|
PLATE CLOVERLEAF 7 H 152MM
|
Facility
|
OP
|
$3,914.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.26 |
| Max. Negotiated Rate |
$3,757.62 |
| Rate for Payer: Aetna Commercial |
$3,013.93
|
| Rate for Payer: Anthem Medicaid |
$1,346.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.07
|
| Rate for Payer: Cash Price |
$1,957.09
|
| Rate for Payer: Cigna Commercial |
$3,248.78
|
| Rate for Payer: First Health Commercial |
$3,718.48
|
| Rate for Payer: Humana Commercial |
$3,327.06
|
| Rate for Payer: Humana KY Medicaid |
$1,346.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,209.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,888.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,444.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,935.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,131.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,405.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.79
|
| Rate for Payer: PHCS Commercial |
$3,757.62
|
| Rate for Payer: United Healthcare All Payer |
$3,444.49
|
|
|
PLATE CLOVERLEAF 8 H 168MM
|
Facility
|
IP
|
$4,037.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.16 |
| Max. Negotiated Rate |
$3,875.70 |
| Rate for Payer: Aetna Commercial |
$3,108.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.01
|
| Rate for Payer: Cash Price |
$2,018.59
|
| Rate for Payer: Cigna Commercial |
$3,350.87
|
| Rate for Payer: First Health Commercial |
$3,835.33
|
| Rate for Payer: Humana Commercial |
$3,431.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,512.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.66
|
| Rate for Payer: PHCS Commercial |
$3,875.70
|
| Rate for Payer: United Healthcare All Payer |
$3,552.73
|
|
|
PLATE CLOVERLEAF 8 H 168MM
|
Facility
|
OP
|
$4,037.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.16 |
| Max. Negotiated Rate |
$3,875.70 |
| Rate for Payer: Aetna Commercial |
$3,108.64
|
| Rate for Payer: Anthem Medicaid |
$1,388.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.01
|
| Rate for Payer: Cash Price |
$2,018.59
|
| Rate for Payer: Cigna Commercial |
$3,350.87
|
| Rate for Payer: First Health Commercial |
$3,835.33
|
| Rate for Payer: Humana Commercial |
$3,431.61
|
| Rate for Payer: Humana KY Medicaid |
$1,388.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,512.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.66
|
| Rate for Payer: PHCS Commercial |
$3,875.70
|
| Rate for Payer: United Healthcare All Payer |
$3,552.73
|
|
|
PLATE CLOVERLEAF 9 H 184MM
|
Facility
|
OP
|
$4,206.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.89 |
| Max. Negotiated Rate |
$4,038.06 |
| Rate for Payer: Aetna Commercial |
$3,238.86
|
| Rate for Payer: Anthem Medicaid |
$1,446.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.92
|
| Rate for Payer: Cash Price |
$2,103.16
|
| Rate for Payer: Cigna Commercial |
$3,491.24
|
| Rate for Payer: First Health Commercial |
$3,995.99
|
| Rate for Payer: Humana Commercial |
$3,575.36
|
| Rate for Payer: Humana KY Medicaid |
$1,446.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,461.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,449.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,365.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.35
|
| Rate for Payer: PHCS Commercial |
$4,038.06
|
| Rate for Payer: United Healthcare All Payer |
$3,701.55
|
|
|
PLATE CLOVERLEAF 9 H 184MM
|
Facility
|
IP
|
$4,206.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.89 |
| Max. Negotiated Rate |
$4,038.06 |
| Rate for Payer: Aetna Commercial |
$3,238.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.92
|
| Rate for Payer: Cash Price |
$2,103.16
|
| Rate for Payer: Cigna Commercial |
$3,491.24
|
| Rate for Payer: First Health Commercial |
$3,995.99
|
| Rate for Payer: Humana Commercial |
$3,575.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,449.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,104.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,365.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.35
|
| Rate for Payer: PHCS Commercial |
$4,038.06
|
| Rate for Payer: United Healthcare All Payer |
$3,701.55
|
|
|
PLATE CLOVERLEAF W/PF 3H
|
Facility
|
OP
|
$3,322.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.67 |
| Max. Negotiated Rate |
$3,189.36 |
| Rate for Payer: Aetna Commercial |
$2,558.13
|
| Rate for Payer: Anthem Medicaid |
$1,142.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,591.36
|
| Rate for Payer: Cash Price |
$1,661.12
|
| Rate for Payer: Cigna Commercial |
$2,757.47
|
| Rate for Payer: First Health Commercial |
$3,156.14
|
| Rate for Payer: Humana Commercial |
$2,823.91
|
| Rate for Payer: Humana KY Medicaid |
$1,142.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,154.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,724.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,451.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,165.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,923.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,491.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,657.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,890.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,292.35
