|
PLATE TUB 1/3*98 8HL
|
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: 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
|
| 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
|
|
|
PLATE TUB 1/3*98 8HL
|
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 PF 10H
|
Facility
|
IP
|
$1,723.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,654.18 |
| Rate for Payer: Aetna Commercial |
$1,326.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Cash Price |
$861.55
|
| Rate for Payer: Cigna Commercial |
$1,430.17
|
| Rate for Payer: First Health Commercial |
$1,636.94
|
| Rate for Payer: Humana Commercial |
$1,464.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.16
|
| Rate for Payer: PHCS Commercial |
$1,654.18
|
| Rate for Payer: United Healthcare All Payer |
$1,516.33
|
|
|
PLATE TUB 1/3 PF 10H
|
Facility
|
OP
|
$1,723.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$1,654.18 |
| Rate for Payer: Aetna Commercial |
$1,326.79
|
| Rate for Payer: Anthem Medicaid |
$592.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,344.02
|
| Rate for Payer: Cash Price |
$861.55
|
| Rate for Payer: Cigna Commercial |
$1,430.17
|
| Rate for Payer: First Health Commercial |
$1,636.94
|
| Rate for Payer: Humana Commercial |
$1,464.64
|
| Rate for Payer: Humana KY Medicaid |
$592.57
|
| Rate for Payer: Kentucky WC Medicaid |
$598.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,412.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,271.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$516.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$604.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,516.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$344.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$534.16
|
| Rate for Payer: PHCS Commercial |
$1,654.18
|
| Rate for Payer: United Healthcare All Payer |
$1,516.33
|
|
|
PLATE TUB 1/3 PF 4 H
|
Facility
|
OP
|
$1,558.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.61 |
| Max. Negotiated Rate |
$1,496.19 |
| Rate for Payer: Aetna Commercial |
$1,200.07
|
| Rate for Payer: Anthem Medicaid |
$535.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.65
|
| Rate for Payer: Cash Price |
$779.26
|
| Rate for Payer: Cigna Commercial |
$1,293.58
|
| Rate for Payer: First Health Commercial |
$1,480.60
|
| Rate for Payer: Humana Commercial |
$1,324.75
|
| Rate for Payer: Humana KY Medicaid |
$535.98
|
| Rate for Payer: Kentucky WC Medicaid |
$541.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,277.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,168.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.14
|
| Rate for Payer: PHCS Commercial |
$1,496.19
|
| Rate for Payer: United Healthcare All Payer |
$1,371.51
|
|
|
PLATE TUB 1/3 PF 4 H
|
Facility
|
IP
|
$1,558.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$202.61 |
| Max. Negotiated Rate |
$1,496.19 |
| Rate for Payer: Aetna Commercial |
$1,200.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.65
|
| Rate for Payer: Cash Price |
$779.26
|
| Rate for Payer: Cigna Commercial |
$1,293.58
|
| Rate for Payer: First Health Commercial |
$1,480.60
|
| Rate for Payer: Humana Commercial |
$1,324.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,277.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,168.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$311.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$202.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$483.14
|
| Rate for Payer: PHCS Commercial |
$1,496.19
|
| Rate for Payer: United Healthcare All Payer |
$1,371.51
|
|
|
PLATE TUB 1/3 PF 5H
|
Facility
|
OP
|
$1,580.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.41 |
| Max. Negotiated Rate |
$1,516.85 |
| Rate for Payer: Aetna Commercial |
$1,216.64
|
| Rate for Payer: Anthem Medicaid |
$543.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.44
|
| Rate for Payer: Cash Price |
$790.02
|
| Rate for Payer: Cigna Commercial |
$1,311.44
|
| Rate for Payer: First Health Commercial |
$1,501.05
|
| Rate for Payer: Humana Commercial |
$1,343.04
|
| Rate for Payer: Humana KY Medicaid |
$543.38
|
| Rate for Payer: Kentucky WC Medicaid |
$548.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.82
|
| Rate for Payer: PHCS Commercial |
$1,516.85
|
| Rate for Payer: United Healthcare All Payer |
$1,390.44
|
|
|
PLATE TUB 1/3 PF 5H
|
Facility
|
IP
|
$1,580.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.41 |
| Max. Negotiated Rate |
$1,516.85 |
| Rate for Payer: Aetna Commercial |
$1,216.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,232.44
|
| Rate for Payer: Cash Price |
$790.02
|
| Rate for Payer: Cigna Commercial |
$1,311.44
|
| Rate for Payer: First Health Commercial |
$1,501.05
|
| Rate for Payer: Humana Commercial |
$1,343.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,295.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,166.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,390.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,185.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$489.82
