|
PLATE INTERM 120MM 110^
|
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 110^
|
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 120MM 120^
|
Facility
|
OP
|
$4,836.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.06 |
| Max. Negotiated Rate |
$4,643.40 |
| Rate for Payer: Aetna Commercial |
$3,724.40
|
| Rate for Payer: Anthem Medicaid |
$1,663.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,772.77
|
| Rate for Payer: Cash Price |
$2,418.44
|
| Rate for Payer: Cigna Commercial |
$4,014.61
|
| Rate for Payer: First Health Commercial |
$4,595.04
|
| Rate for Payer: Humana Commercial |
$4,111.35
|
| Rate for Payer: Humana KY Medicaid |
$1,663.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,680.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,966.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,569.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,696.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,256.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,627.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,869.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,208.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,337.45
|
| Rate for Payer: PHCS Commercial |
$4,643.40
|
| Rate for Payer: United Healthcare All Payer |
$4,256.45
|
|
|
PLATE INTERM 120MM 120^
|
Facility
|
IP
|
$4,836.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,451.06 |
| Max. Negotiated Rate |
$4,643.40 |
| Rate for Payer: Aetna Commercial |
$3,724.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,772.77
|
| Rate for Payer: Cash Price |
$2,418.44
|
| Rate for Payer: Cigna Commercial |
$4,014.61
|
| Rate for Payer: First Health Commercial |
$4,595.04
|
| Rate for Payer: Humana Commercial |
$4,111.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,966.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,569.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,256.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,627.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,869.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,208.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,337.45
|
| Rate for Payer: PHCS Commercial |
$4,643.40
|
| Rate for Payer: United Healthcare All Payer |
$4,256.45
|
|
|
PLATE INTERM 120MM 130^
|
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 130^
|
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 120MM 140^
|
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 140^
|
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 120MM 150^
|
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 150^
|
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 120MM 90^
|
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 120MM 90^
|
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 127MM 130^
|
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 127MM 130^
|
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 127MM 135^
|
Facility
|
OP
|
$4,845.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.65 |
| Max. Negotiated Rate |
$4,651.68 |
| Rate for Payer: Aetna Commercial |
$3,731.03
|
| Rate for Payer: Anthem Medicaid |
$1,666.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,779.49
|
| Rate for Payer: Cash Price |
$2,422.75
|
| Rate for Payer: Cigna Commercial |
$4,021.76
|
| Rate for Payer: First Health Commercial |
$4,603.23
|
| Rate for Payer: Humana Commercial |
$4,118.68
|
| Rate for Payer: Humana KY Medicaid |
$1,666.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,683.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,973.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,699.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,264.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,634.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,876.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,215.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,343.39
|
| Rate for Payer: PHCS Commercial |
$4,651.68
|
| Rate for Payer: United Healthcare All Payer |
$4,264.04
|
|
|
PLATE INTERM 127MM 135^
|
Facility
|
IP
|
$4,845.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.65 |
| Max. Negotiated Rate |
$4,651.68 |
| Rate for Payer: Aetna Commercial |
$3,731.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,779.49
|
| Rate for Payer: Cash Price |
$2,422.75
|
| Rate for Payer: Cigna Commercial |
$4,021.76
|
| Rate for Payer: First Health Commercial |
$4,603.23
|
| Rate for Payer: Humana Commercial |
$4,118.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,973.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,575.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,453.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,264.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,634.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,876.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,215.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,343.39
|
| Rate for Payer: PHCS Commercial |
$4,651.68
|
| Rate for Payer: United Healthcare All Payer |
$4,264.04
|
|
|
PLATE INTERM 127MM 140^
|
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 127MM 140^
|
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 127MM 150^
|
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 127MM 150^
|
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 130^55MM
|
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 130^55MM
|
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 140^55MM
|
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 140^55MM
|
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 150^55MM
|
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
|
|