|
| Rate for Payer: PHCS Commercial |
$3,189.36
|
| Rate for Payer: United Healthcare All Payer |
$2,923.58
|
|
|
PLATE CLOVERLEAF W/PF 3H
|
Facility
|
IP
|
$3,322.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.67 |
| Max. Negotiated Rate |
$3,189.36 |
| Rate for Payer: Aetna Commercial |
$2,558.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,591.36
|
| Rate for Payer: Cash Price |
$1,661.12
|
| Rate for Payer: Cigna Commercial |
$2,757.47
|
| Rate for Payer: First Health Commercial |
$3,156.14
|
| Rate for Payer: Humana Commercial |
$2,823.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,724.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,451.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,923.58
|
| Rate for Payer: Ohio Health Group HMO |
$2,491.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,657.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,890.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,292.35
|
| Rate for Payer: PHCS Commercial |
$3,189.36
|
| Rate for Payer: United Healthcare All Payer |
$2,923.58
|
|
|
PLATE CLOVERLEAF W/PF 4H
|
Facility
|
OP
|
$3,429.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.96 |
| Max. Negotiated Rate |
$3,292.68 |
| Rate for Payer: Aetna Commercial |
$2,641.01
|
| Rate for Payer: Anthem Medicaid |
$1,179.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,675.31
|
| Rate for Payer: Cash Price |
$1,714.94
|
| Rate for Payer: Cigna Commercial |
$2,846.80
|
| Rate for Payer: First Health Commercial |
$3,258.39
|
| Rate for Payer: Humana Commercial |
$2,915.40
|
| Rate for Payer: Humana KY Medicaid |
$1,179.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,191.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,812.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,531.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,203.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,018.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,572.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,743.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,366.62
|
| Rate for Payer: PHCS Commercial |
$3,292.68
|
| Rate for Payer: United Healthcare All Payer |
$3,018.29
|
|
|
PLATE CLOVERLEAF W/PF 4H
|
Facility
|
IP
|
$3,429.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.96 |
| Max. Negotiated Rate |
$3,292.68 |
| Rate for Payer: Aetna Commercial |
$2,641.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,675.31
|
| Rate for Payer: Cash Price |
$1,714.94
|
| Rate for Payer: Cigna Commercial |
$2,846.80
|
| Rate for Payer: First Health Commercial |
$3,258.39
|
| Rate for Payer: Humana Commercial |
$2,915.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,812.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,531.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,018.29
|
| Rate for Payer: Ohio Health Group HMO |
$2,572.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,743.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,984.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,366.62
|
| Rate for Payer: PHCS Commercial |
$3,292.68
|
| Rate for Payer: United Healthcare All Payer |
$3,018.29
|
|
|
PLATE CLUSTER 11-HI
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
PLATE CLUSTER 11-HI
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
PLATE CMF 1.2 24H
|
Facility
|
IP
|
$3,051.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$2,929.19 |
| Rate for Payer: Aetna Commercial |
$2,349.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.97
|
| Rate for Payer: Cash Price |
$1,525.62
|
| Rate for Payer: Cigna Commercial |
$2,532.53
|
| Rate for Payer: First Health Commercial |
$2,898.68
|
| Rate for Payer: Humana Commercial |
$2,593.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,502.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,251.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,685.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,288.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,654.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.36
|
| Rate for Payer: PHCS Commercial |
$2,929.19
|
| Rate for Payer: United Healthcare All Payer |
$2,685.09
|
|
|
PLATE CMF 1.2 24H
|
Facility
|
OP
|
$3,051.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.37 |
| Max. Negotiated Rate |
$2,929.19 |
| Rate for Payer: Aetna Commercial |
$2,349.45
|
| Rate for Payer: Anthem Medicaid |
$1,049.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,379.97
|
| Rate for Payer: Cash Price |
$1,525.62
|
| Rate for Payer: Cigna Commercial |
$2,532.53
|
| Rate for Payer: First Health Commercial |
$2,898.68
|
| Rate for Payer: Humana Commercial |
$2,593.55
|
| Rate for Payer: Humana KY Medicaid |
