|
PLATE INTERM 110^55MM
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 110^55MM
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120^55MM
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120^55MM
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 100^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 100^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 110^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 110^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 120^
|
Facility
|
IP
|
$4,847.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.21 |
| Max. Negotiated Rate |
$4,653.84 |
| Rate for Payer: Aetna Commercial |
$3,732.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,781.24
|
| Rate for Payer: Cash Price |
$2,423.88
|
| Rate for Payer: Cigna Commercial |
$4,023.63
|
| Rate for Payer: First Health Commercial |
$4,605.36
|
| Rate for Payer: Humana Commercial |
$4,120.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,975.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,577.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,454.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,266.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,635.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$969.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.80
|
| Rate for Payer: PHCS Commercial |
$4,653.84
|
| Rate for Payer: United Healthcare All Payer |
$4,266.02
|
|
|
PLATE INTERM 120MM 120^
|
Facility
|
OP
|
$4,847.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.21 |
| Max. Negotiated Rate |
$4,653.84 |
| Rate for Payer: Aetna Commercial |
$3,732.77
|
| Rate for Payer: Anthem Medicaid |
$1,667.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,781.24
|
| Rate for Payer: Cash Price |
$2,423.88
|
| Rate for Payer: Cigna Commercial |
$4,023.63
|
| Rate for Payer: First Health Commercial |
$4,605.36
|
| Rate for Payer: Humana Commercial |
$4,120.59
|
| Rate for Payer: Humana KY Medicaid |
$1,667.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,684.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,975.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,577.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,454.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,700.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,266.02
|
| Rate for Payer: Ohio Health Group HMO |
$3,635.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$969.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$630.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,502.80
|
| Rate for Payer: PHCS Commercial |
$4,653.84
|
| Rate for Payer: United Healthcare All Payer |
$4,266.02
|
|
|
PLATE INTERM 120MM 130^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 130^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 140^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 140^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 150^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
| Rate for Payer: Aetna Commercial |
$3,738.16
|
|
|
PLATE INTERM 120MM 150^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 90^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 120MM 90^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 127MM 130^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 127MM 130^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 127MM 135^
|
Facility
|
OP
|
$4,855.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.25 |
| Max. Negotiated Rate |
$4,661.57 |
| Rate for Payer: Aetna Commercial |
$3,738.97
|
| Rate for Payer: Anthem Medicaid |
$1,669.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,787.52
|
| Rate for Payer: Cash Price |
$2,427.90
|
| Rate for Payer: Cigna Commercial |
$4,030.31
|
| Rate for Payer: First Health Commercial |
$4,613.01
|
| Rate for Payer: Humana Commercial |
$4,127.43
|
| Rate for Payer: Humana KY Medicaid |
$1,669.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,981.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,583.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,273.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$971.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,505.30
|
| Rate for Payer: PHCS Commercial |
$4,661.57
|
| Rate for Payer: United Healthcare All Payer |
$4,273.10
|
|
|
PLATE INTERM 127MM 135^
|
Facility
|
IP
|
$4,855.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.25 |
| Max. Negotiated Rate |
$4,661.57 |
| Rate for Payer: Aetna Commercial |
$3,738.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,787.52
|
| Rate for Payer: Cash Price |
$2,427.90
|
| Rate for Payer: Cigna Commercial |
$4,030.31
|
| Rate for Payer: First Health Commercial |
$4,613.01
|
| Rate for Payer: Humana Commercial |
$4,127.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,981.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,583.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,273.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$971.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,505.30
|
| Rate for Payer: PHCS Commercial |
$4,661.57
|
| Rate for Payer: United Healthcare All Payer |
$4,273.10
|
|
|
PLATE INTERM 127MM 140^
|
Facility
|
OP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem Medicaid |
$1,669.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Humana KY Medicaid |
$1,669.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 127MM 140^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
|
PLATE INTERM 127MM 150^
|
Facility
|
IP
|
$4,854.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$4,660.56 |
| Rate for Payer: Aetna Commercial |
$3,738.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.70
|
| Rate for Payer: Cash Price |
$2,427.38
|
| Rate for Payer: Cigna Commercial |
$4,029.44
|
| Rate for Payer: First Health Commercial |
$4,612.01
|
| Rate for Payer: Humana Commercial |
$4,126.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.18
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$970.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$631.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,504.97
|
| Rate for Payer: PHCS Commercial |
$4,660.56
|
| Rate for Payer: United Healthcare All Payer |
$4,272.18
|
|
