|
PLATE TUB 1/3 PF 7H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TUB 1/3 PF 8H
|
Facility
|
OP
|
$1,681.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.51 |
| Max. Negotiated Rate |
$1,614.44 |
| Rate for Payer: Aetna Commercial |
$1,294.92
|
| Rate for Payer: Anthem Medicaid |
$578.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.73
|
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Cigna Commercial |
$1,395.82
|
| Rate for Payer: First Health Commercial |
$1,597.62
|
| Rate for Payer: Humana Commercial |
$1,429.45
|
| Rate for Payer: Humana KY Medicaid |
$578.34
|
| Rate for Payer: Kentucky WC Medicaid |
$584.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,479.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.38
|
| Rate for Payer: PHCS Commercial |
$1,614.44
|
| Rate for Payer: United Healthcare All Payer |
$1,479.90
|
|
|
PLATE TUB 1/3 PF 8H
|
Facility
|
IP
|
$1,681.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.51 |
| Max. Negotiated Rate |
$1,614.44 |
| Rate for Payer: Aetna Commercial |
$1,294.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,311.73
|
| Rate for Payer: Cash Price |
$840.86
|
| Rate for Payer: Cigna Commercial |
$1,395.82
|
| Rate for Payer: First Health Commercial |
$1,597.62
|
| Rate for Payer: Humana Commercial |
$1,429.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,379.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,241.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,479.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,261.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,463.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.38
|
| Rate for Payer: PHCS Commercial |
$1,614.44
|
| Rate for Payer: United Healthcare All Payer |
$1,479.90
|
|
|
PLATE TUB LCK 3.5MM 10 133MM
|
Facility
|
IP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LCK 3.5MM 10 133MM
|
Facility
|
OP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem Medicaid |
$676.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Humana KY Medicaid |
$676.74
|
| Rate for Payer: Kentucky WC Medicaid |
$683.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LCK 3.5MM 4 57MM
|
Facility
|
IP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LCK 3.5MM 4 57MM
|
Facility
|
OP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem Medicaid |
$659.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Humana KY Medicaid |
$659.82
|
| Rate for Payer: Kentucky WC Medicaid |
$666.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LCK 3.5MM 5 70MM
|
Facility
|
OP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem Medicaid |
$647.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Humana KY Medicaid |
$647.73
|
| Rate for Payer: Kentucky WC Medicaid |
$654.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$660.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE TUB LCK 3.5MM 5 70MM
|
Facility
|
IP
|
$1,883.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.05 |
| Max. Negotiated Rate |
$1,808.15 |
| Rate for Payer: Aetna Commercial |
$1,450.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,469.12
|
| Rate for Payer: Cash Price |
$941.74
|
| Rate for Payer: Cigna Commercial |
$1,563.30
|
| Rate for Payer: First Health Commercial |
$1,789.32
|
| Rate for Payer: Humana Commercial |
$1,600.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,544.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,390.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,657.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,412.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,638.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.61
|
| Rate for Payer: PHCS Commercial |
$1,808.15
|
| Rate for Payer: United Healthcare All Payer |
$1,657.47
|
|
|
PLATE TUB LCK 3.5MM 6 82MM
|
Facility
|
IP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LCK 3.5MM 6 82MM
|
Facility
|
OP
|
$1,918.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.59 |
| Max. Negotiated Rate |
$1,841.89 |
| Rate for Payer: Aetna Commercial |
$1,477.35
|
| Rate for Payer: Anthem Medicaid |
$659.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,496.54
|
| Rate for Payer: Cash Price |
$959.32
|
| Rate for Payer: Cigna Commercial |
$1,592.47
|
| Rate for Payer: First Health Commercial |
$1,822.71
|
| Rate for Payer: Humana Commercial |
$1,630.84
|
| Rate for Payer: Humana KY Medicaid |
$659.82
|
| Rate for Payer: Kentucky WC Medicaid |
$666.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,573.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,415.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,688.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,438.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,534.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,669.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,323.86
|
| Rate for Payer: PHCS Commercial |
$1,841.89
|
| Rate for Payer: United Healthcare All Payer |
$1,688.40
|
|
|
PLATE TUB LCK 3.5MM 7 95MM
|
Facility
|
IP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUB LCK 3.5MM 7 95MM
|
Facility
|
OP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem Medicaid |
$662.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Humana KY Medicaid |
$662.24
|