|
| Rate for Payer: PHCS Commercial |
$1,516.85
|
| Rate for Payer: United Healthcare All Payer |
$1,390.44
|
|
|
PLATE TUB 1/3 PF 6H
|
Facility
|
OP
|
$1,565.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.07 |
| Rate for Payer: Humana Commercial |
$1,330.84
|
| Rate for Payer: Humana KY Medicaid |
$538.44
|
| Rate for Payer: Kentucky WC Medicaid |
$543.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.37
|
| Rate for Payer: PHCS Commercial |
$1,503.07
|
| Rate for Payer: United Healthcare All Payer |
$1,377.82
|
| Rate for Payer: Aetna Commercial |
$1,205.59
|
| Rate for Payer: Anthem Medicaid |
$538.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.25
|
| Rate for Payer: Cash Price |
$782.85
|
| Rate for Payer: Cigna Commercial |
$1,299.53
|
| Rate for Payer: First Health Commercial |
$1,487.42
|
|
|
PLATE TUB 1/3 PF 6H
|
Facility
|
IP
|
$1,565.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.07 |
| Rate for Payer: Aetna Commercial |
$1,205.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.25
|
| Rate for Payer: Cash Price |
$782.85
|
| Rate for Payer: Cigna Commercial |
$1,299.53
|
| Rate for Payer: First Health Commercial |
$1,487.42
|
| Rate for Payer: Humana Commercial |
$1,330.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.37
|
| Rate for Payer: PHCS Commercial |
$1,503.07
|
| Rate for Payer: United Healthcare All Payer |
$1,377.82
|
|
|
PLATE TUB 1/3 PF 7H
|
Facility
|
IP
|
$1,594.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$1,530.62 |
| Rate for Payer: Aetna Commercial |
$1,227.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,243.63
|
| Rate for Payer: Cash Price |
$797.20
|
| Rate for Payer: Cigna Commercial |
$1,323.35
|
| Rate for Payer: First Health Commercial |
$1,514.68
|
| Rate for Payer: Humana Commercial |
$1,355.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,307.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,176.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,403.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,195.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.26
|
| Rate for Payer: PHCS Commercial |
$1,530.62
|
| Rate for Payer: United Healthcare All Payer |
$1,403.07
|
|
|
PLATE TUB 1/3 PF 7H
|
Facility
|
OP
|
$1,594.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$1,530.62 |
| Rate for Payer: Aetna Commercial |
$1,227.69
|
| Rate for Payer: Anthem Medicaid |
$548.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,243.63
|
| Rate for Payer: Cash Price |
$797.20
|
| Rate for Payer: Cigna Commercial |
$1,323.35
|
| Rate for Payer: First Health Commercial |
$1,514.68
|
| Rate for Payer: Humana Commercial |
$1,355.24
|
| Rate for Payer: Humana KY Medicaid |
$548.31
|
| Rate for Payer: Kentucky WC Medicaid |
$553.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,307.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,176.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$478.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$559.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,403.07
|
| Rate for Payer: Ohio Health Group HMO |
$1,195.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$318.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$207.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$494.26
|
| Rate for Payer: PHCS Commercial |
$1,530.62
|
| Rate for Payer: United Healthcare All Payer |
$1,403.07
|
|
|
PLATE TUB 1/3 PF 8H
|
Facility
|
OP
|
$1,701.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.21 |
| Max. Negotiated Rate |
$1,633.52 |
| Rate for Payer: Aetna Commercial |
$1,310.22
|
| Rate for Payer: Anthem Medicaid |
$585.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.23
|
| Rate for Payer: Cash Price |
$850.79
|
| Rate for Payer: Cigna Commercial |
$1,412.31
|
| Rate for Payer: First Health Commercial |
$1,616.50
|
| Rate for Payer: Humana Commercial |
$1,446.34
|
| Rate for Payer: Humana KY Medicaid |
$585.17
|
| Rate for Payer: Kentucky WC Medicaid |
$591.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.49
|
| Rate for Payer: PHCS Commercial |
$1,633.52
|
| Rate for Payer: United Healthcare All Payer |
$1,497.39
|
|
|
PLATE TUB 1/3 PF 8H
|
Facility
|
IP
|
$1,701.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.21 |
| Max. Negotiated Rate |
$1,633.52 |
| Rate for Payer: Aetna Commercial |
$1,310.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,327.23
|
| Rate for Payer: Cash Price |
$850.79
|
| Rate for Payer: Cigna Commercial |
$1,412.31
|
| Rate for Payer: First Health Commercial |
$1,616.50
|
| Rate for Payer: Humana Commercial |
$1,446.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,395.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,255.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,497.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.49
|
| Rate for Payer: PHCS Commercial |
$1,633.52
|
