|
PLATE CMF 1.7 L 90^ 10MM RT
|
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^ 12MM LT
|
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 L 90^ 12MM LT
|
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^ 12MM RT
|
Facility
|
OP
|
$1,835.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.51 |
| Max. Negotiated Rate |
$1,761.64 |
| Rate for Payer: Aetna Commercial |
$1,412.98
|
| Rate for Payer: Anthem Medicaid |
$631.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.33
|
| Rate for Payer: Cash Price |
$917.52
|
| Rate for Payer: Cigna Commercial |
$1,523.08
|
| Rate for Payer: First Health Commercial |
$1,743.29
|
| Rate for Payer: Humana Commercial |
$1,559.78
|
| Rate for Payer: Humana KY Medicaid |
$631.07
|
| Rate for Payer: Kentucky WC Medicaid |
$637.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,504.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$643.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,614.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,468.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,266.18
|
| Rate for Payer: PHCS Commercial |
$1,761.64
|
| Rate for Payer: United Healthcare All Payer |
$1,614.84
|
|
|
PLATE CMF 1.7 L 90^ 12MM RT
|
Facility
|
IP
|
$1,835.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$550.51 |
| Max. Negotiated Rate |
$1,761.64 |
| Rate for Payer: Aetna Commercial |
$1,412.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,431.33
|
| Rate for Payer: Cash Price |
$917.52
|
| Rate for Payer: Cigna Commercial |
$1,523.08
|
| Rate for Payer: First Health Commercial |
$1,743.29
|
| Rate for Payer: Humana Commercial |
$1,559.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,504.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,354.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$550.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,614.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,376.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,468.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,596.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,266.18
|
| Rate for Payer: PHCS Commercial |
$1,761.64
|
| Rate for Payer: United Healthcare All Payer |
$1,614.84
|
|
|
PLATE CMF 1.7 L 90^ 6MM LT
|
Facility
|
OP
|
$1,809.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.99 |
| Max. Negotiated Rate |
$1,737.56 |
| Rate for Payer: Aetna Commercial |
$1,393.67
|
| Rate for Payer: Anthem Medicaid |
$622.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.77
|
| Rate for Payer: Cash Price |
$904.98
|
| Rate for Payer: Cigna Commercial |
$1,502.27
|
| Rate for Payer: First Health Commercial |
$1,719.46
|
| Rate for Payer: Humana Commercial |
$1,538.47
|
| Rate for Payer: Humana KY Medicaid |
$622.45
|
| Rate for Payer: Kentucky WC Medicaid |
$628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$634.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.87
|
| Rate for Payer: PHCS Commercial |
$1,737.56
|
| Rate for Payer: United Healthcare All Payer |
$1,592.76
|
|
|
PLATE CMF 1.7 L 90^ 6MM LT
|
Facility
|
IP
|
$1,809.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.99 |
| Max. Negotiated Rate |
$1,737.56 |
| Rate for Payer: Aetna Commercial |
$1,393.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,411.77
|
| Rate for Payer: Cash Price |
$904.98
|
| Rate for Payer: Cigna Commercial |
$1,502.27
|
| Rate for Payer: First Health Commercial |
$1,719.46
|
| Rate for Payer: Humana Commercial |
$1,538.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,484.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,335.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$542.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,592.76
|
| Rate for Payer: Ohio Health Group HMO |
$1,357.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,447.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,574.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,248.87
|
| Rate for Payer: PHCS Commercial |
$1,737.56
|
| Rate for Payer: United Healthcare All Payer |
$1,592.76
|
|
|
PLATE CMF 1.7 L 90^ 6MM RT
|
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 L 90^ 6MM RT
|
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^ 8MM 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^ 8MM 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^ 8MM 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
|
|
|
PLATE CMF 1.7 L 90^ 8MM RT
|
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 MINI 4H 6MM
|
Facility
|
IP
|
$1,863.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.95 |
| Max. Negotiated Rate |
$1,788.63 |
| Rate for Payer: Aetna Commercial |
$1,434.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.26
|
| Rate for Payer: Cash Price |
$931.58
|
| Rate for Payer: Cigna Commercial |
$1,546.42
|
| Rate for Payer: First Health Commercial |
$1,770.00
|
| Rate for Payer: Humana Commercial |
$1,583.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,527.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,639.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,397.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,620.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.58
|
