|
PLATE CMF 1.7 ST 4H 6MM
|
Facility
|
OP
|
$1,121.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.48 |
| Max. Negotiated Rate |
$1,076.74 |
| Rate for Payer: Aetna Commercial |
$863.63
|
| Rate for Payer: Anthem Medicaid |
$385.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.85
|
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Cigna Commercial |
$930.93
|
| Rate for Payer: First Health Commercial |
$1,065.52
|
| Rate for Payer: Humana Commercial |
$953.36
|
| Rate for Payer: Humana KY Medicaid |
$385.72
|
| Rate for Payer: Kentucky WC Medicaid |
$389.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$393.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.01
|
| Rate for Payer: Ohio Health Group HMO |
$841.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$897.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$975.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$773.90
|
| Rate for Payer: PHCS Commercial |
$1,076.74
|
| Rate for Payer: United Healthcare All Payer |
$987.01
|
|
|
PLATE CMF 1.7 ST 4H 6MM
|
Facility
|
IP
|
$1,121.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.48 |
| Max. Negotiated Rate |
$1,076.74 |
| Rate for Payer: Aetna Commercial |
$863.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$874.85
|
| Rate for Payer: Cash Price |
$560.80
|
| Rate for Payer: Cigna Commercial |
$930.93
|
| Rate for Payer: First Health Commercial |
$1,065.52
|
| Rate for Payer: Humana Commercial |
$953.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$919.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$827.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$987.01
|
| Rate for Payer: Ohio Health Group HMO |
$841.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$897.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$975.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$773.90
|
| Rate for Payer: PHCS Commercial |
$1,076.74
|
| Rate for Payer: United Healthcare All Payer |
$987.01
|
|
|
PLATE CMF 1.7 ST 4H 8MM
|
Facility
|
IP
|
$1,723.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.17 |
| Max. Negotiated Rate |
$1,654.93 |
| Rate for Payer: Aetna Commercial |
$1,327.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.63
|
| Rate for Payer: Cash Price |
$861.94
|
| Rate for Payer: Cigna Commercial |
$1,430.83
|
| Rate for Payer: First Health Commercial |
$1,637.70
|
| Rate for Payer: Humana Commercial |
$1,465.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,413.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,517.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,189.48
|
| Rate for Payer: PHCS Commercial |
$1,654.93
|
| Rate for Payer: United Healthcare All Payer |
$1,517.02
|
|
|
PLATE CMF 1.7 ST 4H 8MM
|
Facility
|
OP
|
$1,723.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.17 |
| Max. Negotiated Rate |
$1,654.93 |
| Rate for Payer: Aetna Commercial |
$1,327.40
|
| Rate for Payer: Anthem Medicaid |
$592.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.63
|
| Rate for Payer: Cash Price |
$861.94
|
| Rate for Payer: Cigna Commercial |
$1,430.83
|
| Rate for Payer: First Health Commercial |
$1,637.70
|
| Rate for Payer: Humana Commercial |
$1,465.31
|
| Rate for Payer: Humana KY Medicaid |
$592.85
|
| Rate for Payer: Kentucky WC Medicaid |
$598.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,413.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,272.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$517.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,517.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,189.48
|
| Rate for Payer: PHCS Commercial |
$1,654.93
|
| Rate for Payer: United Healthcare All Payer |
$1,517.02
|
|
|
PLATE CMF 1.7 ST 8H REG
|
Facility
|
OP
|
$1,520.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.20 |
| Max. Negotiated Rate |
$1,459.85 |
| Rate for Payer: Aetna Commercial |
$1,170.92
|
| Rate for Payer: Anthem Medicaid |
$522.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,186.13
|
| Rate for Payer: Cash Price |
$760.34
|
| Rate for Payer: Cigna Commercial |
$1,262.16
|
| Rate for Payer: First Health Commercial |
$1,444.65
|
| Rate for Payer: Humana Commercial |
$1,292.58
|
| Rate for Payer: Humana KY Medicaid |
$522.96
|
| Rate for Payer: Kentucky WC Medicaid |
$528.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,122.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,338.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.27
|
| Rate for Payer: PHCS Commercial |
$1,459.85
|
| Rate for Payer: United Healthcare All Payer |
$1,338.20
|
|
|
PLATE CMF 1.7 ST 8H REG
|
Facility
|
IP
|
$1,520.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.20 |
| Max. Negotiated Rate |
$1,459.85 |
| Rate for Payer: Aetna Commercial |
$1,170.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,186.13
|
| Rate for Payer: Cash Price |
$760.34
|
| Rate for Payer: Cigna Commercial |
$1,262.16
|
| Rate for Payer: First Health Commercial |
$1,444.65
|
| Rate for Payer: Humana Commercial |
$1,292.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,246.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,122.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,338.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,140.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,216.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,322.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.27
|
| Rate for Payer: PHCS Commercial |
$1,459.85
|
| Rate for Payer: United Healthcare All Payer |
$1,338.20
|
|
|
PLATE CMF 1.7 T 5H REG 10MM
|
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 T 5H REG 10MM
|
