|
PLATE CLASSIC CHS SB 4 SLOT135
|
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 SLOT140
|
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 SLOT140
|
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 SLOT145
|
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 SLOT145
|
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 SLOT150
|
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 SLOT150
|
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 5 SLOT130
|
Facility
|
IP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT130
|
Facility
|
OP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem Medicaid |
$1,354.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Humana KY Medicaid |
$1,354.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT135
|
Facility
|
IP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT135
|
Facility
|
OP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem Medicaid |
$1,354.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Humana KY Medicaid |
$1,354.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT140
|
Facility
|
IP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT140
|
Facility
|
OP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem Medicaid |
$1,354.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Humana KY Medicaid |
$1,354.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT145
|
Facility
|
IP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT145
|
Facility
|
OP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem Medicaid |
$1,354.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Humana KY Medicaid |
$1,354.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT150
|
Facility
|
IP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLASSIC CHS SB 5 SLOT150
|
Facility
|
OP
|
$3,937.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.17 |
| Max. Negotiated Rate |
$3,779.76 |
| Rate for Payer: Aetna Commercial |
$3,031.68
|
| Rate for Payer: Anthem Medicaid |
$1,354.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,071.05
|
| Rate for Payer: Cash Price |
$1,968.62
|
| Rate for Payer: Cigna Commercial |
$3,267.92
|
| Rate for Payer: First Health Commercial |
$3,740.39
|
| Rate for Payer: Humana Commercial |
$3,346.66
|
| Rate for Payer: Humana KY Medicaid |
$1,354.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,228.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,181.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,381.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,464.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,149.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,425.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,716.70
|
| Rate for Payer: PHCS Commercial |
$3,779.76
|
| Rate for Payer: United Healthcare All Payer |
$3,464.78
|
|
|
PLATE CLAVICLE LOW PROF 10H L
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAVICLE LOW PROF 10H L
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAVICLE LOW PROF 10H R
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAVICLE LOW PROF 10H R
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAVICLE LOW PROF 6H L
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAVICLE LOW PROF 6H L
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAVICLE LOW PROF 6H R
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE CLAVICLE LOW PROF 6H R
|
Facility
|
OP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem Medicaid |
$1,892.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Humana KY Medicaid |
$1,892.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