| Rate for Payer: United Healthcare All Payer |
$1,497.39
|
|
|
PLATE TUB LCK 3.5MM 10 133MM
|
Facility
|
OP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem Medicaid |
$675.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Humana KY Medicaid |
$675.80
|
| Rate for Payer: Kentucky WC Medicaid |
$682.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$689.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
|
|
PLATE TUB LCK 3.5MM 10 133MM
|
Facility
|
IP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
|
|
PLATE TUB LCK 3.5MM 4 57MM
|
Facility
|
IP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
|
|
PLATE TUB LCK 3.5MM 4 57MM
|
Facility
|
OP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem Medicaid |
$660.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Humana KY Medicaid |
$660.22
|
| Rate for Payer: Kentucky WC Medicaid |
$666.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
|
|
PLATE TUB LCK 3.5MM 5 70MM
|
Facility
|
IP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE TUB LCK 3.5MM 5 70MM
|
Facility
|
OP
|
$1,887.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.36 |
| Max. Negotiated Rate |
$1,811.92 |
| Rate for Payer: Aetna Commercial |
$1,453.31
|
| Rate for Payer: Anthem Medicaid |
$649.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,472.19
|
| Rate for Payer: Cash Price |
$943.71
|
| Rate for Payer: Cigna Commercial |
$1,566.56
|
| Rate for Payer: First Health Commercial |
$1,793.05
|
| Rate for Payer: Humana Commercial |
$1,604.31
|
| Rate for Payer: Humana KY Medicaid |
$649.08
|
| Rate for Payer: Kentucky WC Medicaid |
$655.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,547.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,392.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,660.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,415.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.10
|
| Rate for Payer: PHCS Commercial |
$1,811.92
|
| Rate for Payer: United Healthcare All Payer |
$1,660.93
|
|
|
PLATE TUB LCK 3.5MM 6 82MM
|
Facility
|
OP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem Medicaid |
$660.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Humana KY Medicaid |
$660.22
|
| Rate for Payer: Kentucky WC Medicaid |
$666.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
|
|
PLATE TUB LCK 3.5MM 6 82MM
|
Facility
|
IP
|
$1,919.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.57 |
| Max. Negotiated Rate |
$1,843.01 |
| Rate for Payer: Aetna Commercial |
$1,478.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.44
|
| Rate for Payer: Cash Price |
$959.90
|
| Rate for Payer: Cigna Commercial |
$1,593.43
|
| Rate for Payer: First Health Commercial |
$1,823.81
|
| Rate for Payer: Humana Commercial |
$1,631.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,416.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,439.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$595.14
|
| Rate for Payer: PHCS Commercial |
$1,843.01
|
| Rate for Payer: United Healthcare All Payer |
$1,689.42
|
|
|
PLATE TUB LCK 3.5MM 7 95MM
|
Facility
|
IP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE TUB LCK 3.5MM 7 95MM
|
Facility
|
OP
|
$1,926.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$250.42 |
| Max. Negotiated Rate |
$1,849.23 |
| Rate for Payer: Aetna Commercial |
$1,483.24
|
| Rate for Payer: Anthem Medicaid |
$662.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.50
|
| Rate for Payer: Cash Price |
$963.14
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: First Health Commercial |
$1,829.97
|
| Rate for Payer: Humana Commercial |
$1,637.34
|
| Rate for Payer: Humana KY Medicaid |
$662.45
|
| Rate for Payer: Kentucky WC Medicaid |
$669.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,695.13
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$385.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$250.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$597.15
|
| Rate for Payer: PHCS Commercial |
$1,849.23
|
| Rate for Payer: United Healthcare All Payer |
$1,695.13
|
|
|
PLATE TUB LCK 3.5MM 8 107MM
|
Facility
|
IP
|
$1,965.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.47 |
| Max. Negotiated Rate |
$1,886.52 |
| Rate for Payer: Aetna Commercial |
$1,513.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,532.79
|
| Rate for Payer: Cash Price |
$982.56
|
| Rate for Payer: Cigna Commercial |
$1,631.05
|
| Rate for Payer: First Health Commercial |
$1,866.86
|
| Rate for Payer: Humana Commercial |
$1,670.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,611.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,450.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$589.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,729.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,473.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$609.19
|
| Rate for Payer: PHCS Commercial |
$1,886.52
|
| Rate for Payer: United Healthcare All Payer |
$1,729.31
|
|
