|
PLATE SM CP 3.5MM 11X143MM
|
Facility
|
OP
|
$2,060.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,977.91 |
| Rate for Payer: Aetna Commercial |
$1,586.45
|
| Rate for Payer: Anthem Medicaid |
$708.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.05
|
| Rate for Payer: Cash Price |
$1,030.16
|
| Rate for Payer: Cigna Commercial |
$1,710.07
|
| Rate for Payer: First Health Commercial |
$1,957.30
|
| Rate for Payer: Humana Commercial |
$1,751.27
|
| Rate for Payer: Humana KY Medicaid |
$708.54
|
| Rate for Payer: Kentucky WC Medicaid |
$715.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.70
|
| Rate for Payer: PHCS Commercial |
$1,977.91
|
| Rate for Payer: United Healthcare All Payer |
$1,813.08
|
|
|
PLATE SM CP 3.5MM 11X143MM
|
Facility
|
IP
|
$2,060.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,977.91 |
| Rate for Payer: Aetna Commercial |
$1,586.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.05
|
| Rate for Payer: Cash Price |
$1,030.16
|
| Rate for Payer: Cigna Commercial |
$1,710.07
|
| Rate for Payer: First Health Commercial |
$1,957.30
|
| Rate for Payer: Humana Commercial |
$1,751.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.70
|
| Rate for Payer: PHCS Commercial |
$1,977.91
|
| Rate for Payer: United Healthcare All Payer |
$1,813.08
|
|
|
PLATE SM CP 3.5MM 12X156MM
|
Facility
|
OP
|
$2,060.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,977.91 |
| Rate for Payer: Aetna Commercial |
$1,586.45
|
| Rate for Payer: Anthem Medicaid |
$708.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.05
|
| Rate for Payer: Cash Price |
$1,030.16
|
| Rate for Payer: Cigna Commercial |
$1,710.07
|
| Rate for Payer: First Health Commercial |
$1,957.30
|
| Rate for Payer: Humana Commercial |
$1,751.27
|
| Rate for Payer: Humana KY Medicaid |
$708.54
|
| Rate for Payer: Kentucky WC Medicaid |
$715.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.70
|
| Rate for Payer: PHCS Commercial |
$1,977.91
|
| Rate for Payer: United Healthcare All Payer |
$1,813.08
|
|
|
PLATE SM CP 3.5MM 12X156MM
|
Facility
|
IP
|
$2,060.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.84 |
| Max. Negotiated Rate |
$1,977.91 |
| Rate for Payer: Aetna Commercial |
$1,586.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.05
|
| Rate for Payer: Cash Price |
$1,030.16
|
| Rate for Payer: Cigna Commercial |
$1,710.07
|
| Rate for Payer: First Health Commercial |
$1,957.30
|
| Rate for Payer: Humana Commercial |
$1,751.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.08
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.70
|
| Rate for Payer: PHCS Commercial |
$1,977.91
|
| Rate for Payer: United Healthcare All Payer |
$1,813.08
|
|
|
PLATE SM CP 3.5MM 14X182MM
|
Facility
|
IP
|
$3,979.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.32 |
| Max. Negotiated Rate |
$3,820.22 |
| Rate for Payer: Aetna Commercial |
$3,064.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,103.93
|
| Rate for Payer: Cash Price |
$1,989.70
|
| Rate for Payer: Cigna Commercial |
$3,302.90
|
| Rate for Payer: First Health Commercial |
$3,780.43
|
| Rate for Payer: Humana Commercial |
$3,382.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,263.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,936.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,193.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,501.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,984.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.61
|
| Rate for Payer: PHCS Commercial |
$3,820.22
|
| Rate for Payer: United Healthcare All Payer |
$3,501.87
|
|
|
PLATE SM CP 3.5MM 14X182MM
|
Facility
|
OP
|
$3,979.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.32 |
| Max. Negotiated Rate |
$3,820.22 |
| Rate for Payer: Anthem Medicaid |
$1,368.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,103.93
|
| Rate for Payer: Cash Price |
$1,989.70
|
| Rate for Payer: Cigna Commercial |
$3,302.90
|
| Rate for Payer: First Health Commercial |
$3,780.43
|
| Rate for Payer: Humana Commercial |
$3,382.49
|
| Rate for Payer: Humana KY Medicaid |
$1,368.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,382.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,263.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,936.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,193.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,395.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,501.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,984.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$795.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.61
|
| Rate for Payer: PHCS Commercial |
$3,820.22
|
| Rate for Payer: United Healthcare All Payer |
$3,501.87
|
| Rate for Payer: Aetna Commercial |
$3,064.14
|
|
|
PLATE SM CP 3.5MM 15X195MM
|
Facility
|
OP
|
$4,058.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.58 |
| Max. Negotiated Rate |
$3,895.99 |
| Rate for Payer: Aetna Commercial |
$3,124.91
|
| Rate for Payer: Anthem Medicaid |
$1,395.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,165.49
|
| Rate for Payer: Cash Price |
$2,029.16
|
