|
PLATE MIDSHIFT COMPRESSION 6H
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESSION 8H
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESSION 8H
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MINI 1.5MM 4H
|
Facility
|
OP
|
$4,314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.82 |
| Max. Negotiated Rate |
$4,141.44 |
| Rate for Payer: Aetna Commercial |
$3,321.78
|
| Rate for Payer: Anthem Medicaid |
$1,483.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,364.92
|
| Rate for Payer: Cash Price |
$2,157.00
|
| Rate for Payer: Cigna Commercial |
$3,580.62
|
| Rate for Payer: First Health Commercial |
$4,098.30
|
| Rate for Payer: Humana Commercial |
$3,666.90
|
| Rate for Payer: Humana KY Medicaid |
$1,483.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,498.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,537.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,183.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,513.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,796.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,337.34
|
| Rate for Payer: PHCS Commercial |
$4,141.44
|
| Rate for Payer: United Healthcare All Payer |
$3,796.32
|
|
|
PLATE MINI 1.5MM 4H
|
Facility
|
IP
|
$4,314.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.82 |
| Max. Negotiated Rate |
$4,141.44 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,537.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,183.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,796.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,235.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,337.34
|
| Rate for Payer: PHCS Commercial |
$4,141.44
|
| Rate for Payer: United Healthcare All Payer |
$3,796.32
|
| Rate for Payer: Aetna Commercial |
$3,321.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,364.92
|
| Rate for Payer: Cash Price |
$2,157.00
|
| Rate for Payer: Cigna Commercial |
$3,580.62
|
| Rate for Payer: First Health Commercial |
$4,098.30
|
| Rate for Payer: Humana Commercial |
$3,666.90
|
|
|
PLATE MINI 1.5MM 4H W/BAR
|
Facility
|
OP
|
$4,660.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.86 |
| Max. Negotiated Rate |
$4,474.08 |
| Rate for Payer: Aetna Commercial |
$3,588.58
|
| Rate for Payer: Anthem Medicaid |
$1,602.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,635.19
|
| Rate for Payer: Cash Price |
$2,330.25
|
| Rate for Payer: Cigna Commercial |
$3,868.22
|
| Rate for Payer: First Health Commercial |
$4,427.48
|
| Rate for Payer: Humana Commercial |
$3,961.42
|
| Rate for Payer: Humana KY Medicaid |
$1,602.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,619.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,821.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,439.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,634.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,101.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,495.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,444.76
|
| Rate for Payer: PHCS Commercial |
$4,474.08
|
| Rate for Payer: United Healthcare All Payer |
$4,101.24
|
|
|
PLATE MINI 1.5MM 4H W/BAR
|
Facility
|
IP
|
$4,660.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.86 |
| Max. Negotiated Rate |
$4,474.08 |
| Rate for Payer: Aetna Commercial |
$3,588.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,635.19
|
| Rate for Payer: Cash Price |
$2,330.25
|
| Rate for Payer: Cigna Commercial |
$3,868.22
|
| Rate for Payer: First Health Commercial |
$4,427.48
|
| Rate for Payer: Humana Commercial |
$3,961.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,821.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,439.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,398.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,101.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,495.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$932.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,444.76
|
| Rate for Payer: PHCS Commercial |
$4,474.08
|
| Rate for Payer: United Healthcare All Payer |
$4,101.24
|
|
|
PLATE MINI 1.5MM 6H
|
Facility
|
IP
|
$5,108.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.10 |
| Max. Negotiated Rate |
$4,904.16 |
| Rate for Payer: Aetna Commercial |
$3,933.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,984.63
|
| Rate for Payer: Cash Price |
$2,554.25
|
| Rate for Payer: Cigna Commercial |
$4,240.06
|
| Rate for Payer: First Health Commercial |
$4,853.08
|
| Rate for Payer: Humana Commercial |
$4,342.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,188.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,770.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,532.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,495.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,831.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,583.64
|
| Rate for Payer: PHCS Commercial |
$4,904.16
|
| Rate for Payer: United Healthcare All Payer |
$4,495.48
|
|
|
PLATE MINI 1.5MM 6H
|
Facility
|
OP
|
$5,108.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.10 |