| Rate for Payer: PHCS Commercial |
$1,788.63
|
| Rate for Payer: United Healthcare All Payer |
$1,639.58
|
|
|
PLATE CMF 1.7 MINI 4H 6MM
|
Facility
|
OP
|
$1,863.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.95 |
| Max. Negotiated Rate |
$1,788.63 |
| Rate for Payer: Aetna Commercial |
$1,434.63
|
| Rate for Payer: Anthem Medicaid |
$640.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,453.26
|
| Rate for Payer: Cash Price |
$931.58
|
| Rate for Payer: Cigna Commercial |
$1,546.42
|
| Rate for Payer: First Health Commercial |
$1,770.00
|
| Rate for Payer: Humana Commercial |
$1,583.69
|
| Rate for Payer: Humana KY Medicaid |
$640.74
|
| Rate for Payer: Kentucky WC Medicaid |
$647.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,527.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,375.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$653.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,639.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,397.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,490.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,620.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,285.58
|
| Rate for Payer: PHCS Commercial |
$1,788.63
|
| Rate for Payer: United Healthcare All Payer |
$1,639.58
|
|
|
PLATE CMF 1.7 MINI 6H 8MM
|
Facility
|
OP
|
$1,978.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$1,899.53 |
| Rate for Payer: Aetna Commercial |
$1,523.58
|
| Rate for Payer: Anthem Medicaid |
$680.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,543.37
|
| Rate for Payer: Cash Price |
$989.34
|
| Rate for Payer: Cigna Commercial |
$1,642.30
|
| Rate for Payer: First Health Commercial |
$1,879.75
|
| Rate for Payer: Humana Commercial |
$1,681.88
|
| Rate for Payer: Humana KY Medicaid |
$680.47
|
| Rate for Payer: Kentucky WC Medicaid |
$687.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,622.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,460.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$694.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,741.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,484.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.29
|
| Rate for Payer: PHCS Commercial |
$1,899.53
|
| Rate for Payer: United Healthcare All Payer |
$1,741.24
|
|
|
PLATE CMF 1.7 MINI 6H 8MM
|
Facility
|
IP
|
$1,978.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.60 |
| Max. Negotiated Rate |
$1,899.53 |
| Rate for Payer: Aetna Commercial |
$1,523.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,543.37
|
| Rate for Payer: Cash Price |
$989.34
|
| Rate for Payer: Cigna Commercial |
$1,642.30
|
| Rate for Payer: First Health Commercial |
$1,879.75
|
| Rate for Payer: Humana Commercial |
$1,681.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,622.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,460.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,741.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,484.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,721.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,365.29
|
| Rate for Payer: PHCS Commercial |
$1,899.53
|
| Rate for Payer: United Healthcare All Payer |
$1,741.24
|
|
|
PLATE CMF 1.7 MINI 8H
|
Facility
|
IP
|
$1,813.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.99 |
| Max. Negotiated Rate |
$1,740.77 |
| Rate for Payer: Aetna Commercial |
$1,396.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.37
|
| Rate for Payer: Cash Price |
$906.65
|
| Rate for Payer: Cigna Commercial |
$1,505.04
|
| Rate for Payer: First Health Commercial |
$1,722.63
|
| Rate for Payer: Humana Commercial |
$1,541.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.18
|
| Rate for Payer: PHCS Commercial |
$1,740.77
|
| Rate for Payer: United Healthcare All Payer |
$1,595.70
|
|
|
PLATE CMF 1.7 MINI 8H
|
Facility
|
OP
|
$1,813.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.99 |
| Max. Negotiated Rate |
$1,740.77 |
| Rate for Payer: Aetna Commercial |
$1,396.24
|
| Rate for Payer: Anthem Medicaid |
$623.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,414.37
|
| Rate for Payer: Cash Price |
$906.65
|
| Rate for Payer: Cigna Commercial |
$1,505.04
|
| Rate for Payer: First Health Commercial |
$1,722.63
|
| Rate for Payer: Humana Commercial |
$1,541.31
|
| Rate for Payer: Humana KY Medicaid |
$623.59
|
| Rate for Payer: Kentucky WC Medicaid |
$629.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,486.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$543.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,595.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,359.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,450.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,577.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.18
|
| Rate for Payer: PHCS Commercial |
$1,740.77
|
| Rate for Payer: United Healthcare All Payer |
$1,595.70
|
|
|
PLATE CMF 1.7 SQ 2*2H
|
Facility
|
IP
|
$1,712.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.85 |
| Max. Negotiated Rate |
$1,644.32 |
| Rate for Payer: Aetna Commercial |
$1,318.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.01
|
| Rate for Payer: Cash Price |
