|
PLATE SM CP 3.5MM 20X260MM
|
Facility
|
OP
|
$4,759.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,427.94 |
| Max. Negotiated Rate |
$4,569.42 |
| Rate for Payer: Aetna Commercial |
$3,665.05
|
| Rate for Payer: Anthem Medicaid |
$1,636.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.65
|
| Rate for Payer: Cash Price |
$2,379.91
|
| Rate for Payer: Cigna Commercial |
$3,950.64
|
| Rate for Payer: First Health Commercial |
$4,521.82
|
| Rate for Payer: Humana Commercial |
$4,045.84
|
| Rate for Payer: Humana KY Medicaid |
$1,636.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,653.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,427.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,669.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,569.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,807.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.27
|
| Rate for Payer: PHCS Commercial |
$4,569.42
|
| Rate for Payer: United Healthcare All Payer |
$4,188.63
|
|
|
PLATE SM CP 3.5MM 2X26MM
|
Facility
|
OP
|
$1,845.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.59 |
| Max. Negotiated Rate |
$1,771.49 |
| Rate for Payer: Aetna Commercial |
$1,420.88
|
| Rate for Payer: Anthem Medicaid |
$634.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.33
|
| Rate for Payer: Cash Price |
$922.65
|
| Rate for Payer: Cigna Commercial |
$1,531.60
|
| Rate for Payer: First Health Commercial |
$1,753.04
|
| Rate for Payer: Humana Commercial |
$1,568.51
|
| Rate for Payer: Humana KY Medicaid |
$634.60
|
| Rate for Payer: Kentucky WC Medicaid |
$641.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,513.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$647.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,273.26
|
| Rate for Payer: PHCS Commercial |
$1,771.49
|
| Rate for Payer: United Healthcare All Payer |
$1,623.86
|
|
|
PLATE SM CP 3.5MM 2X26MM
|
Facility
|
IP
|
$1,845.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.59 |
| Max. Negotiated Rate |
$1,771.49 |
| Rate for Payer: Aetna Commercial |
$1,420.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,439.33
|
| Rate for Payer: Cash Price |
$922.65
|
| Rate for Payer: Cigna Commercial |
$1,531.60
|
| Rate for Payer: First Health Commercial |
$1,753.04
|
| Rate for Payer: Humana Commercial |
$1,568.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,513.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,361.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$553.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,623.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,383.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,273.26
|
| Rate for Payer: PHCS Commercial |
$1,771.49
|
| Rate for Payer: United Healthcare All Payer |
$1,623.86
|
|
|
PLATE SM CP 3.5MM 3X39MM
|
Facility
|
OP
|
$1,860.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.26 |
| Max. Negotiated Rate |
$1,786.44 |
| Rate for Payer: Aetna Commercial |
$1,432.88
|
| Rate for Payer: Anthem Medicaid |
$639.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,451.49
|
| Rate for Payer: Cash Price |
$930.44
|
| Rate for Payer: Cigna Commercial |
$1,544.53
|
| Rate for Payer: First Health Commercial |
$1,767.84
|
| Rate for Payer: Humana Commercial |
$1,581.75
|
| Rate for Payer: Humana KY Medicaid |
$639.96
|
| Rate for Payer: Kentucky WC Medicaid |
$646.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,373.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,637.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.01
|
| Rate for Payer: PHCS Commercial |
$1,786.44
|
| Rate for Payer: United Healthcare All Payer |
$1,637.57
|
|
|
PLATE SM CP 3.5MM 3X39MM
|
Facility
|
IP
|
$1,860.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.26 |
| Max. Negotiated Rate |
$1,786.44 |
| Rate for Payer: Aetna Commercial |
$1,432.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,451.49
|
| Rate for Payer: Cash Price |
$930.44
|
| Rate for Payer: Cigna Commercial |
$1,544.53
|
| Rate for Payer: First Health Commercial |
$1,767.84
|
| Rate for Payer: Humana Commercial |
$1,581.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,373.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,637.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.01
|
| Rate for Payer: PHCS Commercial |
$1,786.44
|