| Max. Negotiated Rate |
$4,904.16 |
| Rate for Payer: Aetna Commercial |
$3,933.54
|
| Rate for Payer: Anthem Medicaid |
$1,756.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,984.63
|
| Rate for Payer: Cash Price |
$2,554.25
|
| Rate for Payer: Cigna Commercial |
$4,240.06
|
| Rate for Payer: First Health Commercial |
$4,853.08
|
| Rate for Payer: Humana Commercial |
$4,342.22
|
| Rate for Payer: Humana KY Medicaid |
$1,756.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,774.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,188.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,770.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,532.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,792.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,495.48
|
| Rate for Payer: Ohio Health Group HMO |
$3,831.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,021.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$664.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,583.64
|
| Rate for Payer: PHCS Commercial |
$4,904.16
|
| Rate for Payer: United Healthcare All Payer |
$4,495.48
|
|
|
PLATE MINI 16H
|
Facility
|
IP
|
$5,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.79 |
| Max. Negotiated Rate |
$5,263.68 |
| Rate for Payer: Aetna Commercial |
$4,221.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,276.74
|
| Rate for Payer: Cash Price |
$2,741.50
|
| Rate for Payer: Cigna Commercial |
$4,550.89
|
| Rate for Payer: First Health Commercial |
$5,208.85
|
| Rate for Payer: Humana Commercial |
$4,660.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,496.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,046.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,825.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,112.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,096.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$712.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,699.73
|
| Rate for Payer: PHCS Commercial |
$5,263.68
|
| Rate for Payer: United Healthcare All Payer |
$4,825.04
|
|
|
PLATE MINI 16H
|
Facility
|
OP
|
$5,483.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.79 |
| Max. Negotiated Rate |
$5,263.68 |
| Rate for Payer: Aetna Commercial |
$4,221.91
|
| Rate for Payer: Anthem Medicaid |
$1,885.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,276.74
|
| Rate for Payer: Cash Price |
$2,741.50
|
| Rate for Payer: Cigna Commercial |
$4,550.89
|
| Rate for Payer: First Health Commercial |
$5,208.85
|
| Rate for Payer: Humana Commercial |
$4,660.55
|
| Rate for Payer: Humana KY Medicaid |
$1,885.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,904.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,496.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,046.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,644.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,923.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,825.04
|
| Rate for Payer: Ohio Health Group HMO |
$4,112.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,096.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$712.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,699.73
|
| Rate for Payer: PHCS Commercial |
$5,263.68
|
| Rate for Payer: United Healthcare All Payer |
$4,825.04
|
|
|
PLATE MINI 2*3H 3-D RECTANGLE
|
Facility
|
OP
|
$3,313.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.69 |
| Max. Negotiated Rate |
$3,180.51 |
| Rate for Payer: Kentucky WC Medicaid |
$1,150.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,445.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.04
|
| Rate for Payer: PHCS Commercial |
$3,180.51
|
| Rate for Payer: United Healthcare All Payer |
$2,915.47
|
| Rate for Payer: Aetna Commercial |
$2,551.03
|
| Rate for Payer: Anthem Medicaid |
$1,139.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.16
|
| Rate for Payer: Cash Price |
$1,656.52
|
| Rate for Payer: Cigna Commercial |
$2,749.81
|
| Rate for Payer: First Health Commercial |
$3,147.38
|
| Rate for Payer: Humana Commercial |
$2,816.08
|
| Rate for Payer: Humana KY Medicaid |
$1,139.35
|
|
|
PLATE MINI 2*3H 3-D RECTANGLE
|
Facility
|
IP
|
$3,313.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.69 |
| Max. Negotiated Rate |
$3,180.51 |
| Rate for Payer: Aetna Commercial |
$2,551.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,584.16
|
| Rate for Payer: Cash Price |
$1,656.52
|
| Rate for Payer: Cigna Commercial |
$2,749.81
|
| Rate for Payer: First Health Commercial |
$3,147.38
|
| Rate for Payer: Humana Commercial |
$2,816.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,716.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,445.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$993.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,915.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,484.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$662.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,027.04
|
| Rate for Payer: PHCS Commercial |
$3,180.51
|
| Rate for Payer: United Healthcare All Payer |
$2,915.47
|
|
|
PLATE MINI 2*4H 3-D SQUARE
