|
PLATE COMP 3.5*223 16H
|
Facility
|
IP
|
$3,555.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.76 |
| Max. Negotiated Rate |
$3,413.64 |
| Rate for Payer: Aetna Commercial |
$2,738.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,773.59
|
| Rate for Payer: Cash Price |
$1,777.94
|
| Rate for Payer: Cigna Commercial |
$2,951.38
|
| Rate for Payer: First Health Commercial |
$3,378.09
|
| Rate for Payer: Humana Commercial |
$3,022.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,915.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,624.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,129.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,666.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,844.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,093.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,453.56
|
| Rate for Payer: PHCS Commercial |
$3,413.64
|
| Rate for Payer: United Healthcare All Payer |
$3,129.17
|
|
|
PLATE COMP 3.5*223 16H
|
Facility
|
OP
|
$3,555.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.76 |
| Max. Negotiated Rate |
$3,413.64 |
| Rate for Payer: Aetna Commercial |
$2,738.03
|
| Rate for Payer: Anthem Medicaid |
$1,222.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,773.59
|
| Rate for Payer: Cash Price |
$1,777.94
|
| Rate for Payer: Cigna Commercial |
$2,951.38
|
| Rate for Payer: First Health Commercial |
$3,378.09
|
| Rate for Payer: Humana Commercial |
$3,022.50
|
| Rate for Payer: Humana KY Medicaid |
$1,222.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,235.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,915.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,624.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,247.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,129.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,666.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,844.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,093.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,453.56
|
| Rate for Payer: PHCS Commercial |
$3,413.64
|
| Rate for Payer: United Healthcare All Payer |
$3,129.17
|
|
|
PLATE COMP 3.5*249 18H
|
Facility
|
OP
|
$3,713.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.07 |
| Max. Negotiated Rate |
$3,565.02 |
| Rate for Payer: Aetna Commercial |
$2,859.44
|
| Rate for Payer: Anthem Medicaid |
$1,277.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,896.58
|
| Rate for Payer: Cash Price |
$1,856.78
|
| Rate for Payer: Cigna Commercial |
$3,082.25
|
| Rate for Payer: First Health Commercial |
$3,527.88
|
| Rate for Payer: Humana Commercial |
$3,156.53
|
| Rate for Payer: Humana KY Medicaid |
$1,277.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,290.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,740.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,302.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,267.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,785.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,970.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,562.36
|
| Rate for Payer: PHCS Commercial |
$3,565.02
|
| Rate for Payer: United Healthcare All Payer |
$3,267.93
|
|
|
PLATE COMP 3.5*249 18H
|
Facility
|
IP
|
$3,713.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,114.07 |
| Max. Negotiated Rate |
$3,565.02 |
| Rate for Payer: Aetna Commercial |
$2,859.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,896.58
|
| Rate for Payer: Cash Price |
$1,856.78
|
| Rate for Payer: Cigna Commercial |
$3,082.25
|
| Rate for Payer: First Health Commercial |
$3,527.88
|
| Rate for Payer: Humana Commercial |
$3,156.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,740.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,114.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,267.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,785.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,970.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,562.36
|
| Rate for Payer: PHCS Commercial |
$3,565.02
|
| Rate for Payer: United Healthcare All Payer |
$3,267.93
|
|
|
PLATE COMP 3.5*275 20H
|
Facility
|
OP
|
$3,907.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.34 |
| Max. Negotiated Rate |
$3,751.50 |
