|
PLATE TUB 1/3 5H 62MM
|
Facility
|
OP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem Medicaid |
$403.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Humana KY Medicaid |
$403.65
|
| Rate for Payer: Kentucky WC Medicaid |
$407.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
|
PLATE TUB 1/3 5H 62MM
|
Facility
|
IP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
|
PLATE TUB 1/3*62 5HL
|
Facility
|
IP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
|
PLATE TUB 1/3*62 5HL
|
Facility
|
OP
|
$1,173.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.12 |
| Max. Negotiated Rate |
$1,126.80 |
| Rate for Payer: Aetna Commercial |
$903.79
|
| Rate for Payer: Anthem Medicaid |
$403.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$915.52
|
| Rate for Payer: Cash Price |
$586.88
|
| Rate for Payer: Cigna Commercial |
$974.21
|
| Rate for Payer: First Health Commercial |
$1,115.06
|
| Rate for Payer: Humana Commercial |
$997.69
|
| Rate for Payer: Humana KY Medicaid |
$403.65
|
| Rate for Payer: Kentucky WC Medicaid |
$407.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$962.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$866.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$352.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$411.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,032.90
|
| Rate for Payer: Ohio Health Group HMO |
$880.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$809.89
|
| Rate for Payer: PHCS Commercial |
$1,126.80
|
| Rate for Payer: United Healthcare All Payer |
$1,032.90
|
|
|
PLATE TUB 1/3 6H 74MM
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem Medicaid |
$406.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Humana KY Medicaid |
$406.83
|
| Rate for Payer: Kentucky WC Medicaid |
$410.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3 6H 74MM
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3*74 6HL
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3*74 6HL
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem Medicaid |
$406.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Humana KY Medicaid |
$406.83
|
| Rate for Payer: Kentucky WC Medicaid |
$410.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3 7H 86MM
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem Medicaid |
$406.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Humana KY Medicaid |
$406.83
|
| Rate for Payer: Kentucky WC Medicaid |
$410.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3 7H 86MM
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3*86 7HL
|
Facility
|
IP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3*86 7HL
|
Facility
|
OP
|
$1,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$354.90 |
| Max. Negotiated Rate |
$1,135.68 |
| Rate for Payer: Aetna Commercial |
$910.91
|
| Rate for Payer: Anthem Medicaid |
$406.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$922.74
|
| Rate for Payer: Cash Price |
$591.50
|
| Rate for Payer: Cigna Commercial |
$981.89
|
| Rate for Payer: First Health Commercial |
$1,123.85
|
| Rate for Payer: Humana Commercial |
$1,005.55
|
| Rate for Payer: Humana KY Medicaid |
$406.83
|
| Rate for Payer: Kentucky WC Medicaid |
$410.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$970.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$873.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$354.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$415.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,041.04
|
| Rate for Payer: Ohio Health Group HMO |
$887.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,029.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$816.27
|
| Rate for Payer: PHCS Commercial |
$1,135.68
|
| Rate for Payer: United Healthcare All Payer |
$1,041.04
|
|
|
PLATE TUB 1/3 8H 98MM
|
Facility
|
IP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3 8H 98MM
|
Facility
|
OP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem Medicaid |
$410.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Humana KY Medicaid |
$410.01
|
| Rate for Payer: Kentucky WC Medicaid |
$414.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3*98 8HL
|
Facility
|
OP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem Medicaid |
$410.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Humana KY Medicaid |
$410.01
|
| Rate for Payer: Kentucky WC Medicaid |
$414.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$418.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3*98 8HL
|
Facility
|
IP
|
$1,192.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.68 |
| Max. Negotiated Rate |
$1,144.56 |
| Rate for Payer: Aetna Commercial |
$918.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$929.96
|
