|
PLATE COMP 3.5MM 10H 145MM
|
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 3.5MM 3 54MM
|
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 3.5MM 3 54MM
|
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: 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: Medical Mutual Of Ohio HMO |
$1,473.36
|
| 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 3.5MM 4 67MM
|
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 3.5MM 4 67MM
|
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 3.5MM 5 80MM
|
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 3.5MM 5 80MM
|
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 3.5MM 6 93MM
|
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 3.5MM 6 93MM
|
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 7 106MM
|
Facility
|
IP
|
$1,900.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.05 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,463.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.30
|
| Rate for Payer: Cash Price |
$950.19
|
| Rate for Payer: Cigna Commercial |
$1,577.32
|
| Rate for Payer: First Health Commercial |
$1,805.36
|
| Rate for Payer: Humana Commercial |
$1,615.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.12
|
| Rate for Payer: PHCS Commercial |
$1,824.36
|
| Rate for Payer: United Healthcare All Payer |
$1,672.33
|
|
|
PLATE COMP 3.5MM 7 106MM
|
Facility
|
OP
|
$1,900.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.05 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,463.29
|
| Rate for Payer: Anthem Medicaid |
$653.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,482.30
|
| Rate for Payer: Cash Price |
$950.19
|
| Rate for Payer: Cigna Commercial |
$1,577.32
|
| Rate for Payer: First Health Commercial |
$1,805.36
|
| Rate for Payer: Humana Commercial |
$1,615.32
|
| Rate for Payer: Humana KY Medicaid |
$653.54
|
| Rate for Payer: Kentucky WC Medicaid |
$660.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,558.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,402.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$570.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$666.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,672.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,425.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$380.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$247.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$589.12
|
| Rate for Payer: PHCS Commercial |
$1,824.36
|
| Rate for Payer: United Healthcare All Payer |
$1,672.33
|
|
|
PLATE COMP 3.5MM 8 119MM
|
Facility
|
OP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Anthem Medicaid |
$662.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Humana KY Medicaid |
$662.45
|
| Rate for Payer: Kentucky WC Medicaid |
$669.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE COMP 3.5MM 8 119MM
|
Facility
|
IP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE COMP 3.5MM 9 132MM
|
Facility
|
IP
|
$1,932.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$1,855.44 |
| Rate for Payer: Aetna Commercial |
$1,488.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.54
|
| Rate for Payer: Cash Price |
$966.38
|
| Rate for Payer: Cigna Commercial |
$1,604.18
|
| Rate for Payer: First Health Commercial |
$1,836.11
|
| Rate for Payer: Humana Commercial |
$1,642.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.15
|
| Rate for Payer: PHCS Commercial |
$1,855.44
|
| Rate for Payer: United Healthcare All Payer |
$1,700.82
|
|
|
PLATE COMP 3.5MM 9 132MM
|
Facility
|
OP
|
$1,932.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.26 |
| Max. Negotiated Rate |
$1,855.44 |
| Rate for Payer: Aetna Commercial |
$1,488.22
|
| Rate for Payer: Anthem Medicaid |
$664.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,507.54
|
| Rate for Payer: Cash Price |
$966.38
|
| Rate for Payer: Cigna Commercial |
$1,604.18
|
| Rate for Payer: First Health Commercial |
$1,836.11
|
| Rate for Payer: Humana Commercial |
$1,642.84
|
| Rate for Payer: Humana KY Medicaid |
$664.67
|
| Rate for Payer: Kentucky WC Medicaid |
$671.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,584.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,426.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$678.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,700.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,449.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$599.15
|
| Rate for Payer: PHCS Commercial |
$1,855.44
|
| Rate for Payer: United Healthcare All Payer |
$1,700.82
|
|
|
PLATE COMP 3H 3.5*54 71829403
|
Facility
|
OP
|
$1,791.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.83 |
| Max. Negotiated Rate |
$1,719.36 |
| Rate for Payer: Aetna Commercial |
$1,379.07
|
| Rate for Payer: Anthem Medicaid |
$615.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.98
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna Commercial |
$1,486.53
|
| Rate for Payer: First Health Commercial |
$1,701.45
|
| Rate for Payer: Humana Commercial |
$1,522.35
|
| Rate for Payer: Humana KY Medicaid |
$615.92
|
| Rate for Payer: Kentucky WC Medicaid |
$622.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,468.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$628.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,576.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,343.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.21
|
| Rate for Payer: PHCS Commercial |
$1,719.36
|
| Rate for Payer: United Healthcare All Payer |
$1,576.08
|
|
|
PLATE COMP 3H 3.5*54 71829403
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$232.83 |
| Max. Negotiated Rate |
$1,719.36 |
| Rate for Payer: Aetna Commercial |
$1,379.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,396.98
|
| Rate for Payer: Cash Price |
$895.50
|
| Rate for Payer: Cigna Commercial |
$1,486.53
|
| Rate for Payer: First Health Commercial |
$1,701.45
|
| Rate for Payer: Humana Commercial |