| Rate for Payer: Aetna Commercial |
$3,009.01
|
| Rate for Payer: Anthem Medicaid |
$1,343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.09
|
| Rate for Payer: Cash Price |
$1,953.91
|
| Rate for Payer: Cigna Commercial |
$3,243.48
|
| Rate for Payer: First Health Commercial |
$3,712.42
|
| Rate for Payer: Humana Commercial |
$3,321.64
|
| Rate for Payer: Humana KY Medicaid |
$1,343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,696.39
|
| Rate for Payer: PHCS Commercial |
$3,751.50
|
| Rate for Payer: United Healthcare All Payer |
$3,438.87
|
|
|
PLATE COMP 3.5*275 20H
|
Facility
|
IP
|
$3,907.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.34 |
| Max. Negotiated Rate |
$3,751.50 |
| Rate for Payer: Aetna Commercial |
$3,009.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.09
|
| Rate for Payer: Cash Price |
$1,953.91
|
| Rate for Payer: Cigna Commercial |
$3,243.48
|
| Rate for Payer: First Health Commercial |
$3,712.42
|
| Rate for Payer: Humana Commercial |
$3,321.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,696.39
|
| Rate for Payer: PHCS Commercial |
$3,751.50
|
| Rate for Payer: United Healthcare All Payer |
$3,438.87
|
|
|
PLATE COMP 3.5*41 2H
|
Facility
|
IP
|
$1,771.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.30 |
| Max. Negotiated Rate |
$1,700.17 |
| Rate for Payer: Aetna Commercial |
$1,363.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.39
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: Cigna Commercial |
$1,469.94
|
| Rate for Payer: First Health Commercial |
$1,682.46
|
| Rate for Payer: Humana Commercial |
$1,505.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.00
|
| Rate for Payer: PHCS Commercial |
$1,700.17
|
| Rate for Payer: United Healthcare All Payer |
$1,558.49
|
|
|
PLATE COMP 3.5*41 2H
|
Facility
|
OP
|
$1,771.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.30 |
| Max. Negotiated Rate |
$1,700.17 |
| Rate for Payer: Aetna Commercial |
$1,363.68
|
| Rate for Payer: Anthem Medicaid |
$609.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,381.39
|
| Rate for Payer: Cash Price |
$885.50
|
| Rate for Payer: Cigna Commercial |
$1,469.94
|
| Rate for Payer: First Health Commercial |
$1,682.46
|
| Rate for Payer: Humana Commercial |
$1,505.36
|
| Rate for Payer: Humana KY Medicaid |
$609.05
|
| Rate for Payer: Kentucky WC Medicaid |
$615.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,452.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,307.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,558.49
|
| Rate for Payer: Ohio Health Group HMO |
$1,328.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,540.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,222.00
|
| Rate for Payer: PHCS Commercial |
$1,700.17
|
| Rate for Payer: United Healthcare All Payer |
$1,558.49
|
|
|
PLATE COMP 3.5*54 3H
|
Facility
|
IP
|
$1,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.52 |
| Max. Negotiated Rate |
$1,713.67 |
| Rate for Payer: Aetna Commercial |
$1,374.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.35
|
| Rate for Payer: Cash Price |
$892.54
|
| Rate for Payer: Cigna Commercial |
$1,481.61
|
| Rate for Payer: First Health Commercial |
$1,695.82
|
| Rate for Payer: Humana Commercial |
$1,517.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,553.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.70
|
| Rate for Payer: PHCS Commercial |
$1,713.67
|
| Rate for Payer: United Healthcare All Payer |
$1,570.86
|
|
|
PLATE COMP 3.5*54 3H
|
Facility
|
OP
|
$1,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.52 |
| Max. Negotiated Rate |
$1,713.67 |
| Rate for Payer: Aetna Commercial |
$1,374.50
|
| Rate for Payer: Anthem Medicaid |
$613.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.35
|
| Rate for Payer: Cash Price |
$892.54
|
| Rate for Payer: Cigna Commercial |
$1,481.61
|
| Rate for Payer: First Health Commercial |
$1,695.82
|
| Rate for Payer: Humana Commercial |
$1,517.31
|
| Rate for Payer: Humana KY Medicaid |
$613.89
|
| Rate for Payer: Kentucky WC Medicaid |
$620.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$626.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,553.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.70
|
| Rate for Payer: PHCS Commercial |
$1,713.67
