|
PLATE INTERM 127MM 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: 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 130^55MM
|
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 130^55MM
|
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 140^55MM
|
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: 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
|
| 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
|
|
|
PLATE INTERM 140^55MM
|
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 150^55MM
|
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 150^55MM
|
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 76MM 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 76MM 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 76MM 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 76MM 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 76MM 120^
|
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: 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
|
| 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
|
|
|
PLATE INTERM 76MM 120^
|
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 76MM 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 76MM 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 76MM 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 76MM 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 76MM 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: 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 76MM 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 76MM 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 76MM 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 90^55MM
|
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 90^55MM
|
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 J CLAVICLE LOW PROF 8H R
|
Facility
|
IP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
|
PLATE J CLAVICLE LOW PROF 8H R
|
Facility
|
OP
|
$5,007.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.91 |
| Max. Negotiated Rate |
$4,806.72 |
| Rate for Payer: Aetna Commercial |
$3,855.39
|
| Rate for Payer: Anthem Medicaid |
$1,721.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.46
|
| Rate for Payer: Cash Price |
$2,503.50
|
| Rate for Payer: Cigna Commercial |
$4,155.81
|
| Rate for Payer: First Health Commercial |
$4,756.65
|
| Rate for Payer: Humana Commercial |
$4,255.95
|
| Rate for Payer: Humana KY Medicaid |
$1,721.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,105.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,001.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,552.17
|
| Rate for Payer: PHCS Commercial |
$4,806.72
|
| Rate for Payer: United Healthcare All Payer |
$4,406.16
|
|
