|
PLATE SM CP 3.5MM 7X91MM
|
Facility
|
OP
|
$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 Medicaid |
$678.93
|
| 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: Humana KY Medicaid |
$678.93
|
| Rate for Payer: Kentucky WC Medicaid |
$685.84
|
| 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: Molina Healthcare Medicaid |
$692.56
|
| 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
|
|
|
PLATE SM CP 3.5MM 8X104MM
|
Facility
|
IP
|
$2,024.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.18 |
| Max. Negotiated Rate |
$1,943.47 |
| Rate for Payer: Aetna Commercial |
$1,558.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.07
|
| Rate for Payer: Cash Price |
$1,012.22
|
| Rate for Payer: Cigna Commercial |
$1,680.29
|
| Rate for Payer: First Health Commercial |
$1,923.23
|
| Rate for Payer: Humana Commercial |
$1,720.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.58
|
| Rate for Payer: PHCS Commercial |
$1,943.47
|
| Rate for Payer: United Healthcare All Payer |
$1,781.52
|
|
|
PLATE SM CP 3.5MM 8X104MM
|
Facility
|
OP
|
$2,024.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.18 |
| Max. Negotiated Rate |
$1,943.47 |
| Rate for Payer: Humana Commercial |
$1,720.78
|
| Rate for Payer: Humana KY Medicaid |
$696.21
|
| Rate for Payer: Kentucky WC Medicaid |
$703.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,660.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,494.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.58
|
| Rate for Payer: PHCS Commercial |
$1,943.47
|
| Rate for Payer: United Healthcare All Payer |
$1,781.52
|
| Rate for Payer: Aetna Commercial |
$1,558.83
|
| Rate for Payer: Anthem Medicaid |
$696.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,579.07
|
| Rate for Payer: Cash Price |
$1,012.22
|
| Rate for Payer: Cigna Commercial |
$1,680.29
|
| Rate for Payer: First Health Commercial |
$1,923.23
|
|
|
PLATE SM CP 3.5MM 9X117MM
|
Facility
|
OP
|
$2,038.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.04 |
| Max. Negotiated Rate |
$1,957.25 |
| Rate for Payer: Aetna Commercial |
$1,569.88
|
| Rate for Payer: Anthem Medicaid |
$701.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,590.26
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,692.20
|
| Rate for Payer: First Health Commercial |
$1,936.86
|
| Rate for Payer: Humana Commercial |
$1,732.98
|
| Rate for Payer: Humana KY Medicaid |
$701.14
|
| Rate for Payer: Kentucky WC Medicaid |
$708.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,671.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,504.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,794.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,529.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.03
|
| Rate for Payer: PHCS Commercial |
$1,957.25
|
| Rate for Payer: United Healthcare All Payer |
$1,794.14
|
|
|
PLATE SM CP 3.5MM 9X117MM
|
Facility
|
IP
|
$2,038.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$265.04 |
| Max. Negotiated Rate |
$1,957.25 |
| Rate for Payer: Aetna Commercial |
$1,569.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,590.26
|
| Rate for Payer: Cash Price |
$1,019.40
|
| Rate for Payer: Cigna Commercial |
$1,692.20
|
| Rate for Payer: First Health Commercial |
$1,936.86
|
| Rate for Payer: Humana Commercial |
$1,732.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,671.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,504.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,794.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,529.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$265.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$632.03
|
| Rate for Payer: PHCS Commercial |
$1,957.25
|
| Rate for Payer: United Healthcare All Payer |
$1,794.14
|
|
|
PLATE SM FRAG 10 H 2.7MM 84MM
|
Facility
|
OP
|
$3,254.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.11 |
| Max. Negotiated Rate |
$3,124.53 |
| Rate for Payer: Aetna Commercial |
$2,506.13
|
| Rate for Payer: Anthem Medicaid |
$1,119.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.68
|
| Rate for Payer: Cash Price |
$1,627.36
|
| Rate for Payer: Cigna Commercial |
$2,701.42
|
| Rate for Payer: First Health Commercial |
$3,091.98
|
| Rate for Payer: Humana Commercial |
$2,766.51
|
| Rate for Payer: Humana KY Medicaid |
