|
PLATE CMF 2.0 L RT LONG
|
Facility
|
OP
|
$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 Medicaid |
$406.21
|
| 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: Humana KY Medicaid |
$406.21
|
| Rate for Payer: Kentucky WC Medicaid |
$410.35
|
| 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: Molina Healthcare Medicaid |
$414.36
|
| 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
|
|
|
PLATE CMF 2.0 SQ 3*2H
|
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 SQ 3*2H
|
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 ST 16H REG
|
Facility
|
IP
|
$1,748.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.61 |
| Max. Negotiated Rate |
$1,678.75 |
| Rate for Payer: Aetna Commercial |
$1,346.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,363.99
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cigna Commercial |
$1,451.42
|
| Rate for Payer: First Health Commercial |
$1,661.27
|
| Rate for Payer: Humana Commercial |
$1,486.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,433.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,398.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,521.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,206.60
|
| Rate for Payer: PHCS Commercial |
$1,678.75
|
| Rate for Payer: United Healthcare All Payer |
$1,538.86
|
|
|
PLATE CMF 2.0 ST 16H REG
|
Facility
|
OP
|
$1,748.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.61 |
| Max. Negotiated Rate |
$1,678.75 |
| Rate for Payer: Aetna Commercial |
$1,346.50
|
| Rate for Payer: Anthem Medicaid |
$601.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,363.99
|
| Rate for Payer: Cash Price |
$874.35
|
| Rate for Payer: Cigna Commercial |
$1,451.42
|
| Rate for Payer: First Health Commercial |
$1,661.27
|
| Rate for Payer: Humana Commercial |
$1,486.39
|
| Rate for Payer: Humana KY Medicaid |
$601.38
|
| Rate for Payer: Kentucky WC Medicaid |
$607.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,433.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,290.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$613.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,538.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,311.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,398.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,521.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,206.60
|
| Rate for Payer: PHCS Commercial |
$1,678.75
|
| Rate for Payer: United Healthcare All Payer |
$1,538.86
|
|
|
PLATE CMF 2.0 ST 4H MED
|
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
|
|
|
PLATE CMF 2.0 ST 4H MED
|
Facility
|
OP
|
$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 Medicaid |
$406.21
|
| 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: Humana KY Medicaid |
$406.21
|
| Rate for Payer: Kentucky WC Medicaid |
$410.35
|
| 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: Molina Healthcare Medicaid |
$414.36
|
| 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
|
|
|
PLATE CMF 2.0 ST 4H REG
|
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
|
|
|
PLATE CMF 2.0 ST 4H REG
|
Facility
|
OP
|
$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 Medicaid |
$406.21
|
| 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: Humana KY Medicaid |
$406.21
|
| Rate for Payer: Kentucky WC Medicaid |
$410.35
|
| 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: Molina Healthcare Medicaid |
$414.36
|
| 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
|
|
|
PLATE CMF 2.0 ST 6H REG
|
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
|
|
|
PLATE CMF 2.0 ST 6H REG
|
Facility
|
OP
|
$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 Medicaid |
$406.21
|
| 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: Humana KY Medicaid |
$406.21
|
| Rate for Payer: Kentucky WC Medicaid |
$410.35
|
| 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: Molina Healthcare Medicaid |
$414.36
|
| 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
|
|
|
PLATE CMF 2.0 Y 8H
|
Facility
|
IP
|
$1,691.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.46 |
| Max. Negotiated Rate |
$1,623.89 |
| Rate for Payer: Aetna Commercial |
$1,302.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,319.41
|
| Rate for Payer: Cash Price |
$845.78
|
| Rate for Payer: Cigna Commercial |
$1,403.99
|
| Rate for Payer: First Health Commercial |
$1,606.97
|
| Rate for Payer: Humana Commercial |
$1,437.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,387.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,248.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,488.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,268.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,353.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,471.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,167.17
|
| Rate for Payer: PHCS Commercial |
$1,623.89
|
| Rate for Payer: United Healthcare All Payer |
$1,488.56
|
|
|
PLATE CMF 2.0 Y 8H
|
Facility
|
OP
|
$1,691.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.46 |
| Max. Negotiated Rate |
$1,623.89 |
| Rate for Payer: Aetna Commercial |
$1,302.49
|
| Rate for Payer: Anthem Medicaid |
$581.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,319.41
|
| Rate for Payer: Cash Price |
$845.78
|
| Rate for Payer: Cigna Commercial |
$1,403.99
|
| Rate for Payer: First Health Commercial |
$1,606.97
|
| Rate for Payer: Humana Commercial |
$1,437.82
|
| Rate for Payer: Humana KY Medicaid |
$581.72
|
| Rate for Payer: Kentucky WC Medicaid |