| Rate for Payer: United Healthcare All Payer |
$1,637.57
|
|
|
PLATE SM CP 3.5MM 4X52MM
|
Facility
|
IP
|
$1,884.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.27 |
| Max. Negotiated Rate |
$1,808.88 |
| Rate for Payer: Aetna Commercial |
$1,450.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.71
|
| Rate for Payer: Cash Price |
$942.12
|
| Rate for Payer: Cigna Commercial |
$1,563.93
|
| Rate for Payer: First Health Commercial |
$1,790.04
|
| Rate for Payer: Humana Commercial |
$1,601.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.13
|
| Rate for Payer: PHCS Commercial |
$1,808.88
|
| Rate for Payer: United Healthcare All Payer |
$1,658.14
|
|
|
PLATE SM CP 3.5MM 4X52MM
|
Facility
|
OP
|
$1,884.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.27 |
| Max. Negotiated Rate |
$1,808.88 |
| Rate for Payer: Aetna Commercial |
$1,450.87
|
| Rate for Payer: Anthem Medicaid |
$647.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.71
|
| Rate for Payer: Cash Price |
$942.12
|
| Rate for Payer: Cigna Commercial |
$1,563.93
|
| Rate for Payer: First Health Commercial |
$1,790.04
|
| Rate for Payer: Humana Commercial |
$1,601.61
|
| Rate for Payer: Humana KY Medicaid |
$647.99
|
| Rate for Payer: Kentucky WC Medicaid |
$654.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,639.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.13
|
| Rate for Payer: PHCS Commercial |
$1,808.88
|
| Rate for Payer: United Healthcare All Payer |
$1,658.14
|
|
|
PLATE SM CP 3.5MM 5X65MM
|
Facility
|
IP
|
$1,923.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$1,846.27 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.10
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cigna Commercial |
$1,596.26
|
| Rate for Payer: First Health Commercial |
$1,827.04
|
| Rate for Payer: Humana Commercial |
$1,634.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.01
|
| Rate for Payer: PHCS Commercial |
$1,846.27
|
| Rate for Payer: United Healthcare All Payer |
$1,692.42
|
|
|
PLATE SM CP 3.5MM 5X65MM
|
Facility
|
OP
|
$1,923.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.96 |
| Max. Negotiated Rate |
$1,846.27 |
| Rate for Payer: Aetna Commercial |
$1,480.86
|
| Rate for Payer: Anthem Medicaid |
$661.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,500.10
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cigna Commercial |
$1,596.26
|
| Rate for Payer: First Health Commercial |
$1,827.04
|
| Rate for Payer: Humana Commercial |
$1,634.72
|
| Rate for Payer: Humana KY Medicaid |
$661.39
|
| Rate for Payer: Kentucky WC Medicaid |
$668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,577.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,419.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$674.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,692.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,442.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,673.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.01
|
| Rate for Payer: PHCS Commercial |
$1,846.27
|
| Rate for Payer: United Healthcare All Payer |
$1,692.42
|
|
|
PLATE SM CP 3.5MM 6X78MM
|
Facility
|
OP
|
$1,954.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.31 |
| Max. Negotiated Rate |
$1,876.19 |
| Rate for Payer: Aetna Commercial |
$1,504.86
|
| Rate for Payer: Anthem Medicaid |
$672.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,524.40
|
| Rate for Payer: Cash Price |
$977.18
|
| Rate for Payer: Cigna Commercial |
$1,622.12
|
| Rate for Payer: First Health Commercial |
$1,856.64
|
| Rate for Payer: Humana Commercial |
$1,661.21
|
| Rate for Payer: Humana KY Medicaid |
$672.10
|
| Rate for Payer: Kentucky WC Medicaid |
$678.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,602.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,442.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,700.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.51
|
| Rate for Payer: PHCS Commercial |
$1,876.19
|
| Rate for Payer: United Healthcare All Payer |
$1,719.84
|
|
|
PLATE SM CP 3.5MM 6X78MM
|
Facility
|
IP
|
$1,954.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.31 |
| Max. Negotiated Rate |
$1,876.19 |
| Rate for Payer: Aetna Commercial |
$1,504.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,524.40
|
| Rate for Payer: Cash Price |
$977.18
|
| Rate for Payer: Cigna Commercial |