| Rate for Payer: Kentucky WC Medicaid |
$668.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUB LCK 3.5MM 8 107MM
|
Facility
|
IP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LCK 3.5MM 8 107MM
|
Facility
|
OP
|
$1,967.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$590.36 |
| Max. Negotiated Rate |
$1,889.14 |
| Rate for Payer: Aetna Commercial |
$1,515.24
|
| Rate for Payer: Anthem Medicaid |
$676.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,534.92
|
| Rate for Payer: Cash Price |
$983.92
|
| Rate for Payer: Cigna Commercial |
$1,633.32
|
| Rate for Payer: First Health Commercial |
$1,869.46
|
| Rate for Payer: Humana Commercial |
$1,672.67
|
| Rate for Payer: Humana KY Medicaid |
$676.74
|
| Rate for Payer: Kentucky WC Medicaid |
$683.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,613.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,452.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,731.71
|
| Rate for Payer: Ohio Health Group HMO |
$1,475.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,574.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,712.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,357.82
|
| Rate for Payer: PHCS Commercial |
$1,889.14
|
| Rate for Payer: United Healthcare All Payer |
$1,731.71
|
|
|
PLATE TUB LCK 3.5MM 9 120MM
|
Facility
|
IP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUB LCK 3.5MM 9 120MM
|
Facility
|
OP
|
$1,925.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$577.70 |
| Max. Negotiated Rate |
$1,848.64 |
| Rate for Payer: Aetna Commercial |
$1,482.77
|
| Rate for Payer: Anthem Medicaid |
$662.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,502.02
|
| Rate for Payer: Cash Price |
$962.84
|
| Rate for Payer: Cigna Commercial |
$1,598.31
|
| Rate for Payer: First Health Commercial |
$1,829.39
|
| Rate for Payer: Humana Commercial |
$1,636.82
|
| Rate for Payer: Humana KY Medicaid |
$662.24
|
| Rate for Payer: Kentucky WC Medicaid |
$668.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,579.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,421.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$577.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$675.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,694.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,444.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,540.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,675.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,328.71
|
| Rate for Payer: PHCS Commercial |
$1,848.64
|
| Rate for Payer: United Healthcare All Payer |
$1,694.59
|
|
|
PLATE TUB L-K 3.5M 1/3 5H 62M
|
Facility
|
OP
|
$2,031.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.56 |
| Max. Negotiated Rate |
$1,950.60 |
| Rate for Payer: Aetna Commercial |
$1,564.55
|
| Rate for Payer: Anthem Medicaid |
$698.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.87
|
| Rate for Payer: Cash Price |
$1,015.94
|
| Rate for Payer: Cigna Commercial |
$1,686.46
|
| Rate for Payer: First Health Commercial |
$1,930.29
|
| Rate for Payer: Humana Commercial |
$1,727.10
|
| Rate for Payer: Humana KY Medicaid |
$698.76
|
| Rate for Payer: Kentucky WC Medicaid |
$705.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$712.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,767.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.00
|
| Rate for Payer: PHCS Commercial |
$1,950.60
|
| Rate for Payer: United Healthcare All Payer |
$1,788.05
|
|
|
PLATE TUB L-K 3.5M 1/3 5H 62M
|
Facility
|
IP
|
$2,031.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.56 |
| Max. Negotiated Rate |
$1,950.60 |
| Rate for Payer: Aetna Commercial |
$1,564.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,584.87
|
| Rate for Payer: Cash Price |
$1,015.94
|
| Rate for Payer: Cigna Commercial |
$1,686.46
|
| Rate for Payer: First Health Commercial |
$1,930.29
|
| Rate for Payer: Humana Commercial |
$1,727.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,666.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,499.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$609.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,788.05
|
| Rate for Payer: Ohio Health Group HMO |
$1,523.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,625.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,767.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,402.00
|
| Rate for Payer: PHCS Commercial |
$1,950.60
|
| Rate for Payer: United Healthcare All Payer |
$1,788.05
|
|
|
PLATE TUB L-K 3.5M 1/3 6H 74M
|
Facility
|
OP
|
$2,127.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.29 |
| Max. Negotiated Rate |
$2,042.53 |
| Rate for Payer: Aetna Commercial |
$1,638.28
|
| Rate for Payer: Anthem Medicaid |
$731.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.56
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cigna Commercial |
$1,765.94
|
| Rate for Payer: First Health Commercial |
$2,021.26
|
| Rate for Payer: Humana Commercial |
$1,808.49
|
| Rate for Payer: Humana KY Medicaid |
$731.70
|
| Rate for Payer: Kentucky WC Medicaid |
$739.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$746.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.07
|
| Rate for Payer: PHCS Commercial |
$2,042.53
|
