|
PLATE BROAD 4.5*231 12H
|
Facility
|
OP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem Medicaid |
$1,043.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Humana KY Medicaid |
$1,043.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5*267 14H
|
Facility
|
IP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5*267 14H
|
Facility
|
OP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem Medicaid |
$1,043.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Humana KY Medicaid |
$1,043.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5*303 16H
|
Facility
|
IP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5*303 16H
|
Facility
|
OP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem Medicaid |
$1,043.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Humana KY Medicaid |
$1,043.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5*339 18H
|
Facility
|
OP
|
$3,352.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.84 |
| Max. Negotiated Rate |
$3,218.70 |
| Rate for Payer: Aetna Commercial |
$2,581.66
|
| Rate for Payer: Anthem Medicaid |
$1,153.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.19
|
| Rate for Payer: Cash Price |
$1,676.41
|
| Rate for Payer: Cigna Commercial |
$2,782.83
|
| Rate for Payer: First Health Commercial |
$3,185.17
|
| Rate for Payer: Humana Commercial |
$2,849.89
|
| Rate for Payer: Humana KY Medicaid |
$1,153.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,164.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,749.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,474.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,176.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,950.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,514.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,682.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,916.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.44
|
| Rate for Payer: PHCS Commercial |
$3,218.70
|
| Rate for Payer: United Healthcare All Payer |
$2,950.47
|
|
|
PLATE BROAD 4.5*339 18H
|
Facility
|
IP
|
$3,352.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.84 |
| Max. Negotiated Rate |
$3,218.70 |
| Rate for Payer: Aetna Commercial |
$2,581.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,615.19
|
| Rate for Payer: Cash Price |
$1,676.41
|
| Rate for Payer: Cigna Commercial |
$2,782.83
|
| Rate for Payer: First Health Commercial |
$3,185.17
|
| Rate for Payer: Humana Commercial |
$2,849.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,749.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,474.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,005.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,950.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,514.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,682.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,916.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,313.44
|
| Rate for Payer: PHCS Commercial |
$3,218.70
|
| Rate for Payer: United Healthcare All Payer |
$2,950.47
|
|
|
PLATE BROAD 4.5*375 20H
|
Facility
|
OP
|
$3,845.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.61 |
| Max. Negotiated Rate |
$3,691.56 |
| Rate for Payer: Aetna Commercial |
$2,960.94
|
| Rate for Payer: Anthem Medicaid |
$1,322.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,999.40
|
| Rate for Payer: Cash Price |
$1,922.69
|
| Rate for Payer: Cigna Commercial |
$3,191.67
|
| Rate for Payer: First Health Commercial |
$3,653.11
|
| Rate for Payer: Humana Commercial |
$3,268.57
|
| Rate for Payer: Humana KY Medicaid |
$1,322.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,335.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,153.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,837.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,153.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,348.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,383.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,884.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,076.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,345.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,653.31
|
| Rate for Payer: PHCS Commercial |
$3,691.56
|
| Rate for Payer: United Healthcare All Payer |
$3,383.93
|
|
|
PLATE BROAD 4.5*375 20H
|
Facility
|
IP
|
$3,845.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,153.61 |
| Max. Negotiated Rate |
$3,691.56 |
| Rate for Payer: Aetna Commercial |
$2,960.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,999.40
|
| Rate for Payer: Cash Price |
$1,922.69
|
| Rate for Payer: Cigna Commercial |
$3,191.67
|
| Rate for Payer: First Health Commercial |
$3,653.11
|
| Rate for Payer: Humana Commercial |
$3,268.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,153.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,837.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,153.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,383.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,884.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,076.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,345.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,653.31
|
| Rate for Payer: PHCS Commercial |
$3,691.56
|
| Rate for Payer: United Healthcare All Payer |
$3,383.93
|
|
|
PLATE BROAD 4.5MM 10H 195MM
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5MM 10H 195MM
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5MM 11H 213MM
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5MM 11H 213MM
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5MM 12H 231MM
|
Facility
|
OP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem Medicaid |
$1,043.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Humana KY Medicaid |
$1,043.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5MM 12H 231MM
|
Facility
|
IP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5MM 14H 267MM
|
Facility
|