$1,622.12
|
| Rate for Payer: First Health Commercial |
$1,856.64
|
| Rate for Payer: Humana Commercial |
$1,661.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,602.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,442.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,700.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.51
|
| Rate for Payer: PHCS Commercial |
$1,876.19
|
| Rate for Payer: United Healthcare All Payer |
$1,719.84
|
|
|
PLATE SM CP 3.5MM 7X91MM
|
Facility
|
OP
|
$1,977.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.32 |
| Max. Negotiated Rate |
$1,898.62 |
| Rate for Payer: Aetna Commercial |
$1,522.85
|
| Rate for Payer: Anthem Medicaid |
$680.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.63
|
| Rate for Payer: Cash Price |
$988.86
|
| Rate for Payer: Cigna Commercial |
$1,641.52
|
| Rate for Payer: First Health Commercial |
$1,878.84
|
| Rate for Payer: Humana Commercial |
$1,681.07
|
| Rate for Payer: Humana KY Medicaid |
$680.14
|
| Rate for Payer: Kentucky WC Medicaid |
$687.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$693.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,740.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,483.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,720.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.63
|
| Rate for Payer: PHCS Commercial |
$1,898.62
|
| Rate for Payer: United Healthcare All Payer |
$1,740.40
|
|
|
PLATE SM CP 3.5MM 7X91MM
|
Facility
|
IP
|
$1,977.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.32 |
| Max. Negotiated Rate |
$1,898.62 |
| Rate for Payer: Aetna Commercial |
$1,522.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.63
|
| Rate for Payer: Cash Price |
$988.86
|
| Rate for Payer: Cigna Commercial |
$1,641.52
|
| Rate for Payer: First Health Commercial |
$1,878.84
|
| Rate for Payer: Humana Commercial |
$1,681.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,740.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,483.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,720.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.63
|
| Rate for Payer: PHCS Commercial |
$1,898.62
|
| Rate for Payer: United Healthcare All Payer |
$1,740.40
|
|
|
PLATE SM CP 3.5MM 8X104MM
|
Facility
|
OP
|
$2,032.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.68 |
| Max. Negotiated Rate |
$1,950.97 |
| Rate for Payer: Aetna Commercial |
$1,564.84
|
| Rate for Payer: Anthem Medicaid |
$698.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.16
|
| Rate for Payer: Cash Price |
$1,016.13
|
| Rate for Payer: Cigna Commercial |
$1,686.78
|
| Rate for Payer: First Health Commercial |
$1,930.65
|
| Rate for Payer: Humana Commercial |
$1,727.42
|
| Rate for Payer: Humana KY Medicaid |
$698.89
|
| Rate for Payer: Kentucky WC Medicaid |
$706.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.26
|
| Rate for Payer: PHCS Commercial |
$1,950.97
|
| Rate for Payer: United Healthcare All Payer |
$1,788.39
|
|
|
PLATE SM CP 3.5MM 8X104MM
|
Facility
|
IP
|
$2,032.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.68 |
| Max. Negotiated Rate |
$1,950.97 |
| Rate for Payer: Aetna Commercial |
$1,564.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,585.16
|
| Rate for Payer: Cash Price |
$1,016.13
|
| Rate for Payer: Cigna Commercial |
$1,686.78
|
| Rate for Payer: First Health Commercial |
$1,930.65
|
| Rate for Payer: Humana Commercial |
$1,727.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.39
|
| Rate for Payer: Ohio Health Group HMO |
$1,524.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,768.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.26
|
| Rate for Payer: PHCS Commercial |
$1,950.97
|
| Rate for Payer: United Healthcare All Payer |
$1,788.39
|
|
|
PLATE SM CP 3.5MM 9X117MM
|
Facility
|
IP
|
$2,047.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.35 |
| Max. Negotiated Rate |
$1,965.93 |
| Rate for Payer: Aetna Commercial |
$1,576.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,597.32
|
| Rate for Payer: Cash Price |
$1,023.92
|
| Rate for Payer: Cigna Commercial |
$1,699.71
|
| Rate for Payer: First Health Commercial |
$1,945.45
|
| Rate for Payer: Humana Commercial |
