rate for Payer: United Healthcare All Payer |
$1,735.01
|
|
|
PLATE COMP 3.5*197 14H
|
Facility
|
OP
|
$3,462.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.14 |
| Max. Negotiated Rate |
$3,324.12 |
| Rate for Payer: Anthem Medicaid |
$1,190.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.84
|
| Rate for Payer: Cash Price |
$1,731.31
|
| Rate for Payer: Cigna Commercial |
$2,873.97
|
| Rate for Payer: First Health Commercial |
$3,289.49
|
| Rate for Payer: Humana Commercial |
$2,943.23
|
| Rate for Payer: Humana KY Medicaid |
$1,190.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.35
|
| Rate for Payer: Aetna Commercial |
$2,666.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,214.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.41
|
| Rate for Payer: PHCS Commercial |
$3,324.12
|
| Rate for Payer: United Healthcare All Payer |
$3,047.11
|
|
|
PLATE COMP 3.5*197 14H
|
Facility
|
IP
|
$3,462.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$450.14 |
| Max. Negotiated Rate |
$3,324.12 |
| Rate for Payer: Aetna Commercial |
$2,666.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,700.84
|
| Rate for Payer: Cash Price |
$1,731.31
|
| Rate for Payer: Cigna Commercial |
$2,873.97
|
| Rate for Payer: First Health Commercial |
$3,289.49
|
| Rate for Payer: Humana Commercial |
$2,943.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,839.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,555.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,047.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,596.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$692.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$450.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.41
|
| Rate for Payer: PHCS Commercial |
$3,324.12
|
| Rate for Payer: United Healthcare All Payer |
$3,047.11
|
|
|
PLATE COMP 3.5*223 16H
|
Facility
|
OP
|
$3,652.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.78 |
| Max. Negotiated Rate |
$3,506.06 |
| Rate for Payer: Aetna Commercial |
$2,812.16
|
| Rate for Payer: Anthem Medicaid |
$1,255.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.68
|
| Rate for Payer: Cash Price |
$1,826.08
|
| Rate for Payer: Cigna Commercial |
$3,031.28
|
| Rate for Payer: First Health Commercial |
$3,469.54
|
| Rate for Payer: Humana Commercial |
$3,104.33
|
| Rate for Payer: Humana KY Medicaid |
$1,255.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.17
|
| Rate for Payer: PHCS Commercial |
$3,506.06
|
| Rate for Payer: United Healthcare All Payer |
$3,213.89
|
|
|
PLATE COMP 3.5*223 16H
|
Facility
|
IP
|
$3,652.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.78 |
| Max. Negotiated Rate |
$3,506.06 |
| Rate for Payer: Aetna Commercial |
$2,812.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,848.68
|
| Rate for Payer: Cash Price |
$1,826.08
|
| Rate for Payer: Cigna Commercial |
$3,031.28
|
| Rate for Payer: First Health Commercial |
$3,469.54
|
| Rate for Payer: Humana Commercial |
$3,104.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,994.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,213.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,132.17
|
| Rate for Payer: PHCS Commercial |
$3,506.06
|
| Rate for Payer: United Healthcare All Payer |
$3,213.89
|
|
|
PLATE COMP 3.5*249 18H
|
Facility
|
OP
|
$3,799.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.91 |
| Max. Negotiated Rate |
$3,647.35 |
| Rate for Payer: Aetna Commercial |
$2,925.48
|
| Rate for Payer: Anthem Medicaid |
$1,306.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,963.47
|
| Rate for Payer: Cash Price |
$1,899.66
|
| Rate for Payer: Cigna Commercial |
$3,153.44
|
| Rate for Payer: First Health Commercial |
$3,609.35
|
| Rate for Payer: Humana Commercial |
$3,229.42
|
| Rate for Payer: Humana KY Medicaid |
$1,306.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,319.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,115.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,803.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,332.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,343.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,849.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$759.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.79
|
| Rate for Payer: PHCS Commercial |
$3,647.35
|
| Rate for Payer: United Healthcare All Payer |
$3,343.40
|
|
|
PLATE COMP 3.5*249 18H
|
Facility
|
IP
|
$3,799.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$493.91 |
| Max. Negotiated Rate |
$3,647.35 |
| Rate for Payer: Aetna Commercial |
$2,925.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,963.47
|
| Rate for Payer: Cash Price |
$1,899.66
|
| Rate for Payer: Cigna Commercial |
$3,153.44
|
| Rate for Payer: First Health Commercial |
$3,609.35
|
| Rate for Payer: Humana Commercial |
$3,229.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,115.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,803.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,343.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,849.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$759.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$493.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,177.79
|
| Rate for Payer: PHCS Commercial |
$3,647.35
|
| Rate for Payer: United Healthcare All Payer |
$3,343.40
|
