|
PLATE MINI 2*6H 3-D CVD SQUARE
|
Facility
|
IP
|
$3,504.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.34 |
| Max. Negotiated Rate |
$3,364.28 |
| Rate for Payer: Aetna Commercial |
$2,698.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.48
|
| Rate for Payer: Cash Price |
$1,752.23
|
| Rate for Payer: Cigna Commercial |
$2,908.70
|
| Rate for Payer: First Health Commercial |
$3,329.24
|
| Rate for Payer: Humana Commercial |
$2,978.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,586.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.08
|
| Rate for Payer: PHCS Commercial |
$3,364.28
|
| Rate for Payer: United Healthcare All Payer |
$3,083.92
|
|
|
PLATE MINI 2*6H 3-D CVD SQUARE
|
Facility
|
OP
|
$3,504.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.34 |
| Max. Negotiated Rate |
$3,364.28 |
| Rate for Payer: Aetna Commercial |
$2,698.43
|
| Rate for Payer: Anthem Medicaid |
$1,205.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.48
|
| Rate for Payer: Cash Price |
$1,752.23
|
| Rate for Payer: Cigna Commercial |
$2,908.70
|
| Rate for Payer: First Health Commercial |
$3,329.24
|
| Rate for Payer: Humana Commercial |
$2,978.79
|
| Rate for Payer: Humana KY Medicaid |
$1,205.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,586.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.08
|
| Rate for Payer: PHCS Commercial |
$3,364.28
|
| Rate for Payer: United Healthcare All Payer |
$3,083.92
|
|
|
PLATE MINI 4H
|
Facility
|
IP
|
$1,542.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.62 |
| Max. Negotiated Rate |
$1,480.40 |
| Rate for Payer: Aetna Commercial |
$1,187.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.82
|
| Rate for Payer: Cash Price |
$771.04
|
| Rate for Payer: Cigna Commercial |
$1,279.93
|
| Rate for Payer: First Health Commercial |
$1,464.98
|
| Rate for Payer: Humana Commercial |
$1,310.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.04
|
| Rate for Payer: PHCS Commercial |
$1,480.40
|
| Rate for Payer: United Healthcare All Payer |
$1,357.03
|
|
|
PLATE MINI 4H
|
Facility
|
OP
|
$1,542.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.62 |
| Max. Negotiated Rate |
$1,480.40 |
| Rate for Payer: Aetna Commercial |
$1,187.40
|
| Rate for Payer: Anthem Medicaid |
$530.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,202.82
|
| Rate for Payer: Cash Price |
$771.04
|
| Rate for Payer: Cigna Commercial |
$1,279.93
|
| Rate for Payer: First Health Commercial |
$1,464.98
|
| Rate for Payer: Humana Commercial |
$1,310.77
|
| Rate for Payer: Humana KY Medicaid |
$530.32
|
| Rate for Payer: Kentucky WC Medicaid |
$535.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,264.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$540.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,156.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,233.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,341.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.04
|
| Rate for Payer: PHCS Commercial |
$1,480.40
|
| Rate for Payer: United Healthcare All Payer |
$1,357.03
|
|
|
PLATE MINI 4H LONG BAR
|
Facility
|
IP
|
$1,759.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.74 |
| Max. Negotiated Rate |
$1,688.76 |
| Rate for Payer: Aetna Commercial |
$1,354.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.11
|
| Rate for Payer: Cash Price |
$879.56
|
| Rate for Payer: Cigna Commercial |
$1,460.07
|
| Rate for Payer: First Health Commercial |
$1,671.16
|
| Rate for Payer: Humana Commercial |
$1,495.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.79
|
| Rate for Payer: PHCS Commercial |
$1,688.76
|
| Rate for Payer: United Healthcare All Payer |
$1,548.03
|
|
|
PLATE MINI 4H LONG BAR
|
Facility
|
OP
|
$1,759.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.74 |
| Max. Negotiated Rate |
$1,688.76 |
| Rate for Payer: Aetna Commercial |
$1,354.52
|
| Rate for Payer: Anthem Medicaid |
$604.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,372.11
|
| Rate for Payer: Cash Price |
$879.56
|
| Rate for Payer: Cigna Commercial |
$1,460.07
|
| Rate for Payer: First Health Commercial |
$1,671.16
|
| Rate for Payer: Humana Commercial |
$1,495.25
|
| Rate for Payer: Humana KY Medicaid |
$604.96
|
| Rate for Payer: Kentucky WC Medicaid |
$611.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,442.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,298.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$527.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$617.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,548.03
|
| Rate for Payer: Ohio Health Group HMO |
$1,319.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,407.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,530.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.79
|
| Rate for Payer: PHCS Commercial |
$1,688.76
|
| Rate for Payer: United Healthcare All Payer |
$1,548.03
|
|
|
PLATE MINI 4H SHORT BAR
|
Facility
|
IP
|
$1,690.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.12 |
| Max. Negotiated Rate |
$1,622.79 |
| Rate for Payer: Aetna Commercial |
$1,301.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.52
|
| Rate for Payer: Cash Price |
$845.21
|
| Rate for Payer: Cigna Commercial |
$1,403.04
|
| Rate for Payer: First Health Commercial |
$1,605.89
|
| Rate for Payer: Humana Commercial |
$1,436.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,352.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.38
|
| Rate for Payer: PHCS Commercial |
$1,622.79
|
| Rate for Payer: United Healthcare All Payer |
$1,487.56
|
|
|
PLATE MINI 4H SHORT BAR
|
Facility
|
OP
|
$1,690.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.12 |
| Max. Negotiated Rate |