$1,049.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,060.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,502.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,251.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$915.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,070.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,685.09
|
| Rate for Payer: Ohio Health Group HMO |
$2,288.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,440.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,654.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,105.36
|
| Rate for Payer: PHCS Commercial |
$2,929.19
|
| Rate for Payer: United Healthcare All Payer |
$2,685.09
|
|
|
PLATE CMF 1.2 CRVD 8H
|
Facility
|
OP
|
$1,823.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$1,750.33 |
| Rate for Payer: Aetna Commercial |
$1,403.91
|
| Rate for Payer: Anthem Medicaid |
$627.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.14
|
| Rate for Payer: Cash Price |
$911.63
|
| Rate for Payer: Cigna Commercial |
$1,513.31
|
| Rate for Payer: First Health Commercial |
$1,732.10
|
| Rate for Payer: Humana Commercial |
$1,549.77
|
| Rate for Payer: Humana KY Medicaid |
$627.02
|
| Rate for Payer: Kentucky WC Medicaid |
$633.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.05
|
| Rate for Payer: PHCS Commercial |
$1,750.33
|
| Rate for Payer: United Healthcare All Payer |
$1,604.47
|
|
|
PLATE CMF 1.2 CRVD 8H
|
Facility
|
IP
|
$1,823.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$546.98 |
| Max. Negotiated Rate |
$1,750.33 |
| Rate for Payer: Aetna Commercial |
$1,403.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.14
|
| Rate for Payer: Cash Price |
$911.63
|
| Rate for Payer: Cigna Commercial |
$1,513.31
|
| Rate for Payer: First Health Commercial |
$1,732.10
|
| Rate for Payer: Humana Commercial |
$1,549.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$546.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,458.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.05
|
| Rate for Payer: PHCS Commercial |
$1,750.33
|
| Rate for Payer: United Healthcare All Payer |
$1,604.47
|
|
|
PLATE CMF 1.2 DBL T 9H
|
Facility
|
IP
|
$1,766.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,696.08 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.07
|
| Rate for Payer: Cash Price |
$883.38
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: First Health Commercial |
$1,678.41
|
| Rate for Payer: Humana Commercial |
$1,501.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.06
|
| Rate for Payer: PHCS Commercial |
$1,696.08
|
| Rate for Payer: United Healthcare All Payer |
$1,554.74
|
|
|
PLATE CMF 1.2 DBL T 9H
|
Facility
|
OP
|
$1,766.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,696.08 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Anthem Medicaid |
$607.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.07
|
| Rate for Payer: Cash Price |
$883.38
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: First Health Commercial |
$1,678.41
|
| Rate for Payer: Humana Commercial |
$1,501.74
|
| Rate for Payer: Humana KY Medicaid |
$607.59
|
| Rate for Payer: Kentucky WC Medicaid |
$613.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.06
|
| Rate for Payer: PHCS Commercial |
$1,696.08
|
| Rate for Payer: United Healthcare All Payer |
$1,554.74
|
|
|
PLATE CMF 1.2 DBL Y 6H
|
Facility
|
IP
|
$1,766.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,696.08 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.07
|
| Rate for Payer: Cash Price |
$883.38
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: First Health Commercial |
$1,678.41
|
| Rate for Payer: Humana Commercial |
$1,501.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.06
|
| Rate for Payer: PHCS Commercial |
$1,696.08
|
| Rate for Payer: United Healthcare All Payer |
$1,554.74
|
|
|
PLATE CMF 1.2 DBL Y 6H
|
Facility
|
OP
|
$1,766.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,696.08 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Anthem Medicaid |
$607.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.07
|
| Rate for Payer: Cash Price |
$883.38
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: First Health Commercial |
$1,678.41
|
| Rate for Payer: Humana Commercial |
$1,501.74
|
| Rate for Payer: Humana KY Medicaid |
$607.59
|
| Rate for Payer: Kentucky WC Medicaid |
$613.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.06
|
| Rate for Payer: PHCS Commercial |
$1,696.08
|
| Rate for Payer: United Healthcare All Payer |
$1,554.74
|
|
|
PLATE CMF 1.2 DBL Y 7H
|
Facility
|
OP
|
$1,766.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,696.08 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Anthem Medicaid |
$607.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.07
|
| Rate for Payer: Cash Price |
$883.38
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: First Health Commercial |
$1,678.41
|
| Rate for Payer: Humana Commercial |
$1,501.74
|
| Rate for Payer: Humana KY Medicaid |
$607.59
|
| Rate for Payer: Kentucky WC Medicaid |