$1,119.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,130.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,668.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,401.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,141.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,441.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.96
|
| Rate for Payer: PHCS Commercial |
$3,124.53
|
| Rate for Payer: United Healthcare All Payer |
$2,864.15
|
|
|
PLATE SM FRAG 10 H 2.7MM 84MM
|
Facility
|
IP
|
$3,254.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$423.11 |
| Max. Negotiated Rate |
$3,124.53 |
| Rate for Payer: Aetna Commercial |
$2,506.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,538.68
|
| Rate for Payer: Cash Price |
$1,627.36
|
| Rate for Payer: Cigna Commercial |
$2,701.42
|
| Rate for Payer: First Health Commercial |
$3,091.98
|
| Rate for Payer: Humana Commercial |
$2,766.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,668.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,401.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,864.15
|
| Rate for Payer: Ohio Health Group HMO |
$2,441.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$650.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$423.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,008.96
|
| Rate for Payer: PHCS Commercial |
$3,124.53
|
| Rate for Payer: United Healthcare All Payer |
$2,864.15
|
|
|
PLATE SM FRAG 12 H 2.7MM 100MM
|
Facility
|
IP
|
$3,369.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.04 |
| Max. Negotiated Rate |
$3,234.74 |
| Rate for Payer: Aetna Commercial |
$2,594.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,628.23
|
| Rate for Payer: Cash Price |
$1,684.76
|
| Rate for Payer: Cigna Commercial |
$2,796.70
|
| Rate for Payer: First Health Commercial |
$3,201.04
|
| Rate for Payer: Humana Commercial |
$2,864.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,763.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,965.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,527.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.55
|
| Rate for Payer: PHCS Commercial |
$3,234.74
|
| Rate for Payer: United Healthcare All Payer |
$2,965.18
|
|
|
PLATE SM FRAG 12 H 2.7MM 100MM
|
Facility
|
OP
|
$3,369.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$438.04 |
| Max. Negotiated Rate |
$3,234.74 |
| Rate for Payer: Aetna Commercial |
$2,594.53
|
| Rate for Payer: Anthem Medicaid |
$1,158.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,628.23
|
| Rate for Payer: Cash Price |
$1,684.76
|
| Rate for Payer: Cigna Commercial |
$2,796.70
|
| Rate for Payer: First Health Commercial |
$3,201.04
|
| Rate for Payer: Humana Commercial |
$2,864.09
|
| Rate for Payer: Humana KY Medicaid |
$1,158.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,763.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,182.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,965.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,527.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$673.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$438.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,044.55
|
| Rate for Payer: PHCS Commercial |
$3,234.74
|
| Rate for Payer: United Healthcare All Payer |
$2,965.18
|
|
|
PLATE SM FRAG 2 H 2.7MM 20MM
|
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 FRAG 2 H 2.7MM 20MM
|
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 FRAG 2 H 2.7MM 26MM
|
Facility
|
IP
|
$1,967.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.72 |
| Max. Negotiated Rate |
$1,888.37 |
| Rate for Payer: Aetna Commercial |
$1,514.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Cash Price |
$983.52
|
| Rate for Payer: Cigna Commercial |
$1,632.65
|
| Rate for Payer: First Health Commercial |
$1,868.70
|
| Rate for Payer: Humana Commercial |
$1,671.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,451.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.79
|
| Rate for Payer: PHCS Commercial |
$1,888.37
|
| Rate for Payer: United Healthcare All Payer |
$1,731.00
|
|
|
PLATE SM FRAG 2 H 2.7MM 26MM
|
Facility
|
OP
|
$1,967.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.72 |
| Max. Negotiated Rate |
$1,888.37 |
| Rate for Payer: Aetna Commercial |
$1,514.63
|
| Rate for Payer: Anthem Medicaid |
$676.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Cash Price |
$983.52
|
| Rate for Payer: Cigna Commercial |
$1,632.65
|
| Rate for Payer: First Health Commercial |
$1,868.70
|
| Rate for Payer: Humana Commercial |
$1,671.99
