|
PLATE CLASSIC 2 SLOT 140^
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
PLATE CLASSIC 2 SLOT 140^
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem Medicaid |
$1,280.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Humana KY Medicaid |
$1,280.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,293.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
PLATE CLASSIC 2 SLOT 145^
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem Medicaid |
$1,280.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Humana KY Medicaid |
$1,280.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,293.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
PLATE CLASSIC 2 SLOT 145^
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
PLATE CLASSIC 2 SLOT 150^
|
Facility
|
IP
|
$3,722.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
PLATE CLASSIC 2 SLOT 150^
|
Facility
|
OP
|
$3,722.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.60 |
| Max. Negotiated Rate |
$3,573.12 |
| Rate for Payer: Aetna Commercial |
$2,865.94
|
| Rate for Payer: Anthem Medicaid |
$1,280.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,903.16
|
| Rate for Payer: Cash Price |
$1,861.00
|
| Rate for Payer: Cigna Commercial |
$3,089.26
|
| Rate for Payer: First Health Commercial |
$3,535.90
|
| Rate for Payer: Humana Commercial |
$3,163.70
|
| Rate for Payer: Humana KY Medicaid |
$1,280.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,293.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,052.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,238.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,568.18
|
| Rate for Payer: PHCS Commercial |
$3,573.12
|
| Rate for Payer: United Healthcare All Payer |
$3,275.36
|
|
|
PLATE CLASSIC 4 SLOT 130^ 100
|
Facility
|
OP
|
$3,898.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.64 |
| Max. Negotiated Rate |
$3,742.86 |
| Rate for Payer: Aetna Commercial |
$3,002.08
|
| Rate for Payer: Anthem Medicaid |
$1,340.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,041.07
|
| Rate for Payer: Cash Price |
$1,949.41
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: First Health Commercial |
$3,703.87
|
| Rate for Payer: Humana Commercial |
$3,313.99
|
| Rate for Payer: Humana KY Medicaid |
$1,340.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,197.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,877.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,367.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,430.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,924.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,119.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,391.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,690.18
|
| Rate for Payer: PHCS Commercial |
$3,742.86
|
| Rate for Payer: United Healthcare All Payer |
$3,430.95
|
|
|
PLATE CLASSIC 4 SLOT 130^ 100
|
Facility
|
IP
|
$3,898.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.64 |
| Max. Negotiated Rate |
$3,742.86 |
| Rate for Payer: Aetna Commercial |
$3,002.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,041.07
|
| Rate for Payer: Cash Price |
$1,949.41
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: First Health Commercial |
$3,703.87
|
| Rate for Payer: Humana Commercial |
$3,313.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,197.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,877.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,430.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,924.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,119.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,391.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,690.18
|
| Rate for Payer: PHCS Commercial |
$3,742.86
|
| Rate for Payer: United Healthcare All Payer |
$3,430.95
|
|
|
PLATE CLASSIC 5 SLOT 140^ 120
|
Facility
|
OP
|
$3,898.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.64 |
| Max. Negotiated Rate |
$3,742.86 |
| Rate for Payer: Aetna Commercial |
$3,002.08
|
| Rate for Payer: Anthem Medicaid |
$1,340.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,041.07
|
| Rate for Payer: Cash Price |
$1,949.41
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: First Health Commercial |
$3,703.87
|
| Rate for Payer: Humana Commercial |
$3,313.99
|
| Rate for Payer: Humana KY Medicaid |
$1,340.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,354.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,197.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,877.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,367.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,430.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,924.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,119.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,391.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,690.18
|
| Rate for Payer: PHCS Commercial |
$3,742.86
|
| Rate for Payer: United Healthcare All Payer |
$3,430.95
|
|
|
PLATE CLASSIC 5 SLOT 140^ 120
|
Facility
|
IP
|
$3,898.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,169.64 |
| Max. Negotiated Rate |
$3,742.86 |
| Rate for Payer: Aetna Commercial |
$3,002.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,041.07
|
| Rate for Payer: Cash Price |
$1,949.41
|
| Rate for Payer: Cigna Commercial |
$3,236.01
|
| Rate for Payer: First Health Commercial |
$3,703.87
|
| Rate for Payer: Humana Commercial |
$3,313.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,197.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,877.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,169.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,430.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,924.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,119.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,391.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,690.18
|
| Rate for Payer: PHCS Commercial |
$3,742.86
|
| Rate for Payer: United Healthcare All Payer |
$3,430.95
|
|
|
PLATE CLASSIC 6 SLOT 90^
|
Facility
|
OP
|
$4,536.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.06 |
| Max. Negotiated Rate |
$4,355.40 |
| Rate for Payer: Aetna Commercial |
$3,493.40
|
| Rate for Payer: Anthem Medicaid |
$1,560.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,538.77
|
| Rate for Payer: Cash Price |
$2,268.44
|
| Rate for Payer: Cigna Commercial |
$3,765.61
|
| Rate for Payer: First Health Commercial |
$4,310.04
|
| Rate for Payer: Humana Commercial |
$3,856.35
|
| Rate for Payer: Humana KY Medicaid |
$1,560.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,576.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,720.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,348.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,361.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,591.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,992.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,402.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,629.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,947.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,130.45