$613.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$619.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.06
|
| Rate for Payer: PHCS Commercial |
$1,696.08
|
| Rate for Payer: United Healthcare All Payer |
$1,554.74
|
|
|
PLATE CMF 1.2 DBL Y 7H
|
Facility
|
IP
|
$1,766.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.02 |
| Max. Negotiated Rate |
$1,696.08 |
| Rate for Payer: Aetna Commercial |
$1,360.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,378.07
|
| Rate for Payer: Cash Price |
$883.38
|
| Rate for Payer: Cigna Commercial |
$1,466.40
|
| Rate for Payer: First Health Commercial |
$1,678.41
|
| Rate for Payer: Humana Commercial |
$1,501.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,448.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,303.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,554.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,325.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,413.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,537.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.06
|
| Rate for Payer: PHCS Commercial |
$1,696.08
|
| Rate for Payer: United Healthcare All Payer |
$1,554.74
|
|
|
PLATE CMF 1.2 L 5H LT
|
Facility
|
OP
|
$1,683.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$1,616.01 |
| Rate for Payer: Aetna Commercial |
$1,296.17
|
| Rate for Payer: Anthem Medicaid |
$578.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.01
|
| Rate for Payer: Cash Price |
$841.67
|
| Rate for Payer: Cigna Commercial |
$1,397.17
|
| Rate for Payer: First Health Commercial |
$1,599.17
|
| Rate for Payer: Humana Commercial |
$1,430.84
|
| Rate for Payer: Humana KY Medicaid |
$578.90
|
| Rate for Payer: Kentucky WC Medicaid |
$584.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,380.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,242.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,481.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,346.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.50
|
| Rate for Payer: PHCS Commercial |
$1,616.01
|
| Rate for Payer: United Healthcare All Payer |
$1,481.34
|
|
|
PLATE CMF 1.2 L 5H LT
|
Facility
|
IP
|
$1,683.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$1,616.01 |
| Rate for Payer: Aetna Commercial |
$1,296.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.01
|
| Rate for Payer: Cash Price |
$841.67
|
| Rate for Payer: Cigna Commercial |
$1,397.17
|
| Rate for Payer: First Health Commercial |
$1,599.17
|
| Rate for Payer: Humana Commercial |
$1,430.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,380.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,242.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,481.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,346.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.50
|
| Rate for Payer: PHCS Commercial |
$1,616.01
|
| Rate for Payer: United Healthcare All Payer |
$1,481.34
|
|
|
PLATE CMF 1.2 L 5H RT
|
Facility
|
OP
|
$1,683.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$1,616.01 |
| Rate for Payer: Aetna Commercial |
$1,296.17
|
| Rate for Payer: Anthem Medicaid |
$578.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.01
|
| Rate for Payer: Cash Price |
$841.67
|
| Rate for Payer: Cigna Commercial |
$1,397.17
|
| Rate for Payer: First Health Commercial |
$1,599.17
|
| Rate for Payer: Humana Commercial |
$1,430.84
|
| Rate for Payer: Humana KY Medicaid |
$578.90
|
| Rate for Payer: Kentucky WC Medicaid |
$584.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,380.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,242.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$590.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,481.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,346.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.50
|
| Rate for Payer: PHCS Commercial |
$1,616.01
|
| Rate for Payer: United Healthcare All Payer |
$1,481.34
|
|
|
PLATE CMF 1.2 L 5H RT
|
Facility
|
IP
|
$1,683.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.00 |
| Max. Negotiated Rate |
$1,616.01 |
| Rate for Payer: Aetna Commercial |
$1,296.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,313.01
|
| Rate for Payer: Cash Price |
$841.67
|
| Rate for Payer: Cigna Commercial |
$1,397.17
|
| Rate for Payer: First Health Commercial |
$1,599.17
|
| Rate for Payer: Humana Commercial |
$1,430.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,380.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,242.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$505.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,481.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,262.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,346.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,464.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,161.50
|
| Rate for Payer: PHCS Commercial |
$1,616.01
|
| Rate for Payer: United Healthcare All Payer |
$1,481.34
|
|