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 Y 5H 8MM
|
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 Y 5H 8MM
|
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 2.0 CRVD 6H
|
Facility
|
OP
|
$1,788.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.42 |
| Max. Negotiated Rate |
$1,716.55 |
| Rate for Payer: Aetna Commercial |
$1,376.81
|
| Rate for Payer: Anthem Medicaid |
$614.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.69
|
| Rate for Payer: Cash Price |
$894.04
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,698.67
|
| Rate for Payer: Humana Commercial |
$1,519.86
|
| Rate for Payer: Humana KY Medicaid |
$614.92
|
| Rate for Payer: Kentucky WC Medicaid |
$621.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$627.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.77
|
| Rate for Payer: PHCS Commercial |
$1,716.55
|
| Rate for Payer: United Healthcare All Payer |
$1,573.50
|
|
|
PLATE CMF 2.0 CRVD 6H
|
Facility
|
IP
|
$1,788.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.42 |
| Max. Negotiated Rate |
$1,716.55 |
| Rate for Payer: Aetna Commercial |
$1,376.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,394.69
|
| Rate for Payer: Cash Price |
$894.04
|
| Rate for Payer: Cigna Commercial |
$1,484.10
|
| Rate for Payer: First Health Commercial |
$1,698.67
|
| Rate for Payer: Humana Commercial |
$1,519.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,466.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,319.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$536.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,573.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,341.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,430.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,555.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.77
|
| Rate for Payer: PHCS Commercial |
$1,716.55
|
| Rate for Payer: United Healthcare All Payer |
$1,573.50
|
|
|
PLATE CMF 2.0 DBL Y REG
|
Facility
|
IP
|
$3,242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.60 |
| Max. Negotiated Rate |
$3,112.32 |
| Rate for Payer: Aetna Commercial |
$2,496.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.76
|
| Rate for Payer: Cash Price |
$1,621.00
|
| Rate for Payer: Cigna Commercial |
$2,690.86
|
| Rate for Payer: First Health Commercial |
$3,079.90
|
| Rate for Payer: Humana Commercial |
$2,755.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,658.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,392.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,431.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,820.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.98
|
| Rate for Payer: PHCS Commercial |
$3,112.32
|
| Rate for Payer: United Healthcare All Payer |
$2,852.96
|
|
|
PLATE CMF 2.0 DBL Y REG
|
Facility
|
OP
|
$3,242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.60 |
| Max. Negotiated Rate |
$3,112.32 |
| Rate for Payer: Aetna Commercial |
$2,496.34
|
| Rate for Payer: Anthem Medicaid |
$1,114.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.76
|
| Rate for Payer: Cash Price |
$1,621.00
|
| Rate for Payer: Cigna Commercial |
$2,690.86
|
| Rate for Payer: First Health Commercial |
$3,079.90
|
| Rate for Payer: Humana Commercial |
$2,755.70
|
| Rate for Payer: Humana KY Medicaid |
$1,114.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,126.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,658.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,392.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,137.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,431.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,820.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.98
|
| Rate for Payer: PHCS Commercial |
$3,112.32
|
| Rate for Payer: United Healthcare All Payer |
$2,852.96
|
|
|
PLATE CMF 2.0 L 5H LT
|
Facility
|
IP
|
$1,871.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.55 |
| Max. Negotiated Rate |
$1,796.95 |
| Rate for Payer: Aetna Commercial |
$1,441.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.02
|
| Rate for Payer: Cash Price |
$935.91
|
| Rate for Payer: Cigna Commercial |
$1,553.61
|
| Rate for Payer: First Health Commercial |
$1,778.23
|
| Rate for Payer: Humana Commercial |
$1,591.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.56
|
| Rate for Payer: PHCS Commercial |
$1,796.95
|
| Rate for Payer: United Healthcare All Payer |
$1,647.20
|
|
|
PLATE CMF 2.0 L 5H LT
|
Facility
|
OP
|
$1,871.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.55 |
| Max. Negotiated Rate |
$1,796.95 |
| Rate for Payer: Aetna Commercial |
$1,441.30
|
| Rate for Payer: Anthem Medicaid |
$643.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,460.02
|
| Rate for Payer: Cash Price |
$935.91
|
| Rate for Payer: Cigna Commercial |
$1,553.61
|
| Rate for Payer: First Health Commercial |
$1,778.23
|
| Rate for Payer: Humana Commercial |
$1,591.05
|
| Rate for Payer: Humana KY Medicaid |
$643.72
|
| Rate for Payer: Kentucky WC Medicaid |
$650.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,534.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,381.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$561.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$656.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,647.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,403.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,628.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,291.56
|
| Rate for Payer: PHCS Commercial |
$1,796.95
|
| Rate for Payer: United Healthcare All Payer |
$1,647.20
|
|
|