$1,740.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,679.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,511.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,802.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,535.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.01
|
| Rate for Payer: PHCS Commercial |
$1,965.93
|
| Rate for Payer: United Healthcare All Payer |
$1,802.10
|
|
|
PLATE SM CP 3.5MM 9X117MM
|
Facility
|
OP
|
$2,047.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$614.35 |
| Max. Negotiated Rate |
$1,965.93 |
| Rate for Payer: Aetna Commercial |
$1,576.84
|
| Rate for Payer: Anthem Medicaid |
$704.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,597.32
|
| Rate for Payer: Cash Price |
$1,023.92
|
| Rate for Payer: Cigna Commercial |
$1,699.71
|
| Rate for Payer: First Health Commercial |
$1,945.45
|
| Rate for Payer: Humana Commercial |
$1,740.66
|
| Rate for Payer: Humana KY Medicaid |
$704.25
|
| Rate for Payer: Kentucky WC Medicaid |
$711.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,679.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,511.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$614.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$718.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,802.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,535.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,638.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,781.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,413.01
|
| Rate for Payer: PHCS Commercial |
$1,965.93
|
| Rate for Payer: United Healthcare All Payer |
$1,802.10
|
|
|
PLATE SM FRAG 10 H 2.7MM 84MM
|
Facility
|
OP
|
$3,130.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.02 |
| Max. Negotiated Rate |
$3,004.86 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Anthem Medicaid |
$1,076.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.45
|
| Rate for Payer: Cash Price |
$1,565.03
|
| Rate for Payer: Cigna Commercial |
$2,597.95
|
| Rate for Payer: First Health Commercial |
$2,973.56
|
| Rate for Payer: Humana Commercial |
$2,660.55
|
| Rate for Payer: Humana KY Medicaid |
$1,076.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,087.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,098.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.74
|
| Rate for Payer: PHCS Commercial |
$3,004.86
|
| Rate for Payer: United Healthcare All Payer |
$2,754.45
|
|
|
PLATE SM FRAG 10 H 2.7MM 84MM
|
Facility
|
IP
|
$3,130.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$939.02 |
| Max. Negotiated Rate |
$3,004.86 |
| Rate for Payer: Aetna Commercial |
$2,410.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,441.45
|
| Rate for Payer: Cash Price |
$1,565.03
|
| Rate for Payer: Cigna Commercial |
$2,597.95
|
| Rate for Payer: First Health Commercial |
$2,973.56
|
| Rate for Payer: Humana Commercial |
$2,660.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,566.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,309.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$939.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,754.45
|
| Rate for Payer: Ohio Health Group HMO |
$2,347.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,504.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,723.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,159.74
|
| Rate for Payer: PHCS Commercial |
$3,004.86
|
| Rate for Payer: United Healthcare All Payer |
$2,754.45
|
|
|
PLATE SM FRAG 12 H 2.7MM 100MM
|
Facility
|
OP
|
$3,253.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.92 |
| Max. Negotiated Rate |
$3,122.94 |
| Rate for Payer: Aetna Commercial |
$2,504.86
|
| Rate for Payer: Anthem Medicaid |
$1,118.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,537.39
|
| Rate for Payer: Cash Price |
$1,626.53
|
| Rate for Payer: Cigna Commercial |
$2,700.04
|
| Rate for Payer: First Health Commercial |
$3,090.41
|
| Rate for Payer: Humana Commercial |
$2,765.10
|
| Rate for Payer: Humana KY Medicaid |
$1,118.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,130.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,667.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,400.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,141.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,862.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,602.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,244.61
|
| Rate for Payer: PHCS Commercial |
