|
PLATE MINIMOD 2.4 TALS LL 3H L
|
Facility
|
OP
|
$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 Medicaid |
$1,735.81
|
| 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: Humana KY Medicaid |
$1,735.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.47
|
| 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: Molina Healthcare Medicaid |
$1,770.63
|
| 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
|
|
|
PLATE MINIMOD 2.4 TALS LL 3H R
|
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
|
|
|
PLATE MINIMOD 2.4 TALS LL 3H R
|
Facility
|
OP
|
$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 Medicaid |
$1,735.81
|
| 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: Humana KY Medicaid |
$1,735.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.47
|
| 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: Molina Healthcare Medicaid |
$1,770.63
|
| 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
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H 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
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H L
|
Facility
|
OP
|
$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 Medicaid |
$1,735.81
|
| 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: Humana KY Medicaid |
$1,735.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.47
|
| 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: Molina Healthcare Medicaid |
$1,770.63
|
| 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
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H R
|
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
|
|
|
PLATE MINIMOD 2.4 TALS LL 4H R
|
Facility
|
OP
|
$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 Medicaid |
$1,735.81
|
| 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: Humana KY Medicaid |
$1,735.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,753.47
|
| 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: Molina Healthcare Medicaid |
$1,770.63
|
| 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
|
|
|
PLATE MINIMOD 2.4 TALS MDL L L
|
Facility
|
IP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
|
|
PLATE MINIMOD 2.4 TALS MDL L L
|
Facility
|
OP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem Medicaid |
$1,573.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Humana KY Medicaid |
$1,573.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
|
|
PLATE MINIMOD 2.4 TALS MDL L R
|
Facility
|
IP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
|
|
PLATE MINIMOD 2.4 TALS MDL L R
|
Facility
|
OP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem Medicaid |
$1,573.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Humana KY Medicaid |
$1,573.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
|
|
PLATE MINIMOD 2.4 TALS MDL T L
|
Facility
|
OP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem Medicaid |
$1,573.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Humana KY Medicaid |
$1,573.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
|
|
PLATE MINIMOD 2.4 TALS MDL T L
|
Facility
|
IP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
|
|
PLATE MINIMOD 2.4 TALS MDL T R
|
Facility
|
OP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem Medicaid |
$1,573.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Humana KY Medicaid |
$1,573.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,589.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
|
|
PLATE MINIMOD 2.4 TALS MDL T R
|
Facility
|
IP
|
$4,574.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.67 |
| Max. Negotiated Rate |
$4,391.42 |
| Rate for Payer: Aetna Commercial |
$3,522.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,568.03
|
| Rate for Payer: Cash Price |
$2,287.20
|
| Rate for Payer: Cigna Commercial |
$3,796.75
|
| Rate for Payer: First Health Commercial |
$4,345.68
|
| Rate for Payer: Humana Commercial |
$3,888.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,751.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,025.47
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$914.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$594.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,418.06
|
| Rate for Payer: PHCS Commercial |
$4,391.42
|
| Rate for Payer: United Healthcare All Payer |
$4,025.47
|
|
|
PLATE MINI STR 16H
|
Facility
|
IP
|
$1,911.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.51 |
| Max. Negotiated Rate |
$1,835.17 |
| Rate for Payer: Aetna Commercial |
$1,471.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.08
|
| Rate for Payer: Cash Price |
$955.82
|
| Rate for Payer: Cigna Commercial |
$1,586.66
|
| Rate for Payer: First Health Commercial |
$1,816.06
|
| Rate for Payer: Humana Commercial |
$1,624.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,682.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.61
|