OP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem Medicaid |
$1,043.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Humana KY Medicaid |
$1,043.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,053.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,064.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5MM 14H 267MM
|
Facility
|
IP
|
$3,033.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.11 |
| Max. Negotiated Rate |
$2,912.34 |
| Rate for Payer: Aetna Commercial |
$2,335.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,366.28
|
| Rate for Payer: Cash Price |
$1,516.84
|
| Rate for Payer: Cigna Commercial |
$2,517.96
|
| Rate for Payer: First Health Commercial |
$2,882.01
|
| Rate for Payer: Humana Commercial |
$2,578.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,487.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,238.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$910.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,669.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,275.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,426.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,639.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,093.25
|
| Rate for Payer: PHCS Commercial |
$2,912.34
|
| Rate for Payer: United Healthcare All Payer |
$2,669.65
|
|
|
PLATE BROAD 4.5MM 6H 123MM
|
Facility
|
OP
|
$2,080.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$1,997.12 |
| Rate for Payer: Aetna Commercial |
$1,601.85
|
| Rate for Payer: Anthem Medicaid |
$715.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,622.66
|
| Rate for Payer: Cash Price |
$1,040.16
|
| Rate for Payer: Cigna Commercial |
$1,726.67
|
| Rate for Payer: First Health Commercial |
$1,976.31
|
| Rate for Payer: Humana Commercial |
$1,768.28
|
| Rate for Payer: Humana KY Medicaid |
$715.43
|
| Rate for Payer: Kentucky WC Medicaid |
$722.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,705.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,830.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.43
|
| Rate for Payer: PHCS Commercial |
$1,997.12
|
| Rate for Payer: United Healthcare All Payer |
$1,830.69
|
|
|
PLATE BROAD 4.5MM 6H 123MM
|
Facility
|
IP
|
$2,080.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$1,997.12 |
| Rate for Payer: Aetna Commercial |
$1,601.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,622.66
|
| Rate for Payer: Cash Price |
$1,040.16
|
| Rate for Payer: Cigna Commercial |
$1,726.67
|
| Rate for Payer: First Health Commercial |
$1,976.31
|
| Rate for Payer: Humana Commercial |
$1,768.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,705.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,830.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.43
|
| Rate for Payer: PHCS Commercial |
$1,997.12
|
| Rate for Payer: United Healthcare All Payer |
$1,830.69
|
|
|
PLATE BROAD 4.5MM 7H 141MM
|
Facility
|
OP
|
$2,080.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$1,997.12 |
| Rate for Payer: Aetna Commercial |
$1,601.85
|
| Rate for Payer: Anthem Medicaid |
$715.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,622.66
|
| Rate for Payer: Cash Price |
$1,040.16
|
| Rate for Payer: Cigna Commercial |
$1,726.67
|
| Rate for Payer: First Health Commercial |
$1,976.31
|
| Rate for Payer: Humana Commercial |
$1,768.28
|
| Rate for Payer: Humana KY Medicaid |
$715.43
|
| Rate for Payer: Kentucky WC Medicaid |
$722.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,705.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,830.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.43
|
| Rate for Payer: PHCS Commercial |
$1,997.12
|
| Rate for Payer: United Healthcare All Payer |
$1,830.69
|
|
|
PLATE BROAD 4.5MM 7H 141MM
|
Facility
|
IP
|
$2,080.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.10 |
| Max. Negotiated Rate |
$1,997.12 |
| Rate for Payer: Aetna Commercial |
$1,601.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,622.66
|
| Rate for Payer: Cash Price |
$1,040.16
|
| Rate for Payer: Cigna Commercial |
$1,726.67
|
| Rate for Payer: First Health Commercial |
$1,976.31
|
| Rate for Payer: Humana Commercial |
$1,768.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,705.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,830.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,809.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.43
|
| Rate for Payer: PHCS Commercial |
$1,997.12
|
| Rate for Payer: United Healthcare All Payer |
$1,830.69
|
|
|
PLATE BROAD 4.5MM 8H 159MM
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5MM 8H 159MM
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5MM 9H 177MM
|
Facility
|
IP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
|
PLATE BROAD 4.5MM 9H 177MM
|
Facility
|
OP
|
$2,957.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.21 |
| Max. Negotiated Rate |
$2,839.08 |
| Rate for Payer: Aetna Commercial |
$2,277.18
|
| Rate for Payer: Anthem Medicaid |
$1,017.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,306.76
|
| Rate for Payer: Cash Price |
$1,478.69
|
| Rate for Payer: Cigna Commercial |
$2,454.63
|
| Rate for Payer: First Health Commercial |
$2,809.51
|
| Rate for Payer: Humana Commercial |
$2,513.77
|
| Rate for Payer: Humana KY Medicaid |
$1,017.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,027.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,425.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,182.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$887.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,037.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,602.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,218.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,365.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,572.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,040.59
|
| Rate for Payer: PHCS Commercial |
$2,839.08
|
| Rate for Payer: United Healthcare All Payer |
$2,602.49
|
|