| Rate for Payer: Cigna Commercial |
$3,368.41
|
| Rate for Payer: First Health Commercial |
$3,855.40
|
| Rate for Payer: Humana Commercial |
$3,449.57
|
| Rate for Payer: Humana KY Medicaid |
$1,395.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,409.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,327.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,995.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,217.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,423.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,571.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,043.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.08
|
| Rate for Payer: PHCS Commercial |
$3,895.99
|
| Rate for Payer: United Healthcare All Payer |
$3,571.32
|
|
|
PLATE SM CP 3.5MM 15X195MM
|
Facility
|
IP
|
$4,058.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.58 |
| Max. Negotiated Rate |
$3,895.99 |
| Rate for Payer: Aetna Commercial |
$3,124.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,165.49
|
| Rate for Payer: Cash Price |
$2,029.16
|
| Rate for Payer: Cigna Commercial |
$3,368.41
|
| Rate for Payer: First Health Commercial |
$3,855.40
|
| Rate for Payer: Humana Commercial |
$3,449.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,327.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,995.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,217.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,571.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,043.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$811.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$527.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,258.08
|
| Rate for Payer: PHCS Commercial |
$3,895.99
|
| Rate for Payer: United Healthcare All Payer |
$3,571.32
|
|
|
PLATE SM CP 3.5MM 16X208MM
|
Facility
|
IP
|
$4,252.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.77 |
| Max. Negotiated Rate |
$4,081.97 |
| Rate for Payer: Aetna Commercial |
$3,274.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,316.60
|
| Rate for Payer: Cash Price |
$2,126.02
|
| Rate for Payer: Cigna Commercial |
$3,529.20
|
| Rate for Payer: First Health Commercial |
$4,039.45
|
| Rate for Payer: Humana Commercial |
$3,614.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,486.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,741.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,189.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$850.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.14
|
| Rate for Payer: PHCS Commercial |
$4,081.97
|
| Rate for Payer: United Healthcare All Payer |
$3,741.80
|
|
|
PLATE SM CP 3.5MM 16X208MM
|
Facility
|
OP
|
$4,252.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.77 |
| Max. Negotiated Rate |
$4,081.97 |
| Rate for Payer: Aetna Commercial |
$3,274.08
|
| Rate for Payer: Anthem Medicaid |
$1,462.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,316.60
|
| Rate for Payer: Cash Price |
$2,126.02
|
| Rate for Payer: Cigna Commercial |
$3,529.20
|
| Rate for Payer: First Health Commercial |
$4,039.45
|
| Rate for Payer: Humana Commercial |
$3,614.24
|
| Rate for Payer: Humana KY Medicaid |
$1,462.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,477.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,486.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,138.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,491.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,741.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,189.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$850.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,318.14
|
| Rate for Payer: PHCS Commercial |
$4,081.97
|
| Rate for Payer: United Healthcare All Payer |
$3,741.80
|
|
|
PLATE SM CP 3.5MM 18X234MM
|
Facility
|
OP
|
$4,481.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.61 |
| Max. Negotiated Rate |
$4,302.38 |
| Rate for Payer: Aetna Commercial |
$3,450.87
|
| Rate for Payer: Anthem Medicaid |
$1,541.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.69
|
| Rate for Payer: Cash Price |
$2,240.82
|
| Rate for Payer: Cigna Commercial |
$3,719.77
|
| Rate for Payer: First Health Commercial |
$4,257.57
|
| Rate for Payer: Humana Commercial |
$3,809.40
|
| Rate for Payer: Humana KY Medicaid |
$1,541.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,556.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,572.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.31
|
| Rate for Payer: PHCS Commercial |
$4,302.38
|
| Rate for Payer: United Healthcare All Payer |
$3,943.85
|
|
|
PLATE SM CP 3.5MM 18X234MM
|
Facility
|
IP
|
$4,481.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.61 |
| Max. Negotiated Rate |
$4,302.38 |
| Rate for Payer: Aetna Commercial |
$3,450.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,495.69
|
| Rate for Payer: Cash Price |
$2,240.82
|
| Rate for Payer: Cigna Commercial |
$3,719.77
|
| Rate for Payer: First Health Commercial |
$4,257.57
|
| Rate for Payer: Humana Commercial |
