|
PLATE MINI 6H WITH BAR
|
Facility
|
IP
|
$2,154.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.13 |
| Max. Negotiated Rate |
$2,068.63 |
| Rate for Payer: Aetna Commercial |
$1,659.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.76
|
| Rate for Payer: Cash Price |
$1,077.41
|
| Rate for Payer: Cigna Commercial |
$1,788.50
|
| Rate for Payer: First Health Commercial |
$2,047.08
|
| Rate for Payer: Humana Commercial |
$1,831.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,766.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.99
|
| Rate for Payer: PHCS Commercial |
$2,068.63
|
| Rate for Payer: United Healthcare All Payer |
$1,896.24
|
|
|
PLATE MINI 6H WITH BAR
|
Facility
|
OP
|
$2,154.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.13 |
| Max. Negotiated Rate |
$2,068.63 |
| Rate for Payer: Aetna Commercial |
$1,659.21
|
| Rate for Payer: Anthem Medicaid |
$741.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.76
|
| Rate for Payer: Cash Price |
$1,077.41
|
| Rate for Payer: Cigna Commercial |
$1,788.50
|
| Rate for Payer: First Health Commercial |
$2,047.08
|
| Rate for Payer: Humana Commercial |
$1,831.60
|
| Rate for Payer: Humana KY Medicaid |
$741.04
|
| Rate for Payer: Kentucky WC Medicaid |
$748.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,766.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$430.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$667.99
|
| Rate for Payer: PHCS Commercial |
$2,068.63
|
| Rate for Payer: United Healthcare All Payer |
$1,896.24
|
|
|
PLATE MINI BLUE 16H STRAIGHT
|
Facility
|
OP
|
$1,895.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.39 |
| Max. Negotiated Rate |
$1,819.49 |
| Rate for Payer: Aetna Commercial |
$1,459.38
|
| Rate for Payer: Anthem Medicaid |
$651.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.33
|
| Rate for Payer: Cash Price |
$947.65
|
| Rate for Payer: Cigna Commercial |
$1,573.10
|
| Rate for Payer: First Health Commercial |
$1,800.54
|
| Rate for Payer: Humana Commercial |
$1,611.00
|
| Rate for Payer: Humana KY Medicaid |
$651.79
|
| Rate for Payer: Kentucky WC Medicaid |
$658.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$664.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.54
|
| Rate for Payer: PHCS Commercial |
$1,819.49
|
| Rate for Payer: United Healthcare All Payer |
$1,667.86
|
|
|
PLATE MINI BLUE 16H STRAIGHT
|
Facility
|
IP
|
$1,895.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.39 |
| Max. Negotiated Rate |
$1,819.49 |
| Rate for Payer: Aetna Commercial |
$1,459.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.33
|
| Rate for Payer: Cash Price |
$947.65
|
| Rate for Payer: Cigna Commercial |
$1,573.10
|
| Rate for Payer: First Health Commercial |
$1,800.54
|
| Rate for Payer: Humana Commercial |
$1,611.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.54
|
| Rate for Payer: PHCS Commercial |
$1,819.49
|
| Rate for Payer: United Healthcare All Payer |
$1,667.86
|
|
|
PLATE MINI BLUE 4H
|
Facility
|
OP
|
$1,838.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.99 |
| Max. Negotiated Rate |
$1,764.88 |
| Rate for Payer: Humana Commercial |
$1,562.66
|
| Rate for Payer: Humana KY Medicaid |
$632.23
|
| Rate for Payer: Kentucky WC Medicaid |
$638.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,507.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,356.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$644.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,617.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,378.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.91
|
| Rate for Payer: PHCS Commercial |
$1,764.88
|
| Rate for Payer: United Healthcare All Payer |
$1,617.81
|
| Rate for Payer: Aetna Commercial |
$1,415.58
|
| Rate for Payer: Anthem Medicaid |
$632.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,433.97
|
| Rate for Payer: Cash Price |
$919.21
|
| Rate for Payer: Cigna Commercial |
$1,525.89
|
| Rate for Payer: First Health Commercial |
$1,746.50
|
|
|
PLATE MINI BLUE 4H
|
Facility
|
IP
|
$1,838.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$238.99 |
| Max. Negotiated Rate |
$1,764.88 |
| Rate for Payer: Aetna Commercial |
$1,415.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,433.97
|
| Rate for Payer: Cash Price |
$919.21
|
| Rate for Payer: Cigna Commercial |
$1,525.89
|
| Rate for Payer: First Health Commercial |
$1,746.50
|
| Rate for Payer: Humana Commercial |