$587.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,387.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,248.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$593.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,488.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,268.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,353.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,471.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,167.17
|
| Rate for Payer: PHCS Commercial |
$1,623.89
|
| Rate for Payer: United Healthcare All Payer |
$1,488.56
|
|
|
PLATE CMF 2.3 ANGLE 6H
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ANGLE 6H
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 C 4H
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 C 4H
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 14H
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 14H
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 4H LONG
|
Facility
|
OP
|
$3,261.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.34 |
| Max. Negotiated Rate |
$3,130.68 |
| Rate for Payer: Aetna Commercial |
$2,511.06
|
| Rate for Payer: Anthem Medicaid |
$1,121.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.67
|
| Rate for Payer: Cash Price |
$1,630.56
|
| Rate for Payer: Cigna Commercial |
$2,706.73
|
| Rate for Payer: First Health Commercial |
$3,098.06
|
| Rate for Payer: Humana Commercial |
$2,771.95
|
| Rate for Payer: Humana KY Medicaid |
$1,121.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,132.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,144.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.17
|
| Rate for Payer: PHCS Commercial |
$3,130.68
|
| Rate for Payer: United Healthcare All Payer |
$2,869.79
|
|
|
PLATE CMF 2.3 ST 4H LONG
|
Facility
|
IP
|
$3,261.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.34 |
| Max. Negotiated Rate |
$3,130.68 |
| Rate for Payer: Aetna Commercial |
$2,511.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.67
|
| Rate for Payer: Cash Price |
$1,630.56
|
| Rate for Payer: Cigna Commercial |
$2,706.73
|
| Rate for Payer: First Health Commercial |
$3,098.06
|
| Rate for Payer: Humana Commercial |
$2,771.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.17
|
| Rate for Payer: PHCS Commercial |
$3,130.68
|
| Rate for Payer: United Healthcare All Payer |
$2,869.79
|
|
|
PLATE CMF 2.3 ST 4H MED
|
Facility
|
IP
|
$3,261.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.34 |
| Max. Negotiated Rate |
$3,130.68 |
| Rate for Payer: Aetna Commercial |
$2,511.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.67
|
| Rate for Payer: Cash Price |
$1,630.56
|
| Rate for Payer: Cigna Commercial |
$2,706.73
|
| Rate for Payer: First Health Commercial |
$3,098.06
|
| Rate for Payer: Humana Commercial |
$2,771.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.17
|
| Rate for Payer: PHCS Commercial |
$3,130.68
|
| Rate for Payer: United Healthcare All Payer |
$2,869.79
|
|
|
PLATE CMF 2.3 ST 4H MED
|
Facility
|
OP
|
$3,261.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.34 |
| Max. Negotiated Rate |
$3,130.68 |
| Rate for Payer: Aetna Commercial |
$2,511.06
|
| Rate for Payer: Anthem Medicaid |
$1,121.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.67
|
| Rate for Payer: Cash Price |
$1,630.56
|
| Rate for Payer: Cigna Commercial |
$2,706.73
|
| Rate for Payer: First Health Commercial |
$3,098.06
|
| Rate for Payer: Humana Commercial |
$2,771.95
|
| Rate for Payer: Humana KY Medicaid |
$1,121.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,132.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,144.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.17
|
| Rate for Payer: PHCS Commercial |
$3,130.68
|
| Rate for Payer: United Healthcare All Payer |
$2,869.79
|
|
|
PLATE CMF 2.3 ST 4H SHORT
|
Facility
|
IP
|
$3,261.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.34 |
| Max. Negotiated Rate |
$3,130.68 |
| Rate for Payer: Aetna Commercial |
$2,511.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.67
|
| Rate for Payer: Cash Price |
$1,630.56
|
| Rate for Payer: Cigna Commercial |
$2,706.73
|
| Rate for Payer: First Health Commercial |
$3,098.06
|
| Rate for Payer: Humana Commercial |
$2,771.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.17
|
| Rate for Payer: PHCS Commercial |
$3,130.68
|
| Rate for Payer: United Healthcare All Payer |
$2,869.79
|
|
|
PLATE CMF 2.3 ST 4H SHORT
|
Facility
|
OP
|
$3,261.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.34 |
| Max. Negotiated Rate |
$3,130.68 |
| Rate for Payer: Aetna Commercial |
$2,511.06
|
| Rate for Payer: Anthem Medicaid |
$1,121.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,543.67
|
| Rate for Payer: Cash Price |
$1,630.56
|
| Rate for Payer: Cigna Commercial |
$2,706.73
|
| Rate for Payer: First Health Commercial |
$3,098.06
|
| Rate for Payer: Humana Commercial |
$2,771.95
|
| Rate for Payer: Humana KY Medicaid |
$1,121.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,132.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,674.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,406.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$978.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,144.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,869.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,445.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,608.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,837.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,250.17
|
| Rate for Payer: PHCS Commercial |
$3,130.68
|
| Rate for Payer: United Healthcare All Payer |
$2,869.79
|
|