|
| Rate for Payer: Humana KY Medicaid |
$676.47
|
| Rate for Payer: Kentucky WC Medicaid |
$683.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,612.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,451.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.29
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.79
|
| Rate for Payer: PHCS Commercial |
$1,888.37
|
| Rate for Payer: United Healthcare All Payer |
$1,731.00
|
|
|
PLATE SM FRAG 4 H 2.7MM 36MM
|
Facility
|
IP
|
$1,823.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.06 |
| Max. Negotiated Rate |
$1,750.61 |
| Rate for Payer: Aetna Commercial |
$1,404.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.37
|
| Rate for Payer: Cash Price |
$911.78
|
| Rate for Payer: Cigna Commercial |
$1,513.55
|
| Rate for Payer: First Health Commercial |
$1,732.37
|
| Rate for Payer: Humana Commercial |
$1,550.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.30
|
| Rate for Payer: PHCS Commercial |
$1,750.61
|
| Rate for Payer: United Healthcare All Payer |
$1,604.72
|
|
|
PLATE SM FRAG 4 H 2.7MM 36MM
|
Facility
|
OP
|
$1,823.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.06 |
| Max. Negotiated Rate |
$1,750.61 |
| Rate for Payer: Aetna Commercial |
$1,404.13
|
| Rate for Payer: Anthem Medicaid |
$627.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.37
|
| Rate for Payer: Cash Price |
$911.78
|
| Rate for Payer: Cigna Commercial |
$1,513.55
|
| Rate for Payer: First Health Commercial |
$1,732.37
|
| Rate for Payer: Humana Commercial |
$1,550.02
|
| Rate for Payer: Humana KY Medicaid |
$627.12
|
| Rate for Payer: Kentucky WC Medicaid |
$633.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.30
|
| Rate for Payer: PHCS Commercial |
$1,750.61
|
| Rate for Payer: United Healthcare All Payer |
$1,604.72
|
|
|
PLATE SM FRAG 5 H 2.7MM 44MM
|
Facility
|
OP
|
$1,916.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$1,840.16 |
| Rate for Payer: Aetna Commercial |
$1,475.96
|
| Rate for Payer: Anthem Medicaid |
$659.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.13
|
| Rate for Payer: Cash Price |
$958.41
|
| Rate for Payer: Cigna Commercial |
$1,590.97
|
| Rate for Payer: First Health Commercial |
$1,820.99
|
| Rate for Payer: Humana Commercial |
$1,629.31
|
| Rate for Payer: Humana KY Medicaid |
$659.20
|
| Rate for Payer: Kentucky WC Medicaid |
$665.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$672.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.22
|
| Rate for Payer: PHCS Commercial |
$1,840.16
|
| Rate for Payer: United Healthcare All Payer |
$1,686.81
|
|
|
PLATE SM FRAG 5 H 2.7MM 44MM
|
Facility
|
IP
|
$1,916.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$1,840.16 |
| Rate for Payer: Aetna Commercial |
$1,475.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.13
|
| Rate for Payer: Cash Price |
$958.41
|
| Rate for Payer: Cigna Commercial |
$1,590.97
|
| Rate for Payer: First Health Commercial |
$1,820.99
|
| Rate for Payer: Humana Commercial |
$1,629.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.22
|
| Rate for Payer: PHCS Commercial |
$1,840.16
|
| Rate for Payer: United Healthcare All Payer |
$1,686.81
|
|
|
PLATE SM FRAG 6 H 2.7MM 52MM
|
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 FRAG 6 H 2.7MM 52MM
|
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 FRAG 7 H 2.7MM 60MM
|
Facility
|
OP
|
$2,031.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.11 |
| Max. Negotiated Rate |
$1,950.36 |
| Rate for Payer: Anthem Medicaid |
$698.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.66
|
| Rate for Payer: Cash Price |
$1,015.81
|
| Rate for Payer: Cigna Commercial |
$1,686.24
|
| Rate for Payer: First Health Commercial |
$1,930.04
|
| Rate for Payer: Humana Commercial |
$1,726.88
|
| Rate for Payer: Humana KY Medicaid |
$698.67
|
| Rate for Payer: Kentucky WC Medicaid |
$705.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,665.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,787.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.80
|
| Rate for Payer: PHCS Commercial |
$1,950.36
|
| Rate for Payer: United Healthcare All Payer |
$1,787.83
|
| Rate for Payer: Aetna Commercial |
$1,564.35
|
|
|
PLATE SM FRAG 7 H 2.7MM 60MM
|
Facility
|
IP
|
$2,031.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.11 |
| Max. Negotiated Rate |
$1,950.36 |
| Rate for Payer: Aetna Commercial |
$1,564.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.66
