|
PLATE PROFYLE COMP L 2.3 6H L
|
Facility
|
IP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP L 2.3 6H R
|
Facility
|
IP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP L 2.3 6H R
|
Facility
|
OP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem Medicaid |
$608.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Humana KY Medicaid |
$608.11
|
| Rate for Payer: Kentucky WC Medicaid |
$614.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP OB L 2.3 6H
|
Facility
|
OP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem Medicaid |
$608.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Humana KY Medicaid |
$608.11
|
| Rate for Payer: Kentucky WC Medicaid |
$614.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP OB L 2.3 6H
|
Facility
|
IP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP ST 2.3 4H
|
Facility
|
OP
|
$1,580.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.45 |
| Max. Negotiated Rate |
$1,517.16 |
| Rate for Payer: Anthem Medicaid |
$543.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.69
|
| Rate for Payer: Cash Price |
$790.18
|
| Rate for Payer: Cigna Commercial |
$1,311.71
|
| Rate for Payer: First Health Commercial |
$1,501.35
|
| Rate for Payer: Humana Commercial |
$1,343.31
|
| Rate for Payer: Humana KY Medicaid |
$543.49
|
| Rate for Payer: Kentucky WC Medicaid |
$549.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.90
|
| Rate for Payer: Aetna Commercial |
$1,216.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.91
|
| Rate for Payer: PHCS Commercial |
$1,517.16
|
| Rate for Payer: United Healthcare All Payer |
$1,390.73
|
|
|
PLATE PROFYLE COMP ST 2.3 4H
|
Facility
|
IP
|
$1,580.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.45 |
| Max. Negotiated Rate |
$1,517.16 |
| Rate for Payer: Aetna Commercial |
$1,216.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.69
|
| Rate for Payer: Cash Price |
$790.18
|
| Rate for Payer: Cigna Commercial |
$1,311.71
|
| Rate for Payer: First Health Commercial |
$1,501.35
|
| Rate for Payer: Humana Commercial |
$1,343.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.91
|
| Rate for Payer: PHCS Commercial |
$1,517.16
|
| Rate for Payer: United Healthcare All Payer |
$1,390.73
|
|
|
PLATE PROFYLE COMP ST 2.3 5H
|
Facility
|
OP
|
$1,580.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.45 |
| Max. Negotiated Rate |
$1,517.16 |
| Rate for Payer: Aetna Commercial |
$1,216.88
|
| Rate for Payer: Anthem Medicaid |
$543.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.69
|
| Rate for Payer: Cash Price |
$790.18
|
| Rate for Payer: Cigna Commercial |
$1,311.71
|
| Rate for Payer: First Health Commercial |
$1,501.35
|
| Rate for Payer: Humana Commercial |
$1,343.31
|
| Rate for Payer: Humana KY Medicaid |
$543.49
|
| Rate for Payer: Kentucky WC Medicaid |
$549.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.91
|
| Rate for Payer: PHCS Commercial |
$1,517.16
|
| Rate for Payer: United Healthcare All Payer |
$1,390.73
|
|
|
PLATE PROFYLE COMP ST 2.3 5H
|
Facility
|
IP
|
$1,580.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.45 |
| Max. Negotiated Rate |
$1,517.16 |
| Rate for Payer: Aetna Commercial |
$1,216.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.69
|
| Rate for Payer: Cash Price |
$790.18
|
| Rate for Payer: Cigna Commercial |
$1,311.71
|
| Rate for Payer: First Health Commercial |
$1,501.35
|
| Rate for Payer: Humana Commercial |
$1,343.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.73
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.91
|
| Rate for Payer: PHCS Commercial |
$1,517.16
|
| Rate for Payer: United Healthcare All Payer |
$1,390.73
|
|
|
PLATE PROFYLE COMP ST 2.3 6H
|
Facility
|
IP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP ST 2.3 6H
|
Facility
|
OP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem Medicaid |
$608.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Humana KY Medicaid |
$608.11
|
| Rate for Payer: Kentucky WC Medicaid |
$614.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP ST 2.3 7H
|
Facility
|
IP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP ST 2.3 7H
|
Facility
|
OP
|
$1,768.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.88 |
| Max. Negotiated Rate |
$1,697.56 |
| Rate for Payer: Aetna Commercial |
$1,361.58
|
| Rate for Payer: Anthem Medicaid |
$608.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,379.27
|
| Rate for Payer: Cash Price |
$884.14
|
| Rate for Payer: Cigna Commercial |
$1,467.68
|
| Rate for Payer: First Health Commercial |
$1,679.88
|
| Rate for Payer: Humana Commercial |
$1,503.05
|
| Rate for Payer: Humana KY Medicaid |
$608.11
|
| Rate for Payer: Kentucky WC Medicaid |
$614.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,450.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,305.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$530.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$620.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,556.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,326.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$353.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$229.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$548.17
|
| Rate for Payer: PHCS Commercial |
$1,697.56
|
| Rate for Payer: United Healthcare All Payer |
$1,556.10
|
|
|
PLATE PROFYLE COMP STR BAR 4H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP STR BAR 4H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP STR BAR 5H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP STR BAR 5H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP STR BAR 6H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP STR BAR 6H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP STR BAR 8H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP STR BAR 8H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE PROFYLE COMP T 2.3 6H L
|
Facility
|
IP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
|
PLATE PROFYLE COMP T 2.3 6H L
|
Facility
|
OP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Anthem Medicaid |
$619.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Humana KY Medicaid |
$619.86
|
| Rate for Payer: Kentucky WC Medicaid |
$626.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
|
PLATE PROFYLE COMP T 2.3 6H R
|
Facility
|
IP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
|
PLATE PROFYLE COMP T 2.3 6H R
|
Facility
|
OP
|
$1,802.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$234.32 |
| Max. Negotiated Rate |
$1,730.34 |
| Rate for Payer: Aetna Commercial |
$1,387.88
|
| Rate for Payer: Anthem Medicaid |
$619.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,405.90
|
| Rate for Payer: Cash Price |
$901.22
|
| Rate for Payer: Cigna Commercial |
$1,496.03
|
| Rate for Payer: First Health Commercial |
$1,712.32
|
| Rate for Payer: Humana Commercial |
$1,532.07
|
| Rate for Payer: Humana KY Medicaid |
$619.86
|
| Rate for Payer: Kentucky WC Medicaid |
$626.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,478.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,330.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$540.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$632.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,586.15
|
| Rate for Payer: Ohio Health Group HMO |
$1,351.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$360.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$234.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$558.76
|
| Rate for Payer: PHCS Commercial |
$1,730.34
|
| Rate for Payer: United Healthcare All Payer |
$1,586.15
|
|