$856.42
|
| Rate for Payer: Cigna Commercial |
$1,421.65
|
| Rate for Payer: First Health Commercial |
$1,627.19
|
| Rate for Payer: Humana Commercial |
$1,455.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,404.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,284.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,490.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.85
|
| Rate for Payer: PHCS Commercial |
$1,644.32
|
| Rate for Payer: United Healthcare All Payer |
$1,507.29
|
|
|
PLATE CMF 1.7 SQ 2*2H
|
Facility
|
OP
|
$1,712.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.85 |
| Max. Negotiated Rate |
$1,644.32 |
| Rate for Payer: Aetna Commercial |
$1,318.88
|
| Rate for Payer: Anthem Medicaid |
$589.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.01
|
| Rate for Payer: Cash Price |
$856.42
|
| Rate for Payer: Cigna Commercial |
$1,421.65
|
| Rate for Payer: First Health Commercial |
$1,627.19
|
| Rate for Payer: Humana Commercial |
$1,455.91
|
| Rate for Payer: Humana KY Medicaid |
$589.04
|
| Rate for Payer: Kentucky WC Medicaid |
$595.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,404.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$600.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,284.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,490.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.85
|
| Rate for Payer: PHCS Commercial |
$1,644.32
|
| Rate for Payer: United Healthcare All Payer |
$1,507.29
|
|
|
PLATE CMF 1.7 SQ 3*2H
|
Facility
|
IP
|
$1,712.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.85 |
| Max. Negotiated Rate |
$1,644.32 |
| Rate for Payer: Aetna Commercial |
$1,318.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.01
|
| Rate for Payer: Cash Price |
$856.42
|
| Rate for Payer: Cigna Commercial |
$1,421.65
|
| Rate for Payer: First Health Commercial |
$1,627.19
|
| Rate for Payer: Humana Commercial |
$1,455.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,404.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,284.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,490.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.85
|
| Rate for Payer: PHCS Commercial |
$1,644.32
|
| Rate for Payer: United Healthcare All Payer |
$1,507.29
|
|
|
PLATE CMF 1.7 SQ 3*2H
|
Facility
|
OP
|
$1,712.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.85 |
| Max. Negotiated Rate |
$1,644.32 |
| Rate for Payer: Aetna Commercial |
$1,318.88
|
| Rate for Payer: Anthem Medicaid |
$589.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.01
|
| Rate for Payer: Cash Price |
$856.42
|
| Rate for Payer: Cigna Commercial |
$1,421.65
|
| Rate for Payer: First Health Commercial |
$1,627.19
|
| Rate for Payer: Humana Commercial |
$1,455.91
|
| Rate for Payer: Humana KY Medicaid |
$589.04
|
| Rate for Payer: Kentucky WC Medicaid |
$595.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,404.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$513.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$600.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,507.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,284.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,490.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.85
|
| Rate for Payer: PHCS Commercial |
$1,644.32
|
| Rate for Payer: United Healthcare All Payer |
$1,507.29
|
|
|
PLATE CMF 1.7 ST 16H
|
Facility
|
OP
|
$2,080.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.25 |
| Max. Negotiated Rate |
$1,997.59 |
| Rate for Payer: Aetna Commercial |
$1,602.23
|
| Rate for Payer: Anthem Medicaid |
$715.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.04
|
| Rate for Payer: Cash Price |
$1,040.41
|
| Rate for Payer: Cigna Commercial |
$1,727.08
|
| Rate for Payer: First Health Commercial |
$1,976.78
|
| Rate for Payer: Humana Commercial |
$1,768.70
|
| Rate for Payer: Humana KY Medicaid |
$715.59
|
| Rate for Payer: Kentucky WC Medicaid |
$722.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,810.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.77
|
| Rate for Payer: PHCS Commercial |
$1,997.59
|
| Rate for Payer: United Healthcare All Payer |
$1,831.12
|
|
|
PLATE CMF 1.7 ST 16H
|
Facility
|
IP
|
$2,080.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.25 |
| Max. Negotiated Rate |
$1,997.59 |
| Rate for Payer: Aetna Commercial |
$1,602.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,623.04
|
| Rate for Payer: Cash Price |
$1,040.41
|
| Rate for Payer: Cigna Commercial |
$1,727.08
|
| Rate for Payer: First Health Commercial |
$1,976.78
|
| Rate for Payer: Humana Commercial |
$1,768.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,706.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,535.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$624.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,831.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,560.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,664.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,810.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,435.77
|
| Rate for Payer: PHCS Commercial |
$1,997.59
|
| Rate for Payer: United Healthcare All Payer |
$1,831.12
|
|