$1,622.79 |
| Rate for Payer: Aetna Commercial |
$1,301.62
|
| Rate for Payer: Anthem Medicaid |
$581.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,318.52
|
| Rate for Payer: Cash Price |
$845.21
|
| Rate for Payer: Cigna Commercial |
$1,403.04
|
| Rate for Payer: First Health Commercial |
$1,605.89
|
| Rate for Payer: Humana Commercial |
$1,436.85
|
| Rate for Payer: Humana KY Medicaid |
$581.33
|
| Rate for Payer: Kentucky WC Medicaid |
$587.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,386.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,247.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$507.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$593.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,487.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,267.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,352.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,470.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,166.38
|
| Rate for Payer: PHCS Commercial |
$1,622.79
|
| Rate for Payer: United Healthcare All Payer |
$1,487.56
|
|
|
PLATE MINI 6H
|
Facility
|
OP
|
$1,735.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.51 |
| Max. Negotiated Rate |
$1,665.62 |
| Rate for Payer: Aetna Commercial |
$1,335.97
|
| Rate for Payer: Anthem Medicaid |
$596.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.32
|
| Rate for Payer: Cash Price |
$867.51
|
| Rate for Payer: Cigna Commercial |
$1,440.07
|
| Rate for Payer: First Health Commercial |
$1,648.27
|
| Rate for Payer: Humana Commercial |
$1,474.77
|
| Rate for Payer: Humana KY Medicaid |
$596.67
|
| Rate for Payer: Kentucky WC Medicaid |
$602.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$608.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.16
|
| Rate for Payer: PHCS Commercial |
$1,665.62
|
| Rate for Payer: United Healthcare All Payer |
$1,526.82
|
|
|
PLATE MINI 6H
|
Facility
|
IP
|
$1,735.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.51 |
| Max. Negotiated Rate |
$1,665.62 |
| Rate for Payer: Aetna Commercial |
$1,335.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,353.32
|
| Rate for Payer: Cash Price |
$867.51
|
| Rate for Payer: Cigna Commercial |
$1,440.07
|
| Rate for Payer: First Health Commercial |
$1,648.27
|
| Rate for Payer: Humana Commercial |
$1,474.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,422.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,280.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$520.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,526.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,301.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,388.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,509.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.16
|
| Rate for Payer: PHCS Commercial |
$1,665.62
|
| Rate for Payer: United Healthcare All Payer |
$1,526.82
|
|
|
PLATE MINI 6H WITH BAR
|
Facility
|
IP
|
$2,173.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.14 |
| Max. Negotiated Rate |
$2,086.86 |
| Rate for Payer: Aetna Commercial |
$1,673.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.57
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cigna Commercial |
$1,804.26
|
| Rate for Payer: First Health Commercial |
$2,065.12
|
| Rate for Payer: Humana Commercial |
$1,847.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,912.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,499.93
|
| Rate for Payer: PHCS Commercial |
$2,086.86
|
| Rate for Payer: United Healthcare All Payer |
$1,912.95
|
|
|
PLATE MINI 6H WITH BAR
|
Facility
|
OP
|
$2,173.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.14 |
| Max. Negotiated Rate |
$2,086.86 |
| Rate for Payer: Aetna Commercial |
$1,673.83
|
| Rate for Payer: Anthem Medicaid |
$747.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,695.57
|
| Rate for Payer: Cash Price |
$1,086.90
|
| Rate for Payer: Cigna Commercial |
$1,804.26
|
| Rate for Payer: First Health Commercial |
$2,065.12
|
| Rate for Payer: Humana Commercial |
$1,847.74
|
| Rate for Payer: Humana KY Medicaid |
$747.57
|
| Rate for Payer: Kentucky WC Medicaid |
$755.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,782.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,604.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$762.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,912.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,630.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,739.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,891.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,499.93
|
| Rate for Payer: PHCS Commercial |
$2,086.86
|
| Rate for Payer: United Healthcare All Payer |
$1,912.95
|
|
|
PLATE MINI BLUE 16H STRAIGHT
|
Facility
|
OP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem Medicaid |
$650.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Humana KY Medicaid |
$650.67
|
| Rate for Payer: Kentucky WC Medicaid |
$657.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
PLATE MINI BLUE 16H STRAIGHT
|
Facility
|
IP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
PLATE MINI BLUE 4H
|
Facility
|
OP
|
$1,830.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.09 |
| Max. Negotiated Rate |
$1,757.08 |
| Rate for Payer: Aetna Commercial |
$1,409.32
|
| Rate for Payer: Anthem Medicaid |
$629.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.63
|
| Rate for Payer: Cash Price |
$915.14
|
| Rate for Payer: Cigna Commercial |
$1,519.14
|
| Rate for Payer: First Health Commercial |
$1,738.78
|
| Rate for Payer: Humana Commercial |
$1,555.75
|
| Rate for Payer: Humana KY Medicaid |
$629.44
|
| Rate for Payer: Kentucky WC Medicaid |