$3,809.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,674.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,307.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,344.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,943.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,361.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$582.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,389.31
|
| Rate for Payer: PHCS Commercial |
$4,302.38
|
| Rate for Payer: United Healthcare All Payer |
$3,943.85
|
|
|
PLATE SM CP 3.5MM 20X260MM
|
Facility
|
IP
|
$4,775.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.86 |
| Max. Negotiated Rate |
$4,584.79 |
| Rate for Payer: Aetna Commercial |
$3,677.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.14
|
| Rate for Payer: Cash Price |
$2,387.91
|
| Rate for Payer: Cigna Commercial |
$3,963.93
|
| Rate for Payer: First Health Commercial |
$4,537.03
|
| Rate for Payer: Humana Commercial |
$4,059.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,581.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.50
|
| Rate for Payer: PHCS Commercial |
$4,584.79
|
| Rate for Payer: United Healthcare All Payer |
$4,202.72
|
|
|
PLATE SM CP 3.5MM 20X260MM
|
Facility
|
OP
|
$4,775.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.86 |
| Max. Negotiated Rate |
$4,584.79 |
| Rate for Payer: Aetna Commercial |
$3,677.38
|
| Rate for Payer: Anthem Medicaid |
$1,642.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,725.14
|
| Rate for Payer: Cash Price |
$2,387.91
|
| Rate for Payer: Cigna Commercial |
$3,963.93
|
| Rate for Payer: First Health Commercial |
$4,537.03
|
| Rate for Payer: Humana Commercial |
$4,059.45
|
| Rate for Payer: Humana KY Medicaid |
$1,642.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,659.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,916.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,581.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,480.50
|
| Rate for Payer: PHCS Commercial |
$4,584.79
|
| Rate for Payer: United Healthcare All Payer |
$4,202.72
|
|
|
PLATE SM CP 3.5MM 2X26MM
|
Facility
|
OP
|
$1,852.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$1,778.16 |
| Rate for Payer: Aetna Commercial |
$1,426.23
|
| Rate for Payer: Anthem Medicaid |
$636.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.76
|
| Rate for Payer: Cash Price |
$926.12
|
| Rate for Payer: Cigna Commercial |
$1,537.37
|
| Rate for Payer: First Health Commercial |
$1,759.64
|
| Rate for Payer: Humana Commercial |
$1,574.41
|
| Rate for Payer: Humana KY Medicaid |
$636.99
|
| Rate for Payer: Kentucky WC Medicaid |
$643.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$649.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.20
|
| Rate for Payer: PHCS Commercial |
$1,778.16
|
| Rate for Payer: United Healthcare All Payer |
$1,629.98
|
|
|
PLATE SM CP 3.5MM 2X26MM
|
Facility
|
IP
|
$1,852.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.79 |
| Max. Negotiated Rate |
$1,778.16 |
| Rate for Payer: Aetna Commercial |
$1,426.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.76
|
| Rate for Payer: Cash Price |
$926.12
|
| Rate for Payer: Cigna Commercial |
$1,537.37
|
| Rate for Payer: First Health Commercial |
$1,759.64
|
| Rate for Payer: Humana Commercial |
$1,574.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$574.20
|
| Rate for Payer: PHCS Commercial |
$1,778.16
|
| Rate for Payer: United Healthcare All Payer |
$1,629.98
|
|
|
PLATE SM CP 3.5MM 3X39MM
|
Facility
|
IP
|
$1,866.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.66 |
| Max. Negotiated Rate |
$1,791.94 |
| Rate for Payer: Aetna Commercial |
$1,437.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,455.95
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: First Health Commercial |
$1,773.27
|
| Rate for Payer: Humana Commercial |
$1,586.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,530.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,377.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,642.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,399.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.65
|
| Rate for Payer: PHCS Commercial |
$1,791.94
|
| Rate for Payer: United Healthcare All Payer |
$1,642.61
|
|
|
PLATE SM CP 3.5MM 3X39MM
|
Facility
|
OP
|
$1,866.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.66 |
| Max. Negotiated Rate |
$1,791.94 |
| Rate for Payer: Aetna Commercial |
$1,437.28
|
| Rate for Payer: Anthem Medicaid |
$641.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,455.95
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: First Health Commercial |
$1,773.27
|
| Rate for Payer: Humana Commercial |
$1,586.61
|
| Rate for Payer: Humana KY Medicaid |
$641.92
|
| Rate for Payer: Kentucky WC Medicaid |
$648.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,530.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,377.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,642.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,399.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.65
|
| Rate for Payer: PHCS Commercial |
$1,791.94
|
| Rate for Payer: United Healthcare All Payer |
$1,642.61
|
|
|
PLATE SM CP 3.5MM 4X52MM
