|
PLATE TUB 1/3*26M 2HL
|
Facility
|
IP
|
$1,072.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$1,029.83 |
| Rate for Payer: Aetna Commercial |
$826.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$836.74
|
| Rate for Payer: Cash Price |
$536.37
|
| Rate for Payer: Cigna Commercial |
$890.37
|
| Rate for Payer: First Health Commercial |
$1,019.10
|
| Rate for Payer: Humana Commercial |
$911.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$879.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$791.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.01
|
| Rate for Payer: Ohio Health Group HMO |
$804.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.55
|
| Rate for Payer: PHCS Commercial |
$1,029.83
|
| Rate for Payer: United Healthcare All Payer |
$944.01
|
|
|
PLATE TUB 1/3 2H 26MM
|
Facility
|
IP
|
$1,072.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$1,029.83 |
| Rate for Payer: Aetna Commercial |
$826.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$836.74
|
| Rate for Payer: Cash Price |
$536.37
|
| Rate for Payer: Cigna Commercial |
$890.37
|
| Rate for Payer: First Health Commercial |
$1,019.10
|
| Rate for Payer: Humana Commercial |
$911.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$879.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$791.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.01
|
| Rate for Payer: Ohio Health Group HMO |
$804.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.55
|
| Rate for Payer: PHCS Commercial |
$1,029.83
|
| Rate for Payer: United Healthcare All Payer |
$944.01
|
|
|
PLATE TUB 1/3 2H 26MM
|
Facility
|
OP
|
$1,072.74
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$1,029.83 |
| Rate for Payer: Aetna Commercial |
$826.01
|
| Rate for Payer: Anthem Medicaid |
$368.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$836.74
|
| Rate for Payer: Cash Price |
$536.37
|
| Rate for Payer: Cigna Commercial |
$890.37
|
| Rate for Payer: First Health Commercial |
$1,019.10
|
| Rate for Payer: Humana Commercial |
$911.83
|
| Rate for Payer: Humana KY Medicaid |
$368.92
|
| Rate for Payer: Kentucky WC Medicaid |
$372.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$879.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$791.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$321.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$376.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$944.01
|
| Rate for Payer: Ohio Health Group HMO |
$804.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$214.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$139.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$332.55
|
| Rate for Payer: PHCS Commercial |
$1,029.83
|
| Rate for Payer: United Healthcare All Payer |
$944.01
|
|
|
PLATE TUB 1/3*38 3HL
|
Facility
|
IP
|
$1,088.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$1,045.10 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.15
|
| Rate for Payer: Cash Price |
$544.32
|
| Rate for Payer: Cigna Commercial |
$903.58
|
| Rate for Payer: First Health Commercial |
$1,034.22
|
| Rate for Payer: Humana Commercial |
$925.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.01
|
| Rate for Payer: Ohio Health Group HMO |
$816.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.48
|
| Rate for Payer: PHCS Commercial |
$1,045.10
|
| Rate for Payer: United Healthcare All Payer |
$958.01
|
|
|
PLATE TUB 1/3*38 3HL
|
Facility
|
OP
|
$1,088.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$1,045.10 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Anthem Medicaid |
$374.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.15
|
| Rate for Payer: Cash Price |
$544.32
|
| Rate for Payer: Cigna Commercial |
$903.58
|
| Rate for Payer: First Health Commercial |
$1,034.22
|
| Rate for Payer: Humana Commercial |
$925.35
|
| Rate for Payer: Humana KY Medicaid |
$374.39
|
| Rate for Payer: Kentucky WC Medicaid |
$378.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.01
|
| Rate for Payer: Ohio Health Group HMO |
$816.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.48
|
| Rate for Payer: PHCS Commercial |
$1,045.10
|
| Rate for Payer: United Healthcare All Payer |
$958.01
|
|
|
PLATE TUB 1/3 3H 38MM
|
Facility
|
IP
|
$1,088.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$1,045.10 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.15
|
| Rate for Payer: Cash Price |
$544.32
|
| Rate for Payer: Cigna Commercial |
$903.58
|
| Rate for Payer: First Health Commercial |
$1,034.22
|
| Rate for Payer: Humana Commercial |
$925.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.01
|
| Rate for Payer: Ohio Health Group HMO |
$816.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.48
|
| Rate for Payer: PHCS Commercial |
$1,045.10
|
| Rate for Payer: United Healthcare All Payer |
$958.01
|
|
|
PLATE TUB 1/3 3H 38MM
|
Facility
|
OP
|
$1,088.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.52 |
| Max. Negotiated Rate |
$1,045.10 |
| Rate for Payer: Aetna Commercial |
$838.26
|
| Rate for Payer: Anthem Medicaid |
$374.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$849.15
|
| Rate for Payer: Cash Price |
$544.32
|
| Rate for Payer: Cigna Commercial |
$903.58
|
| Rate for Payer: First Health Commercial |
$1,034.22
|
| Rate for Payer: Humana Commercial |
$925.35
|
| Rate for Payer: Humana KY Medicaid |
$374.39
|
| Rate for Payer: Kentucky WC Medicaid |
$378.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$892.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$803.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$326.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$381.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$958.01
|
| Rate for Payer: Ohio Health Group HMO |
$816.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$217.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$337.48
|
| Rate for Payer: PHCS Commercial |
$1,045.10
|
| Rate for Payer: United Healthcare All Payer |
$958.01
|
|
|
PLATE TUB 1/3 4H 50MM
|
Facility
|
IP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Aetna Commercial |
$868.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
|
|
PLATE TUB 1/3 4H 50MM
|
Facility
|
OP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Aetna Commercial |
$868.88
|
| Rate for Payer: Anthem Medicaid |
$388.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Humana KY Medicaid |
$388.06
|
| Rate for Payer: Kentucky WC Medicaid |
