|
PLATE HUM LK PRX 9H L 3.5*165
|
Facility
|
IP
|
$8,361.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.45 |
| Max. Negotiated Rate |
$8,027.03 |
| Rate for Payer: Aetna Commercial |
$6,438.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,521.96
|
| Rate for Payer: Cash Price |
$4,180.74
|
| Rate for Payer: Cigna Commercial |
$6,940.04
|
| Rate for Payer: First Health Commercial |
$7,943.42
|
| Rate for Payer: Humana Commercial |
$7,107.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,856.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,170.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,508.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,358.11
|
| Rate for Payer: Ohio Health Group HMO |
$6,271.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,689.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,274.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,769.43
|
| Rate for Payer: PHCS Commercial |
$8,027.03
|
| Rate for Payer: United Healthcare All Payer |
$7,358.11
|
|
|
PLATE HUM LK PRX 9H L 4.5*169
|
Facility
|
IP
|
$9,117.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,735.33 |
| Max. Negotiated Rate |
$8,753.05 |
| Rate for Payer: Aetna Commercial |
$7,020.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,111.85
|
| Rate for Payer: Cash Price |
$4,558.88
|
| Rate for Payer: Cigna Commercial |
$7,567.74
|
| Rate for Payer: First Health Commercial |
$8,661.87
|
| Rate for Payer: Humana Commercial |
$7,750.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,728.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,735.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,294.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,932.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,291.25
|
| Rate for Payer: PHCS Commercial |
$8,753.05
|
| Rate for Payer: United Healthcare All Payer |
$8,023.63
|
|
|
PLATE HUM LK PRX 9H L 4.5*169
|
Facility
|
OP
|
$9,117.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,735.33 |
| Max. Negotiated Rate |
$8,753.05 |
| Rate for Payer: Aetna Commercial |
$7,020.68
|
| Rate for Payer: Anthem Medicaid |
$3,135.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,111.85
|
| Rate for Payer: Cash Price |
$4,558.88
|
| Rate for Payer: Cigna Commercial |
$7,567.74
|
| Rate for Payer: First Health Commercial |
$8,661.87
|
| Rate for Payer: Humana Commercial |
$7,750.10
|
| Rate for Payer: Humana KY Medicaid |
$3,135.60
|
| Rate for Payer: Kentucky WC Medicaid |
$3,167.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,476.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,728.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,735.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,198.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,023.63
|
| Rate for Payer: Ohio Health Group HMO |
$6,838.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,294.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,932.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,291.25
|
| Rate for Payer: PHCS Commercial |
$8,753.05
|
| Rate for Payer: United Healthcare All Payer |
$8,023.63
|
|
|
PLATE INF CLAV MED 6H 73MM
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE INF CLAV MED 6H 73MM
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE INF CLAV MED 7H 85MM
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE INF CLAV MED 7H 85MM
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE INNER DIA SF U 105MM
|
Facility
|
OP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem Medicaid |
$3,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Humana KY Medicaid |
$3,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 105MM
|
Facility
|
IP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 130MM
|
Facility
|
IP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 130MM
|
Facility
|
OP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem Medicaid |
$3,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Humana KY Medicaid |
$3,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 155MM
|
Facility
|
OP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem Medicaid |
$3,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Humana KY Medicaid |
$3,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 155MM
|
Facility
|
IP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 180MM
|
Facility
|
OP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem Medicaid |
$3,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Humana KY Medicaid |
$3,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 180MM
|
Facility
|
IP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 80MM
|
Facility
|
OP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem Medicaid |
$3,048.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Humana KY Medicaid |
$3,048.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,079.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,109.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INNER DIA SF U 80MM
|
Facility
|
IP
|
$8,864.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,659.45 |
| Max. Negotiated Rate |
$8,510.23 |
| Rate for Payer: Aetna Commercial |
$6,825.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,914.56
|
| Rate for Payer: Cash Price |
$4,432.41
|
| Rate for Payer: Cigna Commercial |
$7,357.80
|
| Rate for Payer: First Health Commercial |
$8,421.58
|
| Rate for Payer: Humana Commercial |
$7,535.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,269.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,542.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,659.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,801.04
|
| Rate for Payer: Ohio Health Group HMO |
$6,648.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,091.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,712.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,116.73
|
| Rate for Payer: PHCS Commercial |
$8,510.23
|
| Rate for Payer: United Healthcare All Payer |
$7,801.04
|
|
|
PLATE INTERM 100^55MM
|
Facility
|
IP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
|
PLATE INTERM 100^55MM
|
Facility
|
OP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem Medicaid |
$1,665.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Humana KY Medicaid |
$1,665.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,682.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,699.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
|
PLATE INTERM 110^55MM
|
Facility
|
IP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
|
PLATE INTERM 110^55MM
|
Facility
|
OP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem Medicaid |
$1,665.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Humana KY Medicaid |
$1,665.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,682.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,699.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
|
PLATE INTERM 120^55MM
|
Facility
|
OP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem Medicaid |
$1,665.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Humana KY Medicaid |
$1,665.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,682.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,699.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
|
PLATE INTERM 120^55MM
|
Facility
|
IP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
|
PLATE INTERM 120MM 100^
|
Facility
|
IP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
|
PLATE INTERM 120MM 100^
|
Facility
|
OP
|
$4,844.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.31 |
| Max. Negotiated Rate |
$4,650.60 |
| Rate for Payer: Aetna Commercial |
$3,730.17
|
| Rate for Payer: Anthem Medicaid |
$1,665.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,778.62
|
| Rate for Payer: Cash Price |
$2,422.19
|
| Rate for Payer: Cigna Commercial |
$4,020.84
|
| Rate for Payer: First Health Commercial |
$4,602.16
|
| Rate for Payer: Humana Commercial |
$4,117.72
|
| Rate for Payer: Humana KY Medicaid |
$1,665.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,682.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,972.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,699.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,263.05
|
| Rate for Payer: Ohio Health Group HMO |
$3,633.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,875.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,214.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,342.62
|
| Rate for Payer: PHCS Commercial |
$4,650.60
|
| Rate for Payer: United Healthcare All Payer |
$4,263.05
|
|