$1,522.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,468.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,321.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$537.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,576.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,343.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$232.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$555.21
|
| Rate for Payer: PHCS Commercial |
$1,719.36
|
| Rate for Payer: United Healthcare All Payer |
$1,576.08
|
|
|
PLATE COMP 4H 3.5*67 71829404
|
Facility
|
OP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem Medicaid |
$618.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Humana KY Medicaid |
$618.33
|
| Rate for Payer: Kentucky WC Medicaid |
$624.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$630.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
PLATE COMP 4H 3.5*67 71829404
|
Facility
|
IP
|
$1,798.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.74 |
| Max. Negotiated Rate |
$1,726.08 |
| Rate for Payer: Aetna Commercial |
$1,384.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,402.44
|
| Rate for Payer: Cash Price |
$899.00
|
| Rate for Payer: Cigna Commercial |
$1,492.34
|
| Rate for Payer: First Health Commercial |
$1,708.10
|
| Rate for Payer: Humana Commercial |
$1,528.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,474.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,326.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$539.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,582.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,348.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$359.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$557.38
|
| Rate for Payer: PHCS Commercial |
$1,726.08
|
| Rate for Payer: United Healthcare All Payer |
$1,582.24
|
|
|
PLATE COMP 5H 3.5*80 71829405
|
Facility
|
OP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem Medicaid |
$626.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Humana KY Medicaid |
$626.76
|
| Rate for Payer: Kentucky WC Medicaid |
$633.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
PLATE COMP 5H 3.5*80 71829405
|
Facility
|
IP
|
$1,822.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.92 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Aetna Commercial |
$1,403.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,421.55
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna Commercial |
$1,512.68
|
| Rate for Payer: First Health Commercial |
$1,731.38
|
| Rate for Payer: Humana Commercial |
$1,549.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,494.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,603.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,366.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$564.98
|
| Rate for Payer: PHCS Commercial |
$1,749.60
|
| Rate for Payer: United Healthcare All Payer |
$1,603.80
|
|
|
PLATE COMP 6H 3.5*93 71829406
|
Facility
|
OP
|
$1,861.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.93 |
| Max. Negotiated Rate |
$1,786.56 |
| Rate for Payer: Anthem Medicaid |
$640.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,451.58
|
| Rate for Payer: Cash Price |
$930.50
|
| Rate for Payer: Cigna Commercial |
$1,544.63
|
| Rate for Payer: First Health Commercial |
$1,767.95
|
| Rate for Payer: Humana Commercial |
$1,581.85
|
| Rate for Payer: Humana KY Medicaid |
$640.00
|
| Rate for Payer: Kentucky WC Medicaid |
$646.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,526.02
|
| Rate for Payer: Aetna Commercial |
$1,432.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,373.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,637.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.91
|
| Rate for Payer: PHCS Commercial |
$1,786.56
|
| Rate for Payer: United Healthcare All Payer |
$1,637.68
|
|
|
PLATE COMP 6H 3.5*93 71829406
|
Facility
|
IP
|
$1,861.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.93 |
| Max. Negotiated Rate |
$1,786.56 |
| Rate for Payer: Aetna Commercial |
$1,432.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,451.58
|
| Rate for Payer: Cash Price |
$930.50
|
| Rate for Payer: Cigna Commercial |
$1,544.63
|
| Rate for Payer: First Health Commercial |
$1,767.95
|
| Rate for Payer: Humana Commercial |
$1,581.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,526.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,373.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,637.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$372.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.91
|
| Rate for Payer: PHCS Commercial |
$1,786.56
|
| Rate for Payer: United Healthcare All Payer |
$1,637.68
|
|
|
PLATE COMP 7H 3.5*106 71829407
|
Facility
|
IP
|
$1,878.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,803.36 |
| Rate for Payer: Aetna Commercial |
$1,446.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.23
|
| Rate for Payer: Cash Price |
$939.25
|
| Rate for Payer: Cigna Commercial |
$1,559.16
|
| Rate for Payer: First Health Commercial |
$1,784.58
|
| Rate for Payer: Humana Commercial |
$1,596.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.34
|
| Rate for Payer: PHCS Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare All Payer |
$1,653.08
|
|
|
PLATE COMP 7H 3.5*106 71829407
|
Facility
|
OP
|
$1,878.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$244.20 |
| Max. Negotiated Rate |
$1,803.36 |
| Rate for Payer: Aetna Commercial |
$1,446.44
|
| Rate for Payer: Anthem Medicaid |
$646.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,465.23
|
| Rate for Payer: Cash Price |
$939.25
|
| Rate for Payer: Cigna Commercial |
$1,559.16
|
| Rate for Payer: First Health Commercial |
$1,784.58
|
| Rate for Payer: Humana Commercial |
$1,596.72
|
| Rate for Payer: Humana KY Medicaid |
$646.02
|
| Rate for Payer: Kentucky WC Medicaid |
$652.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,540.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,386.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,653.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$375.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$244.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$582.34
|
| Rate for Payer: PHCS Commercial |
$1,803.36
|
| Rate for Payer: United Healthcare All Payer |
$1,653.08
|
|