$635.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,464.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.90
|
| Rate for Payer: PHCS Commercial |
$1,757.08
|
| Rate for Payer: United Healthcare All Payer |
$1,610.66
|
|
|
PLATE MINI BLUE 4H
|
Facility
|
IP
|
$1,830.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.09 |
| Max. Negotiated Rate |
$1,757.08 |
| Rate for Payer: Aetna Commercial |
$1,409.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,427.63
|
| Rate for Payer: Cash Price |
$915.14
|
| Rate for Payer: Cigna Commercial |
$1,519.14
|
| Rate for Payer: First Health Commercial |
$1,738.78
|
| Rate for Payer: Humana Commercial |
$1,555.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,500.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,350.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,610.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,372.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,464.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,592.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,262.90
|
| Rate for Payer: PHCS Commercial |
$1,757.08
|
| Rate for Payer: United Healthcare All Payer |
$1,610.66
|
|
|
PLATE MINI BLUE 6H
|
Facility
|
IP
|
$1,722.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.71 |
| Max. Negotiated Rate |
$1,653.48 |
| Rate for Payer: Aetna Commercial |
$1,326.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.45
|
| Rate for Payer: Cash Price |
$861.18
|
| Rate for Payer: Cigna Commercial |
$1,429.57
|
| Rate for Payer: First Health Commercial |
$1,636.25
|
| Rate for Payer: Humana Commercial |
$1,464.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,498.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.44
|
| Rate for Payer: PHCS Commercial |
$1,653.48
|
| Rate for Payer: United Healthcare All Payer |
$1,515.69
|
|
|
PLATE MINI BLUE 6H
|
Facility
|
OP
|
$1,722.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.71 |
| Max. Negotiated Rate |
$1,653.48 |
| Rate for Payer: Aetna Commercial |
$1,326.22
|
| Rate for Payer: Anthem Medicaid |
$592.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,343.45
|
| Rate for Payer: Cash Price |
$861.18
|
| Rate for Payer: Cigna Commercial |
$1,429.57
|
| Rate for Payer: First Health Commercial |
$1,636.25
|
| Rate for Payer: Humana Commercial |
$1,464.01
|
| Rate for Payer: Humana KY Medicaid |
$592.32
|
| Rate for Payer: Kentucky WC Medicaid |
$598.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,515.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,291.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,498.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,188.44
|
| Rate for Payer: PHCS Commercial |
$1,653.48
|
| Rate for Payer: United Healthcare All Payer |
$1,515.69
|
|
|
PLATE MINI-MOD 1.5 COL 6H*2H R
|
Facility
|
OP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem Medicaid |
$1,957.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Humana KY Medicaid |
$1,957.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,977.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
|
PLATE MINI-MOD 1.5 COL 6H*2H R
|
Facility
|
IP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
|
PLATE MINI-MOD 2.0MM STOUT 12H
|
Facility
|
OP
|
$7,083.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.19 |
| Max. Negotiated Rate |
$6,800.62 |
| Rate for Payer: Aetna Commercial |
$5,454.66
|
| Rate for Payer: Anthem Medicaid |
$2,436.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.50
|
| Rate for Payer: Cash Price |
$3,541.99
|
| Rate for Payer: Cigna Commercial |
$5,879.70
|
| Rate for Payer: First Health Commercial |
$6,729.78
|
| Rate for Payer: Humana Commercial |
$6,021.38
|
| Rate for Payer: Humana KY Medicaid |
$2,436.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,460.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,808.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,227.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,233.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,887.95
|
| Rate for Payer: PHCS Commercial |
$6,800.62
|
| Rate for Payer: United Healthcare All Payer |
$6,233.90
|
|
|
PLATE MINI-MOD 2.0MM STOUT 12H
|
Facility
|
IP
|
$7,083.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,125.19 |
| Max. Negotiated Rate |
$6,800.62 |
| Rate for Payer: Aetna Commercial |
$5,454.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,525.50
|
| Rate for Payer: Cash Price |
$3,541.99
|
| Rate for Payer: Cigna Commercial |
$5,879.70
|
| Rate for Payer: First Health Commercial |
$6,729.78
|
| Rate for Payer: Humana Commercial |
$6,021.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,808.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,227.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,233.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,312.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,667.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,163.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,887.95
|
| Rate for Payer: PHCS Commercial |
$6,800.62
|
| Rate for Payer: United Healthcare All Payer |
$6,233.90
|
|
|
PLATE MINI-MOD 2.0MM STOUT 8H
|
Facility
|
IP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE MINI-MOD 2.0MM STOUT 8H
|
Facility
|
OP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem Medicaid |
$1,465.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Humana KY Medicaid |
$1,465.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE MINI-MOD 2.0 STOUT 6H
|
Facility
|
OP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem Medicaid |
$1,465.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Humana KY Medicaid |
$1,465.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