|
|
PLATE COMP 3.5*275 20H
|
Facility
|
IP
|
$3,980.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.48 |
| Max. Negotiated Rate |
$3,821.40 |
| Rate for Payer: Aetna Commercial |
$3,065.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,104.88
|
| Rate for Payer: Cash Price |
$1,990.31
|
| Rate for Payer: Cigna Commercial |
$3,303.91
|
| Rate for Payer: First Health Commercial |
$3,781.59
|
| Rate for Payer: Humana Commercial |
$3,383.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,937.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,502.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,985.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.99
|
| Rate for Payer: PHCS Commercial |
$3,821.40
|
| Rate for Payer: United Healthcare All Payer |
$3,502.95
|
|
|
PLATE COMP 3.5*275 20H
|
Facility
|
OP
|
$3,980.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.48 |
| Max. Negotiated Rate |
$3,821.40 |
| Rate for Payer: Aetna Commercial |
$3,065.08
|
| Rate for Payer: Anthem Medicaid |
$1,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,104.88
|
| Rate for Payer: Cash Price |
$1,990.31
|
| Rate for Payer: Cigna Commercial |
$3,303.91
|
| Rate for Payer: First Health Commercial |
$3,781.59
|
| Rate for Payer: Humana Commercial |
$3,383.53
|
| Rate for Payer: Humana KY Medicaid |
$1,368.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,382.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,937.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,502.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,985.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.99
|
| Rate for Payer: PHCS Commercial |
$3,821.40
|
| Rate for Payer: United Healthcare All Payer |
$3,502.95
|
|
|
PLATE COMP 3.5*41 2H
|
Facility
|
IP
|
$1,783.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.90 |
| Max. Negotiated Rate |
$1,712.48 |
| Rate for Payer: Aetna Commercial |
$1,373.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.39
|
| Rate for Payer: Cash Price |
$891.91
|
| Rate for Payer: Cigna Commercial |
$1,480.58
|
| Rate for Payer: First Health Commercial |
$1,694.64
|
| Rate for Payer: Humana Commercial |
$1,516.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.99
|
| Rate for Payer: PHCS Commercial |
$1,712.48
|
| Rate for Payer: United Healthcare All Payer |
$1,569.77
|
|
|
PLATE COMP 3.5*41 2H
|
Facility
|
OP
|
$1,783.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.90 |
| Max. Negotiated Rate |
$1,712.48 |
| Rate for Payer: Aetna Commercial |
$1,373.55
|
| Rate for Payer: Anthem Medicaid |
$613.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,391.39
|
| Rate for Payer: Cash Price |
$891.91
|
| Rate for Payer: Cigna Commercial |
$1,480.58
|
| Rate for Payer: First Health Commercial |
$1,694.64
|
| Rate for Payer: Humana Commercial |
$1,516.26
|
| Rate for Payer: Humana KY Medicaid |
$613.46
|
| Rate for Payer: Kentucky WC Medicaid |
$619.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,316.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$356.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$231.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$552.99
|
| Rate for Payer: PHCS Commercial |
$1,712.48
|
| Rate for Payer: United Healthcare All Payer |
$1,569.77
|
|
|
PLATE COMP 3.5*54 3H
|
Facility
|
IP
|
$1,796.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.58 |
| Max. Negotiated Rate |
$1,724.91 |
| Rate for Payer: Aetna Commercial |
$1,383.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,401.49
|
| Rate for Payer: Cash Price |
$898.39
|
| Rate for Payer: Cigna Commercial |
$1,491.33
|
| Rate for Payer: First Health Commercial |
$1,706.94
|
| Rate for Payer: Humana Commercial |
$1,527.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,473.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,581.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,347.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.00
|
| Rate for Payer: PHCS Commercial |
$1,724.91
|
| Rate for Payer: United Healthcare All Payer |
$1,581.17
|
|
|
PLATE COMP 3.5*54 3H
|
Facility
|
OP
|
$1,796.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.58 |
| Max. Negotiated Rate |
$1,724.91 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,473.36
|
| Rate for Payer: Anthem Medicaid |
$617.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,401.49
|
| Rate for Payer: Cash Price |
$898.39
|
| Rate for Payer: Cigna Commercial |
$1,491.33
|
| Rate for Payer: First Health Commercial |
$1,706.94
|
| Rate for Payer: Humana Commercial |
$1,527.26
|
| Rate for Payer: Humana KY Medicaid |
$617.91
|
| Rate for Payer: Kentucky WC Medicaid |
$624.20
|
| Rate for Payer: Aetna Commercial |
$1,383.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,581.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,347.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.00
|
| Rate for Payer: PHCS Commercial |
$1,724.91
|
| Rate for Payer: United Healthcare All Payer |
$1,581.17
|
|
|
PLATE COMP 3.5*67 4H
|
Facility
|
IP
|
$1,816.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.11 |
| Max. Negotiated Rate |
$1,743.55 |
| Rate for Payer: Aetna Commercial |
$1,398.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.64
|
| Rate for Payer: Cash Price |
$908.10
|
| Rate for Payer: Cigna Commercial |
$1,507.45
|
| Rate for Payer: First Health Commercial |
$1,725.39