|
| Rate for Payer: United Healthcare All Payer |
$1,570.86
|
|
|
PLATE COMP 3.5*67 4H
|
Facility
|
IP
|
$1,806.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.85 |
| Max. Negotiated Rate |
$1,733.91 |
| Rate for Payer: Aetna Commercial |
$1,390.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.80
|
| Rate for Payer: Cash Price |
$903.08
|
| Rate for Payer: Cigna Commercial |
$1,499.11
|
| Rate for Payer: First Health Commercial |
$1,715.85
|
| Rate for Payer: Humana Commercial |
$1,535.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.25
|
| Rate for Payer: PHCS Commercial |
$1,733.91
|
| Rate for Payer: United Healthcare All Payer |
$1,589.42
|
|
|
PLATE COMP 3.5*67 4H
|
Facility
|
OP
|
$1,806.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.85 |
| Max. Negotiated Rate |
$1,733.91 |
| Rate for Payer: Aetna Commercial |
$1,390.74
|
| Rate for Payer: Anthem Medicaid |
$621.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.80
|
| Rate for Payer: Cash Price |
$903.08
|
| Rate for Payer: Cigna Commercial |
$1,499.11
|
| Rate for Payer: First Health Commercial |
$1,715.85
|
| Rate for Payer: Humana Commercial |
$1,535.24
|
| Rate for Payer: Humana KY Medicaid |
$621.14
|
| Rate for Payer: Kentucky WC Medicaid |
$627.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.25
|
| Rate for Payer: PHCS Commercial |
$1,733.91
|
| Rate for Payer: United Healthcare All Payer |
$1,589.42
|
|
|
PLATE COMP 3.5*80 5H
|
Facility
|
IP
|
$1,848.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.50 |
| Max. Negotiated Rate |
$1,774.41 |
| Rate for Payer: Aetna Commercial |
$1,423.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,441.71
|
| Rate for Payer: Cash Price |
$924.17
|
| Rate for Payer: Cigna Commercial |
$1,534.12
|
| Rate for Payer: First Health Commercial |
$1,755.92
|
| Rate for Payer: Humana Commercial |
$1,571.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,515.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,626.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.35
|
| Rate for Payer: PHCS Commercial |
$1,774.41
|
| Rate for Payer: United Healthcare All Payer |
$1,626.54
|
|
|
PLATE COMP 3.5*80 5H
|
Facility
|
OP
|
$1,848.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.50 |
| Max. Negotiated Rate |
$1,774.41 |
| Rate for Payer: Aetna Commercial |
$1,423.22
|
| Rate for Payer: Anthem Medicaid |
$635.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,441.71
|
| Rate for Payer: Cash Price |
$924.17
|
| Rate for Payer: Cigna Commercial |
$1,534.12
|
| Rate for Payer: First Health Commercial |
$1,755.92
|
| Rate for Payer: Humana Commercial |
$1,571.09
|
| Rate for Payer: Humana KY Medicaid |
$635.64
|
| Rate for Payer: Kentucky WC Medicaid |
$642.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,515.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,626.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.35
|
| Rate for Payer: PHCS Commercial |
$1,774.41
|
| Rate for Payer: United Healthcare All Payer |
$1,626.54
|
|
|
PLATE COMP 3.5*93 6H
|
Facility
|
OP
|
$1,869.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.83 |
| Max. Negotiated Rate |
$1,794.65 |
| Rate for Payer: Aetna Commercial |
$1,439.46
|
| Rate for Payer: Anthem Medicaid |
$642.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.16
|
| Rate for Payer: Cash Price |
$934.72
|
| Rate for Payer: Cigna Commercial |
$1,551.63
|
| Rate for Payer: First Health Commercial |
$1,775.96
|
| Rate for Payer: Humana Commercial |
$1,589.02
|
| Rate for Payer: Humana KY Medicaid |
$642.90
|
| Rate for Payer: Kentucky WC Medicaid |
$649.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,532.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,379.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$655.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.91
|
| Rate for Payer: PHCS Commercial |
$1,794.65
|
| Rate for Payer: United Healthcare All Payer |
$1,645.10
|
|
|
PLATE COMP 3.5*93 6H
|
Facility
|
IP
|
$1,869.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.83 |
| Max. Negotiated Rate |
$1,794.65 |
| Rate for Payer: Aetna Commercial |
$1,439.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.16
|
| Rate for Payer: Cash Price |
$934.72
|
| Rate for Payer: Cigna Commercial |
$1,551.63