| Rate for Payer: Cash Price |
$596.12
|
| Rate for Payer: Cigna Commercial |
$989.57
|
| Rate for Payer: First Health Commercial |
$1,132.64
|
| Rate for Payer: Humana Commercial |
$1,013.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$977.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$879.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$357.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,049.18
|
| Rate for Payer: Ohio Health Group HMO |
$894.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$953.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,037.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$822.65
|
| Rate for Payer: PHCS Commercial |
$1,144.56
|
| Rate for Payer: United Healthcare All Payer |
$1,049.18
|
|
|
PLATE TUB 1/3 PF 10H
|
Facility
|
OP
|
$1,705.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.52 |
| Max. Negotiated Rate |
$1,636.88 |
| Rate for Payer: Aetna Commercial |
$1,312.91
|
| Rate for Payer: Anthem Medicaid |
$586.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.96
|
| Rate for Payer: Cash Price |
$852.54
|
| Rate for Payer: Cigna Commercial |
$1,415.22
|
| Rate for Payer: First Health Commercial |
$1,619.83
|
| Rate for Payer: Humana Commercial |
$1,449.32
|
| Rate for Payer: Humana KY Medicaid |
$586.38
|
| Rate for Payer: Kentucky WC Medicaid |
$592.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.51
|
| Rate for Payer: PHCS Commercial |
$1,636.88
|
| Rate for Payer: United Healthcare All Payer |
$1,500.47
|
|
|
PLATE TUB 1/3 PF 10H
|
Facility
|
IP
|
$1,705.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.52 |
| Max. Negotiated Rate |
$1,636.88 |
| Rate for Payer: Aetna Commercial |
$1,312.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,329.96
|
| Rate for Payer: Cash Price |
$852.54
|
| Rate for Payer: Cigna Commercial |
$1,415.22
|
| Rate for Payer: First Health Commercial |
$1,619.83
|
| Rate for Payer: Humana Commercial |
$1,449.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,398.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,258.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$511.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,500.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,278.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,364.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,483.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,176.51
|
| Rate for Payer: PHCS Commercial |
$1,636.88
|
| Rate for Payer: United Healthcare All Payer |
$1,500.47
|
|
|
PLATE TUB 1/3 PF 4 H
|
Facility
|
IP
|
$1,534.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.49 |
| Max. Negotiated Rate |
$1,473.57 |
| Rate for Payer: Aetna Commercial |
$1,181.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.28
|
| Rate for Payer: Cash Price |
$767.48
|
| Rate for Payer: Cigna Commercial |
$1,274.03
|
| Rate for Payer: First Health Commercial |
$1,458.22
|
| Rate for Payer: Humana Commercial |
$1,304.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,132.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,350.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,227.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,335.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.13
|
| Rate for Payer: PHCS Commercial |
$1,473.57
|
| Rate for Payer: United Healthcare All Payer |
$1,350.77
|
|
|
PLATE TUB 1/3 PF 4 H
|
Facility
|
OP
|
$1,534.97
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.49 |
| Max. Negotiated Rate |
$1,473.57 |
| Rate for Payer: Aetna Commercial |
$1,181.93
|
| Rate for Payer: Anthem Medicaid |
$527.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,197.28
|
| Rate for Payer: Cash Price |
$767.48
|
| Rate for Payer: Cigna Commercial |
$1,274.03
|
| Rate for Payer: First Health Commercial |
$1,458.22
|
| Rate for Payer: Humana Commercial |
$1,304.72
|
| Rate for Payer: Humana KY Medicaid |
$527.88
|
| Rate for Payer: Kentucky WC Medicaid |
$533.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,258.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,132.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$460.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$538.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,350.77
|
| Rate for Payer: Ohio Health Group HMO |
$1,151.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,227.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,335.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,059.13
|
| Rate for Payer: PHCS Commercial |
$1,473.57
|
| Rate for Payer: United Healthcare All Payer |
$1,350.77
|
|
|
PLATE TUB 1/3 PF 5H
|
Facility
|
OP
|
$1,558.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.50 |
| Max. Negotiated Rate |
$1,496.01 |