$1,562.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,507.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,356.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$551.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,617.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,378.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$367.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$238.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$569.91
|
| Rate for Payer: PHCS Commercial |
$1,764.88
|
| Rate for Payer: United Healthcare All Payer |
$1,617.81
|
|
|
PLATE MINI BLUE 6H
|
Facility
|
OP
|
$1,739.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.07 |
| Max. Negotiated Rate |
$1,669.47 |
| Rate for Payer: Aetna Commercial |
$1,339.05
|
| Rate for Payer: Anthem Medicaid |
$598.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.44
|
| Rate for Payer: Cash Price |
$869.51
|
| Rate for Payer: Cigna Commercial |
$1,443.39
|
| Rate for Payer: First Health Commercial |
$1,652.08
|
| Rate for Payer: Humana Commercial |
$1,478.18
|
| Rate for Payer: Humana KY Medicaid |
$598.05
|
| Rate for Payer: Kentucky WC Medicaid |
$604.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$610.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.10
|
| Rate for Payer: PHCS Commercial |
$1,669.47
|
| Rate for Payer: United Healthcare All Payer |
$1,530.35
|
|
|
PLATE MINI BLUE 6H
|
Facility
|
IP
|
$1,739.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$226.07 |
| Max. Negotiated Rate |
$1,669.47 |
| Rate for Payer: Aetna Commercial |
$1,339.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,356.44
|
| Rate for Payer: Cash Price |
$869.51
|
| Rate for Payer: Cigna Commercial |
$1,443.39
|
| Rate for Payer: First Health Commercial |
$1,652.08
|
| Rate for Payer: Humana Commercial |
$1,478.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,426.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,283.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$521.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,530.35
|
| Rate for Payer: Ohio Health Group HMO |
$1,304.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$347.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$226.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$539.10
|
| Rate for Payer: PHCS Commercial |
$1,669.47
|
| Rate for Payer: United Healthcare All Payer |
$1,530.35
|
|
|
PLATE MINI-MOD 1.5 COL 6H*2H R
|
Facility
|
OP
|
$5,647.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.13 |
| Max. Negotiated Rate |
$5,421.26 |
| Rate for Payer: Aetna Commercial |
$4,348.31
|
| Rate for Payer: Anthem Medicaid |
$1,942.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,404.78
|
| Rate for Payer: Cash Price |
$2,823.57
|
| Rate for Payer: Cigna Commercial |
$4,687.13
|
| Rate for Payer: First Health Commercial |
$5,364.79
|
| Rate for Payer: Humana Commercial |
$4,800.08
|
| Rate for Payer: Humana KY Medicaid |
$1,942.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,961.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,981.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,969.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,235.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.62
|
| Rate for Payer: PHCS Commercial |
$5,421.26
|
| Rate for Payer: United Healthcare All Payer |
$4,969.49
|
|
|
PLATE MINI-MOD 1.5 COL 6H*2H R
|
Facility
|
IP
|
$5,647.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$734.13 |
| Max. Negotiated Rate |
$5,421.26 |
| Rate for Payer: Aetna Commercial |
$4,348.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,404.78
|
| Rate for Payer: Cash Price |
$2,823.57
|
| Rate for Payer: Cigna Commercial |
$4,687.13
|
| Rate for Payer: First Health Commercial |
$5,364.79
|
| Rate for Payer: Humana Commercial |
$4,800.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,630.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,167.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,694.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,969.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,235.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,129.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$734.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,750.62
|
| Rate for Payer: PHCS Commercial |
$5,421.26
|
| Rate for Payer: United Healthcare All Payer |
$4,969.49
|
|
|
PLATE MINI-MOD 2.0MM STOUT 12H
|
Facility
|
IP
|
$6,883.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.92 |
| Max. Negotiated Rate |
$6,608.62 |
| Rate for Payer: Aetna Commercial |
$5,300.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.50
|
| Rate for Payer: Cash Price |
$3,441.99
|
| Rate for Payer: Cigna Commercial |
$5,713.70
|
| Rate for Payer: First Health Commercial |
$6,539.78
|
| Rate for Payer: Humana Commercial |