|
| Rate for Payer: First Health Commercial |
$1,775.96
|
| Rate for Payer: Humana Commercial |
$1,589.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,532.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,379.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.91
|
| Rate for Payer: PHCS Commercial |
$1,794.65
|
| Rate for Payer: United Healthcare All Payer |
$1,645.10
|
|
|
PLATE COMP 3.5MM 10H 145MM
|
Facility
|
OP
|
$1,946.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.03 |
| Max. Negotiated Rate |
$1,868.89 |
| Rate for Payer: Aetna Commercial |
$1,499.01
|
| Rate for Payer: Anthem Medicaid |
$669.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,518.47
|
| Rate for Payer: Cash Price |
$973.38
|
| Rate for Payer: Cigna Commercial |
$1,615.81
|
| Rate for Payer: First Health Commercial |
$1,849.42
|
| Rate for Payer: Humana Commercial |
$1,654.75
|
| Rate for Payer: Humana KY Medicaid |
$669.49
|
| Rate for Payer: Kentucky WC Medicaid |
$676.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,596.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,713.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,460.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,557.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.26
|
| Rate for Payer: PHCS Commercial |
$1,868.89
|
| Rate for Payer: United Healthcare All Payer |
$1,713.15
|
|
|
PLATE COMP 3.5MM 10H 145MM
|
Facility
|
IP
|
$1,946.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.03 |
| Max. Negotiated Rate |
$1,868.89 |
| Rate for Payer: Aetna Commercial |
$1,499.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,518.47
|
| Rate for Payer: Cash Price |
$973.38
|
| Rate for Payer: Cigna Commercial |
$1,615.81
|
| Rate for Payer: First Health Commercial |
$1,849.42
|
| Rate for Payer: Humana Commercial |
$1,654.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,596.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$584.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,713.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,460.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,557.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,343.26
|
| Rate for Payer: PHCS Commercial |
$1,868.89
|
| Rate for Payer: United Healthcare All Payer |
$1,713.15
|
|
|
PLATE COMP 3.5MM 3 54MM
|
Facility
|
IP
|
$1,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.52 |
| Max. Negotiated Rate |
$1,713.67 |
| Rate for Payer: Aetna Commercial |
$1,374.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.35
|
| Rate for Payer: Cash Price |
$892.54
|
| Rate for Payer: Cigna Commercial |
$1,481.61
|
| Rate for Payer: First Health Commercial |
$1,695.82
|
| Rate for Payer: Humana Commercial |
$1,517.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,553.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.70
|
| Rate for Payer: PHCS Commercial |
$1,713.67
|
| Rate for Payer: United Healthcare All Payer |
$1,570.86
|
|
|
PLATE COMP 3.5MM 3 54MM
|
Facility
|
OP
|
$1,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$535.52 |
| Max. Negotiated Rate |
$1,713.67 |
| Rate for Payer: Aetna Commercial |
$1,374.50
|
| Rate for Payer: Anthem Medicaid |
$613.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,392.35
|
| Rate for Payer: Cash Price |
$892.54
|
| Rate for Payer: Cigna Commercial |
$1,481.61
|
| Rate for Payer: First Health Commercial |
$1,695.82
|
| Rate for Payer: Humana Commercial |
$1,517.31
|
| Rate for Payer: Humana KY Medicaid |
$613.89
|
| Rate for Payer: Kentucky WC Medicaid |
$620.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,463.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,317.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$535.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$626.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,570.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,338.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,553.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,231.70
|
| Rate for Payer: PHCS Commercial |
$1,713.67
|
| Rate for Payer: United Healthcare All Payer |
$1,570.86
|
|
|
PLATE COMP 3.5MM 4 67MM
|
Facility
|
OP
|
$1,806.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.85 |
| Max. Negotiated Rate |
$1,733.91 |