| Rate for Payer: PHCS Commercial |
$1,835.17
|
| Rate for Payer: United Healthcare All Payer |
$1,682.24
|
|
|
PLATE MINI STR 16H
|
Facility
|
OP
|
$1,911.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.51 |
| Max. Negotiated Rate |
$1,835.17 |
| Rate for Payer: Aetna Commercial |
$1,471.96
|
| Rate for Payer: Anthem Medicaid |
$657.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,491.08
|
| Rate for Payer: Cash Price |
$955.82
|
| Rate for Payer: Cigna Commercial |
$1,586.66
|
| Rate for Payer: First Health Commercial |
$1,816.06
|
| Rate for Payer: Humana Commercial |
$1,624.89
|
| Rate for Payer: Humana KY Medicaid |
$657.41
|
| Rate for Payer: Kentucky WC Medicaid |
$664.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,567.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,410.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$573.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$670.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,682.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,433.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$382.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$248.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$592.61
|
| Rate for Payer: PHCS Commercial |
$1,835.17
|
| Rate for Payer: United Healthcare All Payer |
$1,682.24
|
|
|
PLATE MINI STR CONDENSED 16H
|
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 STR CONDENSED 16H
|
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 MIN-MD 1.5 COL 12H*2H L
|
Facility
|
OP
|
$7,006.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.81 |
| Max. Negotiated Rate |
$6,726.01 |
| Rate for Payer: Humana Commercial |
$5,955.32
|
| Rate for Payer: Humana KY Medicaid |
$2,409.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,745.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,165.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.94
|
| Rate for Payer: PHCS Commercial |
$6,726.01
|
| Rate for Payer: United Healthcare All Payer |
$6,165.51
|
| Rate for Payer: Aetna Commercial |
$5,394.82
|
| Rate for Payer: Anthem Medicaid |
$2,409.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.88
|
| Rate for Payer: Cash Price |
$3,503.13
|
| Rate for Payer: Cigna Commercial |
$5,815.20
|
| Rate for Payer: First Health Commercial |
$6,655.95
|
|
|
PLATE MIN-MD 1.5 COL 12H*2H L
|
Facility
|
IP
|
$7,006.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.81 |
| Max. Negotiated Rate |
$6,726.01 |
| Rate for Payer: Aetna Commercial |
$5,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.88
|
| Rate for Payer: Cash Price |
$3,503.13
|
| Rate for Payer: Cigna Commercial |
$5,815.20
|
| Rate for Payer: First Health Commercial |
$6,655.95
|
| Rate for Payer: Humana Commercial |
$5,955.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,745.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,165.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.94
|
| Rate for Payer: PHCS Commercial |
$6,726.01
|
| Rate for Payer: United Healthcare All Payer |
$6,165.51
|
|
|
PLATE MIN-MD 1.5 COL 12H*2H R
|
Facility
|
IP
|
$7,006.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.81 |
| Max. Negotiated Rate |
$6,726.01 |
| Rate for Payer: Aetna Commercial |
$5,394.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.88
|
| Rate for Payer: Cash Price |
$3,503.13
|
| Rate for Payer: Cigna Commercial |
$5,815.20
|
| Rate for Payer: First Health Commercial |
$6,655.95
|
| Rate for Payer: Humana Commercial |
$5,955.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,745.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,165.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.94
|
| Rate for Payer: PHCS Commercial |
$6,726.01
|
| Rate for Payer: United Healthcare All Payer |
$6,165.51
|
|
|
PLATE MIN-MD 1.5 COL 12H*2H R
|
Facility
|
OP
|
$7,006.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$910.81 |
| Max. Negotiated Rate |
$6,726.01 |
| Rate for Payer: Aetna Commercial |
$5,394.82
|
| Rate for Payer: Anthem Medicaid |
$2,409.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.88
|
| Rate for Payer: Cash Price |
$3,503.13
|
| Rate for Payer: Cigna Commercial |
$5,815.20
|
| Rate for Payer: First Health Commercial |
$6,655.95
|
| Rate for Payer: Humana Commercial |
$5,955.32
|
| Rate for Payer: Humana KY Medicaid |
$2,409.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,745.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,165.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,401.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$910.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.94
|
| Rate for Payer: PHCS Commercial |
$6,726.01
|
| Rate for Payer: United Healthcare All Payer |
$6,165.51
|
|
|
PLATE MIN-MD 1.5 COL 6H*2H L
|
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 MIN-MD 1.5 COL 6H*2H L
|
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
|
|