|
| Rate for Payer: PHCS Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Payer |
$3,992.45
|
|
|
PLATE CLASSIC 6 SLOT 90^
|
Facility
|
IP
|
$4,536.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.06 |
| Max. Negotiated Rate |
$4,355.40 |
| Rate for Payer: Aetna Commercial |
$3,493.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,538.77
|
| Rate for Payer: Cash Price |
$2,268.44
|
| Rate for Payer: Cigna Commercial |
$3,765.61
|
| Rate for Payer: First Health Commercial |
$4,310.04
|
| Rate for Payer: Humana Commercial |
$3,856.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,720.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,348.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,361.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,992.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,402.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,629.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,947.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,130.45
|
| Rate for Payer: PHCS Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Payer |
$3,992.45
|
|
|
PLATE CLASSIC 6 SLOT 95^
|
Facility
|
IP
|
$4,536.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.06 |
| Max. Negotiated Rate |
$4,355.40 |
| Rate for Payer: Aetna Commercial |
$3,493.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,538.77
|
| Rate for Payer: Cash Price |
$2,268.44
|
| Rate for Payer: Cigna Commercial |
$3,765.61
|
| Rate for Payer: First Health Commercial |
$4,310.04
|
| Rate for Payer: Humana Commercial |
$3,856.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,720.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,348.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,361.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,992.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,402.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,629.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,947.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,130.45
|
| Rate for Payer: PHCS Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Payer |
$3,992.45
|
|
|
PLATE CLASSIC 6 SLOT 95^
|
Facility
|
OP
|
$4,536.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.06 |
| Max. Negotiated Rate |
$4,355.40 |
| Rate for Payer: Aetna Commercial |
$3,493.40
|
| Rate for Payer: Anthem Medicaid |
$1,560.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,538.77
|
| Rate for Payer: Cash Price |
$2,268.44
|
| Rate for Payer: Cigna Commercial |
$3,765.61
|
| Rate for Payer: First Health Commercial |
$4,310.04
|
| Rate for Payer: Humana Commercial |
$3,856.35
|
| Rate for Payer: Humana KY Medicaid |
$1,560.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,576.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,720.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,348.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,361.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,591.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,992.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,402.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,629.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,947.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,130.45
|
| Rate for Payer: PHCS Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Payer |
$3,992.45
|
|
|
PLATE CLASSIC 8 SLOT 130*180
|
Facility
|
IP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE CLASSIC 8 SLOT 130*180
|
Facility
|
OP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem Medicaid |
$1,517.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Humana KY Medicaid |
$1,517.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE CLASSIC 8 SLOT 145^ 180
|
Facility
|
IP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE CLASSIC 8 SLOT 145^ 180
|
Facility
|
OP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem Medicaid |
$1,517.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Humana KY Medicaid |
$1,517.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE CLASSIC 8 SLOT 150^ 180
|
Facility
|
IP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE CLASSIC 8 SLOT 150^ 180
|
Facility
|
OP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem Medicaid |
$1,517.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Humana KY Medicaid |
$1,517.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE CLASSIC 8 SLOT 95^
|
Facility
|
IP
|
$4,536.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.06 |
| Max. Negotiated Rate |
$4,355.40 |
| Rate for Payer: Aetna Commercial |
$3,493.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,538.77
|
| Rate for Payer: Cash Price |
$2,268.44
|
| Rate for Payer: Cigna Commercial |
$3,765.61
|
| Rate for Payer: First Health Commercial |
$4,310.04
|
| Rate for Payer: Humana Commercial |
$3,856.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,720.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,348.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,361.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,992.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,402.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,629.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,947.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,130.45
|
| Rate for Payer: PHCS Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Payer |
$3,992.45
|
|
|
PLATE CLASSIC 8 SLOT 95^
|
Facility
|
OP
|
$4,536.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,361.06 |
| Max. Negotiated Rate |
$4,355.40 |
| Rate for Payer: Aetna Commercial |
$3,493.40
|
| Rate for Payer: Anthem Medicaid |
$1,560.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,538.77
|
| Rate for Payer: Cash Price |
$2,268.44
|
| Rate for Payer: Cigna Commercial |
$3,765.61
|
| Rate for Payer: First Health Commercial |
$4,310.04
|
| Rate for Payer: Humana Commercial |
$3,856.35
|
| Rate for Payer: Humana KY Medicaid |
$1,560.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,576.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,720.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,348.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,361.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,591.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,992.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,402.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,629.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,947.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,130.45
|
| Rate for Payer: PHCS Commercial |
$4,355.40
|
| Rate for Payer: United Healthcare All Payer |
$3,992.45
|
|
|
PLATE CLASSIC CHS SB 4 SLOT130
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE CLASSIC CHS SB 4 SLOT130
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE CLASSIC CHS SB 4 SLOT135
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