$3,122.94
|
| Rate for Payer: United Healthcare All Payer |
$2,862.69
|
|
|
PLATE SM FRAG 12 H 2.7MM 100MM
|
Facility
|
IP
|
$3,253.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$975.92 |
| Max. Negotiated Rate |
$3,122.94 |
| Rate for Payer: Aetna Commercial |
$2,504.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,537.39
|
| Rate for Payer: Cash Price |
$1,626.53
|
| Rate for Payer: Cigna Commercial |
$2,700.04
|
| Rate for Payer: First Health Commercial |
$3,090.41
|
| Rate for Payer: Humana Commercial |
$2,765.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,667.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,400.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$975.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,862.69
|
| Rate for Payer: Ohio Health Group HMO |
$2,439.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,602.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,830.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,244.61
|
| Rate for Payer: PHCS Commercial |
$3,122.94
|
| Rate for Payer: United Healthcare All Payer |
$2,862.69
|
|
|
PLATE SM FRAG 2 H 2.7MM 20MM
|
Facility
|
OP
|
$1,860.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.26 |
| Max. Negotiated Rate |
$1,786.44 |
| Rate for Payer: Aetna Commercial |
$1,432.88
|
| Rate for Payer: Anthem Medicaid |
$639.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,451.49
|
| Rate for Payer: Cash Price |
$930.44
|
| Rate for Payer: Cigna Commercial |
$1,544.53
|
| Rate for Payer: First Health Commercial |
$1,767.84
|
| Rate for Payer: Humana Commercial |
$1,581.75
|
| Rate for Payer: Humana KY Medicaid |
$639.96
|
| Rate for Payer: Kentucky WC Medicaid |
$646.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,373.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,637.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.01
|
| Rate for Payer: PHCS Commercial |
$1,786.44
|
| Rate for Payer: United Healthcare All Payer |
$1,637.57
|
|
|
PLATE SM FRAG 2 H 2.7MM 20MM
|
Facility
|
IP
|
$1,860.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.26 |
| Max. Negotiated Rate |
$1,786.44 |
| Rate for Payer: Aetna Commercial |
$1,432.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,451.49
|
| Rate for Payer: Cash Price |
$930.44
|
| Rate for Payer: Cigna Commercial |
$1,544.53
|
| Rate for Payer: First Health Commercial |
$1,767.84
|
| Rate for Payer: Humana Commercial |
$1,581.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,373.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,637.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.01
|
| Rate for Payer: PHCS Commercial |
$1,786.44
|
| Rate for Payer: United Healthcare All Payer |
$1,637.57
|
|
|
PLATE SM FRAG 2 H 2.7MM 26MM
|
Facility
|
IP
|
$1,969.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$1,891.14 |
| Rate for Payer: Aetna Commercial |
$1,516.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.55
|
| Rate for Payer: Cash Price |
$984.97
|
| Rate for Payer: Cigna Commercial |
$1,635.05
|
| Rate for Payer: First Health Commercial |
$1,871.44
|
| Rate for Payer: Humana Commercial |
$1,674.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.26
|
| Rate for Payer: PHCS Commercial |
$1,891.14
|
| Rate for Payer: United Healthcare All Payer |
$1,733.55
|
|
|
PLATE SM FRAG 2 H 2.7MM 26MM
|
Facility
|
OP
|
$1,969.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.98 |
| Max. Negotiated Rate |
$1,891.14 |
| Rate for Payer: Aetna Commercial |
$1,516.85
|
| Rate for Payer: Anthem Medicaid |
$677.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,536.55
|
| Rate for Payer: Cash Price |
$984.97
|
| Rate for Payer: Cigna Commercial |
$1,635.05
|
| Rate for Payer: First Health Commercial |
$1,871.44
|
| Rate for Payer: Humana Commercial |
$1,674.45
|
| Rate for Payer: Humana KY Medicaid |
$677.46
|
| Rate for Payer: Kentucky WC Medicaid |
$684.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,615.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,733.55
|
| Rate for Payer: Ohio Health Group HMO |
$1,477.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,575.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,713.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,359.26
|
| Rate for Payer: PHCS Commercial |
$1,891.14
|
| Rate for Payer: United Healthcare All Payer |
$1,733.55
|
|