$392.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
|
|
PLATE TUB 1/3*50 4HL
|
Facility
|
OP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Aetna Commercial |
$868.88
|
| Rate for Payer: Anthem Medicaid |
$388.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Humana KY Medicaid |
$388.06
|
| Rate for Payer: Kentucky WC Medicaid |
$392.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
|
|
PLATE TUB 1/3*50 4HL
|
Facility
|
IP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Aetna Commercial |
$868.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
|
|
PLATE TUB 1/3 5H 62MM
|
Facility
|
IP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Aetna Commercial |
$868.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
|
|
PLATE TUB 1/3 5H 62MM
|
Facility
|
OP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Anthem Medicaid |
$388.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Humana KY Medicaid |
$388.06
|
| Rate for Payer: Kentucky WC Medicaid |
$392.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
| Rate for Payer: Aetna Commercial |
$868.88
|
|
|
PLATE TUB 1/3*62 5HL
|
Facility
|
OP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Aetna Commercial |
$868.88
|
| Rate for Payer: Anthem Medicaid |
$388.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Humana KY Medicaid |
$388.06
|
| Rate for Payer: Kentucky WC Medicaid |
$392.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$395.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
|
|
PLATE TUB 1/3*62 5HL
|
Facility
|
IP
|
$1,128.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.69 |
| Max. Negotiated Rate |
$1,083.28 |
| Rate for Payer: Aetna Commercial |
$868.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$880.17
|
| Rate for Payer: Cash Price |
$564.21
|
| Rate for Payer: Cigna Commercial |
$936.59
|
| Rate for Payer: First Health Commercial |
$1,072.00
|
| Rate for Payer: Humana Commercial |
$959.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$925.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$832.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$338.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$993.01
|
| Rate for Payer: Ohio Health Group HMO |
$846.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$349.81
|
| Rate for Payer: PHCS Commercial |
$1,083.28
|
| Rate for Payer: United Healthcare All Payer |
$993.01
|
|
|
PLATE TUB 1/3 6H 74MM
|
Facility
|
IP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3 6H 74MM
|
Facility
|
OP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem Medicaid |
$390.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Humana KY Medicaid |
$390.80
|
| Rate for Payer: Kentucky WC Medicaid |
$394.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3*74 6HL
|
Facility
|
IP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3*74 6HL
|
Facility
|
OP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem Medicaid |
$390.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Humana KY Medicaid |
$390.80
|
| Rate for Payer: Kentucky WC Medicaid |
$394.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3 7H 86MM
|
Facility
|
OP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem Medicaid |
$390.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Humana KY Medicaid |
$390.80
|
| Rate for Payer: Kentucky WC Medicaid |
$394.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3 7H 86MM
|
Facility
|
IP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3*86 7HL
|
Facility
|
IP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3*86 7HL
|
Facility
|
OP
|
$1,136.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,090.92 |
| Rate for Payer: Aetna Commercial |
$875.01
|
| Rate for Payer: Anthem Medicaid |
$390.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.38
|
| Rate for Payer: Cash Price |
$568.19
|
| Rate for Payer: Cigna Commercial |
$943.20
|
| Rate for Payer: First Health Commercial |
$1,079.56
|
| Rate for Payer: Humana Commercial |
$965.92
|
| Rate for Payer: Humana KY Medicaid |
$390.80
|
| Rate for Payer: Kentucky WC Medicaid |
$394.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$931.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$838.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$340.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.01
|
| Rate for Payer: Ohio Health Group HMO |
$852.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$227.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$147.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$352.28
|
| Rate for Payer: PHCS Commercial |
$1,090.92
|
| Rate for Payer: United Healthcare All Payer |
$1,000.01
|
|
|
PLATE TUB 1/3 8H 98MM
|
Facility
|
OP
|
$1,144.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$881.14
|
| Rate for Payer: Anthem Medicaid |
$393.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.59
|
| Rate for Payer: Cash Price |
$572.17
|
| Rate for Payer: Cigna Commercial |
$949.80
|
| Rate for Payer: First Health Commercial |
$1,087.12
|
| Rate for Payer: Humana Commercial |
$972.69
|
| Rate for Payer: Humana KY Medicaid |
$393.54
|
| Rate for Payer: Kentucky WC Medicaid |
$397.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$401.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,007.02
|
| Rate for Payer: Ohio Health Group HMO |
$858.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.75
|
| Rate for Payer: PHCS Commercial |
$1,098.57
|
| Rate for Payer: United Healthcare All Payer |
$1,007.02
|
|
|
PLATE TUB 1/3 8H 98MM
|
Facility
|
IP
|
$1,144.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$1,098.57 |
| Rate for Payer: Aetna Commercial |
$881.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$892.59
|
| Rate for Payer: Cash Price |
$572.17
|
| Rate for Payer: Cigna Commercial |
$949.80
|
| Rate for Payer: First Health Commercial |
$1,087.12
|
| Rate for Payer: Humana Commercial |
$972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$938.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$844.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$343.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,007.02
|
| Rate for Payer: Ohio Health Group HMO |
$858.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$228.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$148.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$354.75
|
| Rate for Payer: PHCS Commercial |
$1,098.57
|
| Rate for Payer: United Healthcare All Payer |
$1,007.02
|
|