|
| Rate for Payer: Humana Commercial |
$1,543.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.02
|
| Rate for Payer: PHCS Commercial |
$1,743.55
|
| Rate for Payer: United Healthcare All Payer |
$1,598.26
|
|
|
PLATE COMP 3.5*67 4H
|
Facility
|
OP
|
$1,816.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.11 |
| Max. Negotiated Rate |
$1,743.55 |
| Rate for Payer: Aetna Commercial |
$1,398.47
|
| Rate for Payer: Anthem Medicaid |
$624.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.64
|
| Rate for Payer: Cash Price |
$908.10
|
| Rate for Payer: Cigna Commercial |
$1,507.45
|
| Rate for Payer: First Health Commercial |
$1,725.39
|
| Rate for Payer: Humana Commercial |
$1,543.77
|
| Rate for Payer: Humana KY Medicaid |
$624.59
|
| Rate for Payer: Kentucky WC Medicaid |
$630.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.02
|
| Rate for Payer: PHCS Commercial |
$1,743.55
|
| Rate for Payer: United Healthcare All Payer |
$1,598.26
|
|
|
PLATE COMP 3.5*80 5H
|
Facility
|
OP
|
$1,855.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.16 |
| Max. Negotiated Rate |
$1,780.85 |
| Rate for Payer: Aetna Commercial |
$1,428.39
|
| Rate for Payer: Anthem Medicaid |
$637.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.94
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Cigna Commercial |
$1,539.69
|
| Rate for Payer: First Health Commercial |
$1,762.30
|
| Rate for Payer: Humana Commercial |
$1,576.79
|
| Rate for Payer: Humana KY Medicaid |
$637.95
|
| Rate for Payer: Kentucky WC Medicaid |
$644.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,369.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.07
|
| Rate for Payer: PHCS Commercial |
$1,780.85
|
| Rate for Payer: United Healthcare All Payer |
$1,632.44
|
|
|
PLATE COMP 3.5*80 5H
|
Facility
|
IP
|
$1,855.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.16 |
| Max. Negotiated Rate |
$1,780.85 |
| Rate for Payer: Aetna Commercial |
$1,428.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,446.94
|
| Rate for Payer: Cash Price |
$927.52
|
| Rate for Payer: Cigna Commercial |
$1,539.69
|
| Rate for Payer: First Health Commercial |
$1,762.30
|
| Rate for Payer: Humana Commercial |
$1,576.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,521.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,369.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$556.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,632.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,391.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.07
|
| Rate for Payer: PHCS Commercial |
$1,780.85
|
| Rate for Payer: United Healthcare All Payer |
$1,632.44
|
|
|
PLATE COMP 3.5*93 6H
|
Facility
|
OP
|
$1,874.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.68 |
| Max. Negotiated Rate |
$1,799.49 |
| Rate for Payer: Aetna Commercial |
$1,443.34
|
| Rate for Payer: Anthem Medicaid |
$644.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.09
|
| Rate for Payer: Cash Price |
$937.24
|
| Rate for Payer: Cigna Commercial |
$1,555.81
|
| Rate for Payer: First Health Commercial |
$1,780.75
|
| Rate for Payer: Humana Commercial |
$1,593.30
|
| Rate for Payer: Humana KY Medicaid |
$644.63
|
| Rate for Payer: Kentucky WC Medicaid |
$651.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$657.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.09
|
| Rate for Payer: PHCS Commercial |
$1,799.49
|
| Rate for Payer: United Healthcare All Payer |
$1,649.53
|
|
|
PLATE COMP 3.5*93 6H
|
Facility
|
IP
|
$1,874.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$243.68 |
| Max. Negotiated Rate |
$1,799.49 |
| Rate for Payer: Aetna Commercial |
$1,443.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,462.09
|
| Rate for Payer: Cash Price |
$937.24
|
| Rate for Payer: Cigna Commercial |
$1,555.81
|
| Rate for Payer: First Health Commercial |
$1,780.75
|
| Rate for Payer: Humana Commercial |
$1,593.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,537.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,383.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$562.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,649.53
|
| Rate for Payer: Ohio Health Group HMO |
$1,405.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$374.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$243.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$581.09
|
| Rate for Payer: PHCS Commercial |
$1,799.49
|
| Rate for Payer: United Healthcare All Payer |
$1,649.53
|
|
|
PLATE COMP 3.5MM 10H 145MM
|
Facility
|
OP
|
$1,945.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.94 |
| Max. Negotiated Rate |
$1,867.87 |
| Rate for Payer: Aetna Commercial |
$1,498.19
|
| Rate for Payer: Anthem Medicaid |
$669.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.65
|
| Rate for Payer: Cash Price |
$972.85
|
| Rate for Payer: Cigna Commercial |
$1,614.93
|
| Rate for Payer: First Health Commercial |
$1,848.42
|
| Rate for Payer: Humana Commercial |
$1,653.84
|
| Rate for Payer: Humana KY Medicaid |
$669.13
|
| Rate for Payer: Kentucky WC Medicaid |
$675.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,435.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$389.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$603.17
|
| Rate for Payer: PHCS Commercial |
$1,867.87
|
| Rate for Payer: United Healthcare All Payer |
$1,712.22
|
|