$5,851.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,644.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,057.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,162.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.03
|
| Rate for Payer: PHCS Commercial |
$6,608.62
|
| Rate for Payer: United Healthcare All Payer |
$6,057.90
|
|
|
PLATE MINI-MOD 2.0MM STOUT 12H
|
Facility
|
OP
|
$6,883.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$894.92 |
| Max. Negotiated Rate |
$6,608.62 |
| Rate for Payer: Aetna Commercial |
$5,300.66
|
| Rate for Payer: Anthem Medicaid |
$2,367.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,369.50
|
| Rate for Payer: Cash Price |
$3,441.99
|
| Rate for Payer: Cigna Commercial |
$5,713.70
|
| Rate for Payer: First Health Commercial |
$6,539.78
|
| Rate for Payer: Humana Commercial |
$5,851.38
|
| Rate for Payer: Humana KY Medicaid |
$2,367.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,391.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,644.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,080.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,065.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,414.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,057.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,162.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,376.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$894.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,134.03
|
| Rate for Payer: PHCS Commercial |
$6,608.62
|
| Rate for Payer: United Healthcare All Payer |
$6,057.90
|
|
|
PLATE MINI-MOD 2.0MM STOUT 8H
|
Facility
|
IP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE MINI-MOD 2.0MM STOUT 8H
|
Facility
|
OP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem Medicaid |
$1,482.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Humana KY Medicaid |
$1,482.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,512.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE MINI-MOD 2.0 STOUT 6H
|
Facility
|
OP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem Medicaid |
$1,482.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Humana KY Medicaid |
$1,482.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,512.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE MINI-MOD 2.0 STOUT 6H
|
Facility
|
IP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE MINI-MOD 2.4 MESH 12*3H
|
Facility
|
IP
|
$7,532.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.17 |
| Max. Negotiated Rate |
$7,230.76 |
| Rate for Payer: Aetna Commercial |
$5,799.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,874.99
|
| Rate for Payer: Cash Price |
$3,766.02
|
| Rate for Payer: Cigna Commercial |
$6,251.59
|
| Rate for Payer: First Health Commercial |
$7,155.44
|
| Rate for Payer: Humana Commercial |
$6,402.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,176.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,558.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,259.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,628.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,649.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,334.93
|
| Rate for Payer: PHCS Commercial |
$7,230.76
|
| Rate for Payer: United Healthcare All Payer |
$6,628.20
|
|
|
PLATE MINI-MOD 2.4 MESH 12*3H
|
Facility
|
OP
|
$7,532.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.17 |
| Max. Negotiated Rate |
$7,230.76 |
| Rate for Payer: Aetna Commercial |
$5,799.67
|
| Rate for Payer: Anthem Medicaid |
$2,590.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,874.99
|
| Rate for Payer: Cash Price |
$3,766.02
|
| Rate for Payer: Cigna Commercial |
$6,251.59
|
| Rate for Payer: First Health Commercial |
$7,155.44
|
| Rate for Payer: Humana Commercial |
$6,402.23
|
| Rate for Payer: Humana KY Medicaid |
$2,590.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,616.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,176.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,558.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,259.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,642.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,628.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,649.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,334.93
|
| Rate for Payer: PHCS Commercial |
$7,230.76
|
| Rate for Payer: United Healthcare All Payer |
$6,628.20
|
|
|
PLATE MINI-MOD 2.4 STOUT 12H
|
Facility
|
OP
|
$5,529.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.89 |
| Max. Negotiated Rate |
$5,308.70 |
| Rate for Payer: Aetna Commercial |
$4,258.02
|