|
Facility
|
IP
|
$3,450.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$3,312.02 |
| Rate for Payer: Aetna Commercial |
$2,656.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.02
|
| Rate for Payer: Cash Price |
$1,725.01
|
| Rate for Payer: Cigna Commercial |
$2,863.52
|
| Rate for Payer: First Health Commercial |
$3,277.52
|
| Rate for Payer: Humana Commercial |
$2,932.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,829.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,546.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,036.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,587.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.51
|
| Rate for Payer: PHCS Commercial |
$3,312.02
|
| Rate for Payer: United Healthcare All Payer |
$3,036.02
|
|
|
PLATE MINI 2*4H 3-D SQUARE
|
Facility
|
OP
|
$3,450.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.50 |
| Max. Negotiated Rate |
$3,312.02 |
| Rate for Payer: Aetna Commercial |
$2,656.52
|
| Rate for Payer: Anthem Medicaid |
$1,186.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,691.02
|
| Rate for Payer: Cash Price |
$1,725.01
|
| Rate for Payer: Cigna Commercial |
$2,863.52
|
| Rate for Payer: First Health Commercial |
$3,277.52
|
| Rate for Payer: Humana Commercial |
$2,932.52
|
| Rate for Payer: Humana KY Medicaid |
$1,186.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,198.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,829.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,546.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,035.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,210.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,036.02
|
| Rate for Payer: Ohio Health Group HMO |
$2,587.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.51
|
| Rate for Payer: PHCS Commercial |
$3,312.02
|
| Rate for Payer: United Healthcare All Payer |
$3,036.02
|
|
|
PLATE MINI 2*6H 3-D CVD SQUARE
|
Facility
|
OP
|
$3,604.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.54 |
| Max. Negotiated Rate |
$3,459.99 |
| Rate for Payer: Aetna Commercial |
$2,775.20
|
| Rate for Payer: Anthem Medicaid |
$1,239.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.24
|
| Rate for Payer: Cash Price |
$1,802.08
|
| Rate for Payer: Cigna Commercial |
$2,991.45
|
| Rate for Payer: First Health Commercial |
$3,423.95
|
| Rate for Payer: Humana Commercial |
$3,063.54
|
| Rate for Payer: Humana KY Medicaid |
$1,239.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,252.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,955.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.29
|
| Rate for Payer: PHCS Commercial |
$3,459.99
|
| Rate for Payer: United Healthcare All Payer |
$3,171.66
|
|
|
PLATE MINI 2*6H 3-D CVD SQUARE
|
Facility
|
IP
|
$3,604.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.54 |
| Max. Negotiated Rate |
$3,459.99 |
| Rate for Payer: Aetna Commercial |
$2,775.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.24
|
| Rate for Payer: Cash Price |
$1,802.08
|
| Rate for Payer: Cigna Commercial |
$2,991.45
|
| Rate for Payer: First Health Commercial |
$3,423.95
|
| Rate for Payer: Humana Commercial |
$3,063.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,955.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,659.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,171.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$720.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.29
|
| Rate for Payer: PHCS Commercial |
$3,459.99
|
| Rate for Payer: United Healthcare All Payer |
$3,171.66
|
|
|
PLATE MINI 4H
|
Facility
|
IP
|
$1,565.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.46 |
| Max. Negotiated Rate |
$1,502.47 |
| Rate for Payer: Aetna Commercial |
$1,205.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.75
|
| Rate for Payer: Cash Price |
$782.54
|
| Rate for Payer: Cigna Commercial |
$1,299.01
|
| Rate for Payer: First Health Commercial |
$1,486.82
|
| Rate for Payer: Humana Commercial |
$1,330.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.17
|
| Rate for Payer: PHCS Commercial |
$1,502.47
|
| Rate for Payer: United Healthcare All Payer |
$1,377.26
|
|
|
PLATE MINI 4H
|
Facility
|
OP
|
$1,565.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.46 |
| Max. Negotiated Rate |
$1,502.47 |
| Rate for Payer: Aetna Commercial |
$1,205.10
|
| Rate for Payer: Anthem Medicaid |
$538.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,220.75
|
| Rate for Payer: Cash Price |
$782.54
|
| Rate for Payer: Cigna Commercial |
$1,299.01
|
| Rate for Payer: First Health Commercial |
$1,486.82
|
| Rate for Payer: Humana Commercial |
$1,330.31
|
| Rate for Payer: Humana KY Medicaid |
$538.23
|
| Rate for Payer: Kentucky WC Medicaid |
$543.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,173.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.17
|
| Rate for Payer: PHCS Commercial |
$1,502.47
|
| Rate for Payer: United Healthcare All Payer |
$1,377.26
|
|
|
PLATE MINI 4H LONG BAR
|
Facility
|
OP
|
$1,772.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.47 |
