|
PLATE CMF 1.2 L 8H LT
|
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 8H LT
|
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 L 8H 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 8H 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
|
|
|
PLATE CMF 1.2 SQ 2*2H
|
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 SQ 2*2H
|
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 SQ 3*2H
|
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 SQ 3*2H
|
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 SQ 4*2H
|
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 SQ 4*2H
|
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 ST 8H
|
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 ST 8H
|
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 T 5H 90^
|
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 T 5H 90^
|
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 T 7H 90^
|
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 T 7H 90^
|
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 Y 6H
|
Facility
|
OP
|
$1,688.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.42 |
| Max. Negotiated Rate |
$1,620.54 |
| Rate for Payer: Aetna Commercial |
$1,299.81
|
| Rate for Payer: Anthem Medicaid |
$580.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.69
|
| Rate for Payer: Cash Price |
$844.03
|
| Rate for Payer: Cigna Commercial |
$1,401.09
|
| Rate for Payer: First Health Commercial |
$1,603.66
|
| Rate for Payer: Humana Commercial |
$1,434.85
|
| Rate for Payer: Humana KY Medicaid |
$580.52
|
| Rate for Payer: Kentucky WC Medicaid |
$586.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,384.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$592.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,266.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,350.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,468.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.76
|
| Rate for Payer: PHCS Commercial |
$1,620.54
|
| Rate for Payer: United Healthcare All Payer |
$1,485.49
|
|
|
PLATE CMF 1.2 Y 6H
|
Facility
|
IP
|
$1,688.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$506.42 |
| Max. Negotiated Rate |
$1,620.54 |
| Rate for Payer: Aetna Commercial |
$1,299.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,316.69
|
| Rate for Payer: Cash Price |
$844.03
|
| Rate for Payer: Cigna Commercial |
$1,401.09
|
| Rate for Payer: First Health Commercial |
$1,603.66
|
| Rate for Payer: Humana Commercial |
$1,434.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,384.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,245.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$506.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,485.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,266.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,350.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,468.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,164.76
|
| Rate for Payer: PHCS Commercial |
$1,620.54
|
| Rate for Payer: United Healthcare All Payer |
$1,485.49
|
|
|
PLATE CMF 1.7 DBL Y 6H REG
|
Facility
|
OP
|
$2,083.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.01 |
| Max. Negotiated Rate |
$2,000.04 |
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: Anthem Medicaid |
$716.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.03
|
| Rate for Payer: Cash Price |
$1,041.68
|
| Rate for Payer: Cigna Commercial |
$1,729.20
|
| Rate for Payer: First Health Commercial |
$1,979.20
|
| Rate for Payer: Humana Commercial |
$1,770.86
|
| Rate for Payer: Humana KY Medicaid |
$716.47
|
| Rate for Payer: Kentucky WC Medicaid |
$723.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.53
|
| Rate for Payer: PHCS Commercial |
$2,000.04
|
| Rate for Payer: United Healthcare All Payer |
$1,833.37
|
|
|
PLATE CMF 1.7 DBL Y 6H REG
|
Facility
|
IP
|
$2,083.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.01 |
| Max. Negotiated Rate |
$2,000.04 |
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.03
|
| Rate for Payer: Cash Price |
$1,041.68
|
| Rate for Payer: Cigna Commercial |
$1,729.20
|
| Rate for Payer: First Health Commercial |
$1,979.20
|
| Rate for Payer: Humana Commercial |
$1,770.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.53
|
| Rate for Payer: PHCS Commercial |
$2,000.04
|
| Rate for Payer: United Healthcare All Payer |
$1,833.37
|
|
|
PLATE CMF 1.7 DBL Y 7H REG
|
Facility
|
OP
|
$2,083.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.01 |
| Max. Negotiated Rate |
$2,000.04 |
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: Anthem Medicaid |
$716.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.03
|
| Rate for Payer: Cash Price |
$1,041.68
|
| Rate for Payer: Cigna Commercial |
$1,729.20
|
| Rate for Payer: First Health Commercial |
$1,979.20
|
| Rate for Payer: Humana Commercial |
$1,770.86
|
| Rate for Payer: Humana KY Medicaid |
$716.47
|
| Rate for Payer: Kentucky WC Medicaid |
$723.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$730.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.53
|
| Rate for Payer: PHCS Commercial |
$2,000.04
|
| Rate for Payer: United Healthcare All Payer |
$1,833.37
|
|
|
PLATE CMF 1.7 DBL Y 7H REG
|
Facility
|
IP
|
$2,083.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$625.01 |
| Max. Negotiated Rate |
$2,000.04 |
| Rate for Payer: Aetna Commercial |
$1,604.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,625.03
|
| Rate for Payer: Cash Price |
$1,041.68
|
| Rate for Payer: Cigna Commercial |
$1,729.20
|
| Rate for Payer: First Health Commercial |
$1,979.20
|
| Rate for Payer: Humana Commercial |
$1,770.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,708.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,537.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,833.37
|
| Rate for Payer: Ohio Health Group HMO |
$1,562.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,812.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,437.53
|
| Rate for Payer: PHCS Commercial |
$2,000.04
|
| Rate for Payer: United Healthcare All Payer |
$1,833.37
|
|
|
PLATE CMF 1.7 L 90^ 10MM LT
|
Facility
|
IP
|
$2,050.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.26 |
| Max. Negotiated Rate |
$1,968.84 |
| Rate for Payer: Aetna Commercial |
$1,579.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.69
|
| Rate for Payer: Cash Price |
$1,025.44
|
| Rate for Payer: Cigna Commercial |
$1,702.23
|
| Rate for Payer: First Health Commercial |
$1,948.34
|
| Rate for Payer: Humana Commercial |
$1,743.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,513.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,538.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,784.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.11
|
| Rate for Payer: PHCS Commercial |
$1,968.84
|
| Rate for Payer: United Healthcare All Payer |
$1,804.77
|
|
|
PLATE CMF 1.7 L 90^ 10MM LT
|
Facility
|
OP
|
$2,050.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.26 |
| Max. Negotiated Rate |
$1,968.84 |
| Rate for Payer: Aetna Commercial |
$1,579.18
|
| Rate for Payer: Anthem Medicaid |
$705.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.69
|
| Rate for Payer: Cash Price |
$1,025.44
|
| Rate for Payer: Cigna Commercial |
$1,702.23
|
| Rate for Payer: First Health Commercial |
$1,948.34
|
| Rate for Payer: Humana Commercial |
$1,743.25
|
| Rate for Payer: Humana KY Medicaid |
$705.30
|
| Rate for Payer: Kentucky WC Medicaid |
$712.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,513.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,538.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,784.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.11
|
| Rate for Payer: PHCS Commercial |
$1,968.84
|
| Rate for Payer: United Healthcare All Payer |
$1,804.77
|
|
|
PLATE CMF 1.7 L 90^ 10MM RT
|
Facility
|
IP
|
$2,050.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.26 |
| Max. Negotiated Rate |
$1,968.84 |
| Rate for Payer: Aetna Commercial |
$1,579.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,599.69
|
| Rate for Payer: Cash Price |
$1,025.44
|
| Rate for Payer: Cigna Commercial |
$1,702.23
|
| Rate for Payer: First Health Commercial |
$1,948.34
|
| Rate for Payer: Humana Commercial |
$1,743.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,681.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,513.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,804.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,538.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,784.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,415.11
|
| Rate for Payer: PHCS Commercial |
$1,968.84
|
| Rate for Payer: United Healthcare All Payer |
$1,804.77
|
|
