|
PLATE CMF 2.3 ST 6H LONG
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 6H LONG
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 6H MED
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 6H MED
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 6H SHORT
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 6H SHORT
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 8H
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.3 ST 8H
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 16H 120M
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 16H 120M
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 4H 35MM
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 4H 35MM
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 6H 40MM
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 6H 40MM
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 6H 50MM
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 6H 50MM
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 8H 60MM
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 8H 60MM
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 ANGLE 6H 40MM
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 ANGLE 6H 40MM
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 CRVD 4H 39MM
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 CRVD 4H 39MM
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 CRVD 6H 49MM
|
Facility
|
OP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem Medicaid |
$1,057.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Humana KY Medicaid |
$1,057.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE CMF 2.7 CRVD 6H 49MM
|
Facility
|
IP
|
$3,076.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.92 |
| Max. Negotiated Rate |
$2,953.34 |
| Rate for Payer: Aetna Commercial |
$2,368.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,399.59
|
| Rate for Payer: Cash Price |
$1,538.20
|
| Rate for Payer: Cigna Commercial |
$2,553.41
|
| Rate for Payer: First Health Commercial |
$2,922.58
|
| Rate for Payer: Humana Commercial |
$2,614.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,522.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,270.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,707.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,307.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,461.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,676.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,122.72
|
| Rate for Payer: PHCS Commercial |
$2,953.34
|
| Rate for Payer: United Healthcare All Payer |
$2,707.23
|
|
|
PLATE COLUMN FUSION 3.5MM
|
Facility
|
OP
|
$8,107.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,432.12 |
| Max. Negotiated Rate |
$7,782.80 |
| Rate for Payer: Aetna Commercial |
$6,242.45
|
| Rate for Payer: Anthem Medicaid |
$2,788.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,323.52
|
| Rate for Payer: Cash Price |
$4,053.54
|
| Rate for Payer: Cigna Commercial |
$6,728.88
|
| Rate for Payer: First Health Commercial |
$7,701.73
|
| Rate for Payer: Humana Commercial |
$6,891.02
|
| Rate for Payer: Humana KY Medicaid |
$2,788.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,816.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,647.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,983.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,432.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,843.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,134.23
|
| Rate for Payer: Ohio Health Group HMO |
$6,080.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,485.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,053.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,593.89
|
| Rate for Payer: PHCS Commercial |
$7,782.80
|
| Rate for Payer: United Healthcare All Payer |
$7,134.23
|
|