| Max. Negotiated Rate |
$1,701.96 |
| Rate for Payer: Aetna Commercial |
$1,365.11
|
| Rate for Payer: Anthem Medicaid |
$609.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.84
|
| Rate for Payer: Cash Price |
$886.43
|
| Rate for Payer: Cigna Commercial |
$1,471.48
|
| Rate for Payer: First Health Commercial |
$1,684.23
|
| Rate for Payer: Humana Commercial |
$1,506.94
|
| Rate for Payer: Humana KY Medicaid |
$609.69
|
| Rate for Payer: Kentucky WC Medicaid |
$615.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$621.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.59
|
| Rate for Payer: PHCS Commercial |
$1,701.96
|
| Rate for Payer: United Healthcare All Payer |
$1,560.13
|
|
|
PLATE MINI 4H LONG BAR
|
Facility
|
IP
|
$1,772.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.47 |
| Max. Negotiated Rate |
$1,701.96 |
| Rate for Payer: Aetna Commercial |
$1,365.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,382.84
|
| Rate for Payer: Cash Price |
$886.43
|
| Rate for Payer: Cigna Commercial |
$1,471.48
|
| Rate for Payer: First Health Commercial |
$1,684.23
|
| Rate for Payer: Humana Commercial |
$1,506.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,453.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$531.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,329.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.59
|
| Rate for Payer: PHCS Commercial |
$1,701.96
|
| Rate for Payer: United Healthcare All Payer |
$1,560.13
|
|
|
PLATE MINI 4H SHORT BAR
|
Facility
|
OP
|
$1,709.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$1,641.21 |
| Rate for Payer: Aetna Commercial |
$1,316.38
|
| Rate for Payer: Anthem Medicaid |
$587.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,333.48
|
| Rate for Payer: Cash Price |
$854.80
|
| Rate for Payer: Cigna Commercial |
$1,418.96
|
| Rate for Payer: First Health Commercial |
$1,624.11
|
| Rate for Payer: Humana Commercial |
$1,453.15
|
| Rate for Payer: Humana KY Medicaid |
$587.93
|
| Rate for Payer: Kentucky WC Medicaid |
$593.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,401.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,261.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$599.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,504.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.97
|
| Rate for Payer: PHCS Commercial |
$1,641.21
|
| Rate for Payer: United Healthcare All Payer |
$1,504.44
|
|
|
PLATE MINI 4H SHORT BAR
|
Facility
|
IP
|
$1,709.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.25 |
| Max. Negotiated Rate |
$1,641.21 |
| Rate for Payer: Humana Commercial |
$1,453.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,401.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,261.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,504.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,282.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.97
|
| Rate for Payer: PHCS Commercial |
$1,641.21
|
| Rate for Payer: United Healthcare All Payer |
$1,504.44
|
| Rate for Payer: Aetna Commercial |
$1,316.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,333.48
|
| Rate for Payer: Cash Price |
$854.80
|
| Rate for Payer: Cigna Commercial |
$1,418.96
|
| Rate for Payer: First Health Commercial |
$1,624.11
|
|
|
PLATE MINI 6H
|
Facility
|
IP
|
$1,750.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.59 |
| Max. Negotiated Rate |
$1,680.65 |
| Rate for Payer: Aetna Commercial |
$1,348.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.53
|
| Rate for Payer: Cash Price |
$875.34
|
| Rate for Payer: Cigna Commercial |
$1,453.06
|
| Rate for Payer: First Health Commercial |
$1,663.15
|
| Rate for Payer: Humana Commercial |
$1,488.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,313.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.71
|
| Rate for Payer: PHCS Commercial |
$1,680.65
|
| Rate for Payer: United Healthcare All Payer |
$1,540.60
|
|
|
PLATE MINI 6H
|
Facility
|
OP
|
$1,750.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.59 |
| Max. Negotiated Rate |
$1,680.65 |
| Rate for Payer: Aetna Commercial |
$1,348.02
|
| Rate for Payer: Anthem Medicaid |
$602.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,365.53
|
| Rate for Payer: Cash Price |
$875.34
|
| Rate for Payer: Cigna Commercial |
$1,453.06
|
| Rate for Payer: First Health Commercial |
$1,663.15
|
| Rate for Payer: Humana Commercial |
$1,488.08
|
| Rate for Payer: Humana KY Medicaid |
$602.06
|
| Rate for Payer: Kentucky WC Medicaid |
$608.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,435.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,292.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$525.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$614.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,540.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,313.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$350.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$542.71
|
| Rate for Payer: PHCS Commercial |
$1,680.65
|
| Rate for Payer: United Healthcare All Payer |
$1,540.60
|
|