| Rate for Payer: United Healthcare All Payer |
$1,872.32
|
|
|
PLATE TUB L-K 3.5M 1/3 6H 74M
|
Facility
|
IP
|
$2,127.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.29 |
| Max. Negotiated Rate |
$2,042.53 |
| Rate for Payer: Aetna Commercial |
$1,638.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,659.56
|
| Rate for Payer: Cash Price |
$1,063.82
|
| Rate for Payer: Cigna Commercial |
$1,765.94
|
| Rate for Payer: First Health Commercial |
$2,021.26
|
| Rate for Payer: Humana Commercial |
$1,808.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,744.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,570.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,872.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,595.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,702.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,851.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.07
|
| Rate for Payer: PHCS Commercial |
$2,042.53
|
| Rate for Payer: United Healthcare All Payer |
$1,872.32
|
|
|
PLATE TUB L-K 3.5M 1/3 7H 86M
|
Facility
|
OP
|
$2,216.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.97 |
| Max. Negotiated Rate |
$2,127.90 |
| Rate for Payer: Aetna Commercial |
$1,706.75
|
| Rate for Payer: Anthem Medicaid |
$762.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,728.92
|
| Rate for Payer: Cash Price |
$1,108.28
|
| Rate for Payer: Cigna Commercial |
$1,839.74
|
| Rate for Payer: First Health Commercial |
$2,105.73
|
| Rate for Payer: Humana Commercial |
$1,884.08
|
| Rate for Payer: Humana KY Medicaid |
$762.27
|
| Rate for Payer: Kentucky WC Medicaid |
$770.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,635.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$777.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,950.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,662.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,928.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.43
|
| Rate for Payer: PHCS Commercial |
$2,127.90
|
| Rate for Payer: United Healthcare All Payer |
$1,950.57
|
|
|
PLATE TUB L-K 3.5M 1/3 7H 86M
|
Facility
|
IP
|
$2,216.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$664.97 |
| Max. Negotiated Rate |
$2,127.90 |
| Rate for Payer: Aetna Commercial |
$1,706.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,728.92
|
| Rate for Payer: Cash Price |
$1,108.28
|
| Rate for Payer: Cigna Commercial |
$1,839.74
|
| Rate for Payer: First Health Commercial |
$2,105.73
|
| Rate for Payer: Humana Commercial |
$1,884.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,817.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,635.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$664.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,950.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,662.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,773.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,928.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,529.43
|
| Rate for Payer: PHCS Commercial |
$2,127.90
|
| Rate for Payer: United Healthcare All Payer |
$1,950.57
|
|
|
PLATE TUB L-K 3.5M 1/3 8H 98M
|
Facility
|
IP
|
$2,992.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.67 |
| Max. Negotiated Rate |
$2,872.56 |
| Rate for Payer: Aetna Commercial |
$2,304.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,333.95
|
| Rate for Payer: Cash Price |
$1,496.12
|
| Rate for Payer: Cigna Commercial |
$2,483.57
|
| Rate for Payer: First Health Commercial |
$2,842.64
|
| Rate for Payer: Humana Commercial |
$2,543.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,453.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,208.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,633.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,244.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,393.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,603.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.65
|
| Rate for Payer: PHCS Commercial |
$2,872.56
|
| Rate for Payer: United Healthcare All Payer |
$2,633.18
|
|
|
PLATE TUB L-K 3.5M 1/3 8H 98M
|
Facility
|
OP
|
$2,992.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.67 |
| Max. Negotiated Rate |
$2,872.56 |
| Rate for Payer: Aetna Commercial |
$2,304.03
|
| Rate for Payer: Anthem Medicaid |
$1,029.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,333.95
|
| Rate for Payer: Cash Price |
$1,496.12
|
| Rate for Payer: Cigna Commercial |
$2,483.57
|
| Rate for Payer: First Health Commercial |
$2,842.64
|
| Rate for Payer: Humana Commercial |
$2,543.41
|
| Rate for Payer: Humana KY Medicaid |
$1,029.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,039.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,453.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,208.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,049.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,633.18
|
| Rate for Payer: Ohio Health Group HMO |
$2,244.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,393.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,603.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.65
|
| Rate for Payer: PHCS Commercial |
$2,872.56
|
| Rate for Payer: United Healthcare All Payer |
$2,633.18
|
|