|
| Rate for Payer: Cash Price |
$1,015.81
|
| Rate for Payer: Cigna Commercial |
$1,686.24
|
| Rate for Payer: First Health Commercial |
$1,930.04
|
| Rate for Payer: Humana Commercial |
$1,726.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,665.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,787.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$406.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$629.80
|
| Rate for Payer: PHCS Commercial |
$1,950.36
|
| Rate for Payer: United Healthcare All Payer |
$1,787.83
|
|
|
PLATE SM FRAG 8 H 2.7MM 68MM
|
Facility
|
OP
|
$2,096.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.51 |
| Max. Negotiated Rate |
$2,012.35 |
| Rate for Payer: Aetna Commercial |
$1,614.07
|
| Rate for Payer: Anthem Medicaid |
$720.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,635.04
|
| Rate for Payer: Cash Price |
$1,048.10
|
| Rate for Payer: Cigna Commercial |
$1,739.85
|
| Rate for Payer: First Health Commercial |
$1,991.39
|
| Rate for Payer: Humana Commercial |
$1,781.77
|
| Rate for Payer: Humana KY Medicaid |
$720.88
|
| Rate for Payer: Kentucky WC Medicaid |
$728.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,718.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,547.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$735.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,844.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,572.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.82
|
| Rate for Payer: PHCS Commercial |
$2,012.35
|
| Rate for Payer: United Healthcare All Payer |
$1,844.66
|
|
|
PLATE SM FRAG 8 H 2.7MM 68MM
|
Facility
|
IP
|
$2,096.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$272.51 |
| Max. Negotiated Rate |
$2,012.35 |
| Rate for Payer: Aetna Commercial |
$1,614.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,635.04
|
| Rate for Payer: Cash Price |
$1,048.10
|
| Rate for Payer: Cigna Commercial |
$1,739.85
|
| Rate for Payer: First Health Commercial |
$1,991.39
|
| Rate for Payer: Humana Commercial |
$1,781.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,718.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,547.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,844.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,572.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$419.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$272.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$649.82
|
| Rate for Payer: PHCS Commercial |
$2,012.35
|
| Rate for Payer: United Healthcare All Payer |
$1,844.66
|
|
|
PLATE SM FRAG 9 H 2.7MM 76MM
|
Facility
|
IP
|
$3,161.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.99 |
| Max. Negotiated Rate |
$3,034.99 |
| Rate for Payer: Aetna Commercial |
$2,434.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.93
|
| Rate for Payer: Cash Price |
$1,580.72
|
| Rate for Payer: Cigna Commercial |
$2,624.00
|
| Rate for Payer: First Health Commercial |
$3,003.38
|
| Rate for Payer: Humana Commercial |
$2,687.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,592.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,782.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.05
|
| Rate for Payer: PHCS Commercial |
$3,034.99
|
| Rate for Payer: United Healthcare All Payer |
$2,782.08
|
|
|
PLATE SM FRAG 9 H 2.7MM 76MM
|
Facility
|
OP
|
$3,161.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$410.99 |
| Max. Negotiated Rate |
$3,034.99 |
| Rate for Payer: Aetna Commercial |
$2,434.32
|
| Rate for Payer: Anthem Medicaid |
$1,087.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.93
|
| Rate for Payer: Cash Price |
$1,580.72
|
| Rate for Payer: Cigna Commercial |
$2,624.00
|
| Rate for Payer: First Health Commercial |
$3,003.38
|
| Rate for Payer: Humana Commercial |
$2,687.23
|
| Rate for Payer: Humana KY Medicaid |
$1,087.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,592.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,333.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,109.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,782.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,371.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$632.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$410.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$980.05
|
| Rate for Payer: PHCS Commercial |
$3,034.99
|
| Rate for Payer: United Healthcare All Payer |
$2,782.08
|
|