|
Facility
|
OP
|
$1,888.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$1,812.60 |
| Rate for Payer: Aetna Commercial |
$1,453.85
|
| Rate for Payer: Anthem Medicaid |
$649.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.73
|
| Rate for Payer: Cash Price |
$944.06
|
| Rate for Payer: Cigna Commercial |
$1,567.14
|
| Rate for Payer: First Health Commercial |
$1,793.71
|
| Rate for Payer: Humana Commercial |
$1,604.90
|
| Rate for Payer: Humana KY Medicaid |
$649.32
|
| Rate for Payer: Kentucky WC Medicaid |
$655.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.32
|
| Rate for Payer: PHCS Commercial |
$1,812.60
|
| Rate for Payer: United Healthcare All Payer |
$1,661.55
|
|
|
PLATE SM CP 3.5MM 4X52MM
|
Facility
|
IP
|
$1,888.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.46 |
| Max. Negotiated Rate |
$1,812.60 |
| Rate for Payer: Humana Commercial |
$1,604.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,393.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,661.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.32
|
| Rate for Payer: PHCS Commercial |
$1,812.60
|
| Rate for Payer: United Healthcare All Payer |
$1,661.55
|
| Rate for Payer: Aetna Commercial |
$1,453.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.73
|
| Rate for Payer: Cash Price |
$944.06
|
| Rate for Payer: Cigna Commercial |
$1,567.14
|
| Rate for Payer: First Health Commercial |
$1,793.71
|
|
|
PLATE SM CP 3.5MM 5X65MM
|
Facility
|
OP
|
$1,924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem Medicaid |
$661.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Humana KY Medicaid |
$661.66
|
| Rate for Payer: Kentucky WC Medicaid |
$668.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
|
PLATE SM CP 3.5MM 5X65MM
|
Facility
|
IP
|
$1,924.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.12 |
| Max. Negotiated Rate |
$1,847.04 |
| Rate for Payer: Aetna Commercial |
$1,481.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.72
|
| Rate for Payer: Cash Price |
$962.00
|
| Rate for Payer: Cigna Commercial |
$1,596.92
|
| Rate for Payer: First Health Commercial |
$1,827.80
|
| Rate for Payer: Humana Commercial |
$1,635.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,693.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,443.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$384.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$596.44
|
| Rate for Payer: PHCS Commercial |
$1,847.04
|
| Rate for Payer: United Healthcare All Payer |
$1,693.12
|
|
|
PLATE SM CP 3.5MM 6X78MM
|
Facility
|
IP
|
$1,952.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.85 |
| Max. Negotiated Rate |
$1,874.59 |
| Rate for Payer: Aetna Commercial |
$1,503.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.11
|
| Rate for Payer: Cash Price |
$976.35
|
| Rate for Payer: Cigna Commercial |
$1,620.74
|
| Rate for Payer: First Health Commercial |
$1,855.06
|
| Rate for Payer: Humana Commercial |
$1,659.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,718.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.34
|
| Rate for Payer: PHCS Commercial |
$1,874.59
|
| Rate for Payer: United Healthcare All Payer |
$1,718.38
|
|
|
PLATE SM CP 3.5MM 6X78MM
|
Facility
|
OP
|
$1,952.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$253.85 |
| Max. Negotiated Rate |
$1,874.59 |
| Rate for Payer: Aetna Commercial |
$1,503.58
|
| Rate for Payer: Anthem Medicaid |
$671.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,523.11
|
| Rate for Payer: Cash Price |
$976.35
|
| Rate for Payer: Cigna Commercial |
$1,620.74
|
| Rate for Payer: First Health Commercial |
$1,855.06
|
| Rate for Payer: Humana Commercial |
$1,659.80
|
| Rate for Payer: Humana KY Medicaid |
$671.53
|
| Rate for Payer: Kentucky WC Medicaid |
$678.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,601.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,441.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$585.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,718.38
|
| Rate for Payer: Ohio Health Group HMO |
$1,464.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$390.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$253.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$605.34
|
| Rate for Payer: PHCS Commercial |
$1,874.59
|
| Rate for Payer: United Healthcare All Payer |
$1,718.38
|
|
|
PLATE SM CP 3.5MM 7X91MM
|
Facility
|
IP
|
$1,974.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.65 |
| Max. Negotiated Rate |
$1,895.25 |
| Rate for Payer: Aetna Commercial |
$1,520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,539.89
|
| Rate for Payer: Cash Price |
$987.11
|
| Rate for Payer: Cigna Commercial |
$1,638.60
|
| Rate for Payer: First Health Commercial |
$1,875.51
|
| Rate for Payer: Humana Commercial |
$1,678.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,618.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,737.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,480.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.01
|
| Rate for Payer: PHCS Commercial |
$1,895.25
|
| Rate for Payer: United Healthcare All Payer |
$1,737.31
|
|