| Rate for Payer: Aetna Commercial |
$1,390.74
|
| Rate for Payer: Anthem Medicaid |
$621.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.80
|
| Rate for Payer: Cash Price |
$903.08
|
| Rate for Payer: Cigna Commercial |
$1,499.11
|
| Rate for Payer: First Health Commercial |
$1,715.85
|
| Rate for Payer: Humana Commercial |
$1,535.24
|
| Rate for Payer: Humana KY Medicaid |
$621.14
|
| Rate for Payer: Kentucky WC Medicaid |
$627.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.25
|
| Rate for Payer: PHCS Commercial |
$1,733.91
|
| Rate for Payer: United Healthcare All Payer |
$1,589.42
|
|
|
PLATE COMP 3.5MM 4 67MM
|
Facility
|
IP
|
$1,806.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.85 |
| Max. Negotiated Rate |
$1,733.91 |
| Rate for Payer: Aetna Commercial |
$1,390.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.80
|
| Rate for Payer: Cash Price |
$903.08
|
| Rate for Payer: Cigna Commercial |
$1,499.11
|
| Rate for Payer: First Health Commercial |
$1,715.85
|
| Rate for Payer: Humana Commercial |
$1,535.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,332.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,444.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.25
|
| Rate for Payer: PHCS Commercial |
$1,733.91
|
| Rate for Payer: United Healthcare All Payer |
$1,589.42
|
|
|
PLATE COMP 3.5MM 5 80MM
|
Facility
|
OP
|
$1,848.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.50 |
| Max. Negotiated Rate |
$1,774.41 |
| Rate for Payer: Aetna Commercial |
$1,423.22
|
| Rate for Payer: Anthem Medicaid |
$635.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,441.71
|
| Rate for Payer: Cash Price |
$924.17
|
| Rate for Payer: Cigna Commercial |
$1,534.12
|
| Rate for Payer: First Health Commercial |
$1,755.92
|
| Rate for Payer: Humana Commercial |
$1,571.09
|
| Rate for Payer: Humana KY Medicaid |
$635.64
|
| Rate for Payer: Kentucky WC Medicaid |
$642.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,515.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,626.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.35
|
| Rate for Payer: PHCS Commercial |
$1,774.41
|
| Rate for Payer: United Healthcare All Payer |
$1,626.54
|
|
|
PLATE COMP 3.5MM 5 80MM
|
Facility
|
IP
|
$1,848.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$554.50 |
| Max. Negotiated Rate |
$1,774.41 |
| Rate for Payer: Aetna Commercial |
$1,423.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,441.71
|
| Rate for Payer: Cash Price |
$924.17
|
| Rate for Payer: Cigna Commercial |
$1,534.12
|
| Rate for Payer: First Health Commercial |
$1,755.92
|
| Rate for Payer: Humana Commercial |
$1,571.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,515.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,364.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,626.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,478.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,608.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,275.35
|
| Rate for Payer: PHCS Commercial |
$1,774.41
|
| Rate for Payer: United Healthcare All Payer |
$1,626.54
|
|
|
PLATE COMP 3.5MM 6 93MM
|
Facility
|
OP
|
$1,869.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.83 |
| Max. Negotiated Rate |
$1,794.65 |
| Rate for Payer: Aetna Commercial |
$1,439.46
|
| Rate for Payer: Anthem Medicaid |
$642.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,458.16
|
| Rate for Payer: Cash Price |
$934.72
|
| Rate for Payer: Cigna Commercial |
$1,551.63
|
| Rate for Payer: First Health Commercial |
$1,775.96
|
| Rate for Payer: Humana Commercial |
$1,589.02
|
| Rate for Payer: Humana KY Medicaid |
$642.90
|
| Rate for Payer: Kentucky WC Medicaid |
$649.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,532.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,379.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$655.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,645.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,402.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,495.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,626.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.91
|
| Rate for Payer: PHCS Commercial |
$1,794.65
|
| Rate for Payer: United Healthcare All Payer |
$1,645.10
|
|