| Rate for Payer: Anthem Medicaid |
$1,901.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.32
|
| Rate for Payer: Cash Price |
$2,764.95
|
| Rate for Payer: Cigna Commercial |
$4,589.82
|
| Rate for Payer: First Health Commercial |
$5,253.40
|
| Rate for Payer: Humana Commercial |
$4,700.42
|
| Rate for Payer: Humana KY Medicaid |
$1,901.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,939.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,714.27
|
| Rate for Payer: PHCS Commercial |
$5,308.70
|
| Rate for Payer: United Healthcare All Payer |
$4,866.31
|
|
|
PLATE MINI-MOD 2.4 STOUT 12H
|
Facility
|
IP
|
$5,529.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.89 |
| Max. Negotiated Rate |
$5,308.70 |
| Rate for Payer: Aetna Commercial |
$4,258.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.32
|
| Rate for Payer: Cash Price |
$2,764.95
|
| Rate for Payer: Cigna Commercial |
$4,589.82
|
| Rate for Payer: First Health Commercial |
$5,253.40
|
| Rate for Payer: Humana Commercial |
$4,700.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,105.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$718.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,714.27
|
| Rate for Payer: PHCS Commercial |
$5,308.70
|
| Rate for Payer: United Healthcare All Payer |
$4,866.31
|
|
|
PLATE MINI-MOD 2.4 STOUT 6H
|
Facility
|
IP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE MINI-MOD 2.4 STOUT 6H
|
Facility
|
OP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem Medicaid |
$1,482.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Humana KY Medicaid |
$1,482.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,512.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE MINI-MOD 2.4 STOUT 8H
|
Facility
|
IP
|
$4,920.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.63 |
| Max. Negotiated Rate |
$4,723.39 |
| Rate for Payer: Aetna Commercial |
$3,788.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.76
|
| Rate for Payer: Cash Price |
$2,460.10
|
| Rate for Payer: Cigna Commercial |
$4,083.77
|
| Rate for Payer: First Health Commercial |
$4,674.19
|
| Rate for Payer: Humana Commercial |
$4,182.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,034.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,476.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,329.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,690.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$984.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,525.26
|
| Rate for Payer: PHCS Commercial |
$4,723.39
|
| Rate for Payer: United Healthcare All Payer |
$4,329.78
|
|
|
PLATE MINI-MOD 2.4 STOUT 8H
|
Facility
|
OP
|
$4,920.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.63 |
| Max. Negotiated Rate |
$4,723.39 |
| Rate for Payer: Anthem Medicaid |
$1,692.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.76
|
| Rate for Payer: Cash Price |
$2,460.10
|
| Rate for Payer: Cigna Commercial |
$4,083.77
|
| Rate for Payer: First Health Commercial |
$4,674.19
|
| Rate for Payer: Humana Commercial |
$4,182.17
|
| Rate for Payer: Humana KY Medicaid |
$1,692.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,709.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,034.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,631.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,476.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,726.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,329.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,690.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$984.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,525.26
|
| Rate for Payer: PHCS Commercial |
$4,723.39
|
| Rate for Payer: United Healthcare All Payer |
$4,329.78
|
| Rate for Payer: Aetna Commercial |
$3,788.55
|
|
|
PLATE MINIMOD 2.4 TALS LL 3H L
|
Facility
|
IP
|
$5,047.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.16 |
| Max. Negotiated Rate |
$4,845.52 |
| Rate for Payer: Aetna Commercial |
$3,886.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,936.99
|
| Rate for Payer: Cash Price |
$2,523.71
|
| Rate for Payer: Cigna Commercial |
$4,189.36
|
| Rate for Payer: First Health Commercial |
$4,795.05
|
| Rate for Payer: Humana Commercial |
$4,290.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,138.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,725.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,441.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,785.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,564.70
|
| Rate for Payer: PHCS Commercial |
$4,845.52
|
| Rate for Payer: United Healthcare All Payer |
$4,441.73
|
|