| Rate for Payer: Aetna Commercial |
$1,199.92
|
| Rate for Payer: Anthem Medicaid |
$535.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.51
|
| Rate for Payer: Cash Price |
$779.17
|
| Rate for Payer: Cigna Commercial |
$1,293.42
|
| Rate for Payer: First Health Commercial |
$1,480.42
|
| Rate for Payer: Humana Commercial |
$1,324.59
|
| Rate for Payer: Humana KY Medicaid |
$535.91
|
| Rate for Payer: Kentucky WC Medicaid |
$541.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,277.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$546.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,168.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,355.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.25
|
| Rate for Payer: PHCS Commercial |
$1,496.01
|
| Rate for Payer: United Healthcare All Payer |
$1,371.34
|
|
|
PLATE TUB 1/3 PF 5H
|
Facility
|
IP
|
$1,558.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$467.50 |
| Max. Negotiated Rate |
$1,496.01 |
| Rate for Payer: Aetna Commercial |
$1,199.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,215.51
|
| Rate for Payer: Cash Price |
$779.17
|
| Rate for Payer: Cigna Commercial |
$1,293.42
|
| Rate for Payer: First Health Commercial |
$1,480.42
|
| Rate for Payer: Humana Commercial |
$1,324.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,277.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,150.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$467.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,371.34
|
| Rate for Payer: Ohio Health Group HMO |
$1,168.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,246.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,355.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,075.25
|
| Rate for Payer: PHCS Commercial |
$1,496.01
|
| Rate for Payer: United Healthcare All Payer |
$1,371.34
|
|
|
PLATE TUB 1/3 PF 6H
|
Facility
|
OP
|
$1,542.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.83 |
| Max. Negotiated Rate |
$1,481.05 |
| Rate for Payer: Aetna Commercial |
$1,187.93
|
| Rate for Payer: Anthem Medicaid |
$530.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,203.35
|
| Rate for Payer: Cash Price |
$771.38
|
| Rate for Payer: Cigna Commercial |
$1,280.49
|
| Rate for Payer: First Health Commercial |
$1,465.62
|
| Rate for Payer: Humana Commercial |
$1,311.35
|
| Rate for Payer: Humana KY Medicaid |
$530.56
|
| Rate for Payer: Kentucky WC Medicaid |
$535.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,265.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,342.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.50
|
| Rate for Payer: PHCS Commercial |
$1,481.05
|
| Rate for Payer: United Healthcare All Payer |
$1,357.63
|
|
|
PLATE TUB 1/3 PF 6H
|
Facility
|
IP
|
$1,542.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.83 |
| Max. Negotiated Rate |
$1,481.05 |
| Rate for Payer: Aetna Commercial |
$1,187.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,203.35
|
| Rate for Payer: Cash Price |
$771.38
|
| Rate for Payer: Cigna Commercial |
$1,280.49
|
| Rate for Payer: First Health Commercial |
$1,465.62
|
| Rate for Payer: Humana Commercial |
$1,311.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,265.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.63
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,342.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.50
|
| Rate for Payer: PHCS Commercial |
$1,481.05
|
| Rate for Payer: United Healthcare All Payer |
$1,357.63
|
|
|
PLATE TUB 1/3 PF 7H
|
Facility
|
OP
|
$1,573.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.18 |
| Max. Negotiated Rate |
$1,510.96 |
| Rate for Payer: Aetna Commercial |
$1,211.92
|
| Rate for Payer: Anthem Medicaid |
$541.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,227.66
|
| Rate for Payer: Cash Price |
$786.96
|
| Rate for Payer: Cigna Commercial |
$1,306.35
|
| Rate for Payer: First Health Commercial |
$1,495.22
|
| Rate for Payer: Humana Commercial |
$1,337.83
|
| Rate for Payer: Humana KY Medicaid |
$541.27
|
| Rate for Payer: Kentucky WC Medicaid |
$546.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,290.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,161.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$472.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$552.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,385.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,180.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,259.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,369.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.00
|
| Rate for Payer: PHCS Commercial |
$1,510.96
|
| Rate for Payer: United Healthcare All Payer |
$1,385.05
|
|