PLATE CMF 2.0 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 2.0 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
|
|
|
PLATE CMF 2.0 L 9H LT
|
Facility
|
IP
|
$1,723.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: Aetna Commercial |
$1,326.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.96
|
| Rate for Payer: Cash Price |
$861.51
|
| Rate for Payer: Cigna Commercial |
$1,430.11
|
| Rate for Payer: First Health Commercial |
$1,636.87
|
| Rate for Payer: Humana Commercial |
$1,464.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.88
|
| Rate for Payer: PHCS Commercial |
$1,654.10
|
| Rate for Payer: United Healthcare All Payer |
$1,516.26
|
|
|
PLATE CMF 2.0 L 9H LT
|
Facility
|
OP
|
$1,723.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: Aetna Commercial |
$1,326.73
|
| Rate for Payer: Anthem Medicaid |
$592.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.96
|
| Rate for Payer: Cash Price |
$861.51
|
| Rate for Payer: Cigna Commercial |
$1,430.11
|
| Rate for Payer: First Health Commercial |
$1,636.87
|
| Rate for Payer: Humana Commercial |
$1,464.57
|
| Rate for Payer: Humana KY Medicaid |
$592.55
|
| Rate for Payer: Kentucky WC Medicaid |
$598.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.88
|
| Rate for Payer: PHCS Commercial |
$1,654.10
|
| Rate for Payer: United Healthcare All Payer |
$1,516.26
|
|
|
PLATE CMF 2.0 L 9H RT
|
Facility
|
IP
|
$1,723.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: Aetna Commercial |
$1,326.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.96
|
| Rate for Payer: Cash Price |
$861.51
|
| Rate for Payer: Cigna Commercial |
$1,430.11
|
| Rate for Payer: First Health Commercial |
$1,636.87
|
| Rate for Payer: Humana Commercial |
$1,464.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.88
|
| Rate for Payer: PHCS Commercial |
$1,654.10
|
| Rate for Payer: United Healthcare All Payer |
$1,516.26
|
|
|
PLATE CMF 2.0 L 9H RT
|
Facility
|
OP
|
$1,723.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.91 |
| Max. Negotiated Rate |
$1,654.10 |
| Rate for Payer: Aetna Commercial |
$1,326.73
|
| Rate for Payer: Anthem Medicaid |
$592.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.96
|
| Rate for Payer: Cash Price |
$861.51
|
| Rate for Payer: Cigna Commercial |
$1,430.11
|
| Rate for Payer: First Health Commercial |
$1,636.87
|
| Rate for Payer: Humana Commercial |
$1,464.57
|
| Rate for Payer: Humana KY Medicaid |
$592.55
|
| Rate for Payer: Kentucky WC Medicaid |
$598.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,499.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.88
|
| Rate for Payer: PHCS Commercial |
$1,654.10
|
| Rate for Payer: United Healthcare All Payer |
$1,516.26
|
|
|
PLATE CMF 2.0 L LT LONG
|
Facility
|
IP
|
$3,242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.60 |
| Max. Negotiated Rate |
$3,112.32 |
| Rate for Payer: Aetna Commercial |
$2,496.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.76
|
| Rate for Payer: Cash Price |
$1,621.00
|
| Rate for Payer: Cigna Commercial |
$2,690.86
|
| Rate for Payer: First Health Commercial |
$3,079.90
|
| Rate for Payer: Humana Commercial |
$2,755.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,658.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,392.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,431.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,820.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.98
|
| Rate for Payer: PHCS Commercial |
$3,112.32
|
| Rate for Payer: United Healthcare All Payer |
$2,852.96
|
|
|
PLATE CMF 2.0 L LT LONG
|
Facility
|
OP
|
$3,242.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.60 |
| Max. Negotiated Rate |
$3,112.32 |
| Rate for Payer: Aetna Commercial |
$2,496.34
|
| Rate for Payer: Anthem Medicaid |
$1,114.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,528.76
|
| Rate for Payer: Cash Price |
$1,621.00
|
| Rate for Payer: Cigna Commercial |
$2,690.86
|
| Rate for Payer: First Health Commercial |
$3,079.90
|
| Rate for Payer: Humana Commercial |
$2,755.70
|
| Rate for Payer: Humana KY Medicaid |
$1,114.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,126.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,658.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,392.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$972.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,137.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,852.96
|
| Rate for Payer: Ohio Health Group HMO |
$2,431.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,593.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,820.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,236.98
|
| Rate for Payer: PHCS Commercial |
$3,112.32
|
| Rate for Payer: United Healthcare All Payer |
$2,852.96
|
|
|
PLATE CMF 2.0 L RT LONG
|
Facility
|
IP
|
$1,181.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.36 |
| Max. Negotiated Rate |
$1,133.95 |
| Rate for Payer: Aetna Commercial |
$909.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$921.34
|
| Rate for Payer: Cash Price |
$590.60
|
| Rate for Payer: Cigna Commercial |
$980.40
|
| Rate for Payer: First Health Commercial |
$1,122.14
|
| Rate for Payer: Humana Commercial |
$1,004.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$968.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$871.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,039.46
|
| Rate for Payer: Ohio Health Group HMO |
$885.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,027.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$815.03
|
| Rate for Payer: PHCS Commercial |
$1,133.95
|
| Rate for Payer: United Healthcare All Payer |
$1,039.46
|
|
