|
PLATE INTERM 150^55MM
|
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 76MM 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 76MM 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
|
|
|
PLATE INTERM 76MM 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 76MM 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 76MM 120^
|
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 76MM 120^
|
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 76MM 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 76MM 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 76MM 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 76MM 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 76MM 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 76MM 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 76MM 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 76MM 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 90^55MM
|
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 90^55MM
|
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 J CLAVICLE LOW PROF 8H R
|
Facility
|
OP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem Medicaid |
$1,722.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Humana KY Medicaid |
$1,722.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,739.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,756.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE J CLAVICLE LOW PROF 8H R
|
Facility
|
IP
|
$5,007.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,502.25 |
| Max. Negotiated Rate |
$4,807.20 |
| Rate for Payer: Aetna Commercial |
$3,855.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,905.85
|
| Rate for Payer: Cash Price |
$2,503.75
|
| Rate for Payer: Cigna Commercial |
$4,156.23
|
| Rate for Payer: First Health Commercial |
$4,757.12
|
| Rate for Payer: Humana Commercial |
$4,256.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,106.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,695.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,502.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,406.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,755.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,006.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,356.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,455.18
|
| Rate for Payer: PHCS Commercial |
$4,807.20
|
| Rate for Payer: United Healthcare All Payer |
$4,406.60
|
|
|
PLATE JONES SMALL
|
Facility
|
OP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem Medicaid |
$1,848.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Humana KY Medicaid |
$1,848.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,885.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
PLATE JONES SMALL
|
Facility
|
IP
|
$5,375.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,612.50 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$4,138.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,192.50
|
| Rate for Payer: Cash Price |
$2,687.50
|
| Rate for Payer: Cigna Commercial |
$4,461.25
|
| Rate for Payer: First Health Commercial |
$5,106.25
|
| Rate for Payer: Humana Commercial |
$4,568.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,407.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,966.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,612.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,730.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,031.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,300.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,676.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,708.75
|
| Rate for Payer: PHCS Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare All Payer |
$4,730.00
|
|
|
PLATE KEYED 135 DEG 12H
|
Facility
|
IP
|
$3,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$3,568.80 |
| Rate for Payer: Aetna Commercial |
$2,862.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.65
|
| Rate for Payer: Cash Price |
$1,858.75
|
| Rate for Payer: Cigna Commercial |
$3,085.53
|
| Rate for Payer: First Health Commercial |
$3,531.62
|
| Rate for Payer: Humana Commercial |
$3,159.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.07
|
| Rate for Payer: PHCS Commercial |
$3,568.80
|
| Rate for Payer: United Healthcare All Payer |
$3,271.40
|
|
|
PLATE KEYED 135 DEG 12H
|
Facility
|
OP
|
$3,717.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.25 |
| Max. Negotiated Rate |
$3,568.80 |
| Rate for Payer: Aetna Commercial |
$2,862.47
|
| Rate for Payer: Anthem Medicaid |
$1,278.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,899.65
|
| Rate for Payer: Cash Price |
$1,858.75
|
| Rate for Payer: Cigna Commercial |
$3,085.53
|
| Rate for Payer: First Health Commercial |
$3,531.62
|
| Rate for Payer: Humana Commercial |
$3,159.88
|
| Rate for Payer: Humana KY Medicaid |
$1,278.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,291.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,048.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,743.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,115.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,304.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,271.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,788.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,974.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,234.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,565.07
|
| Rate for Payer: PHCS Commercial |
$3,568.80
|
| Rate for Payer: United Healthcare All Payer |
$3,271.40
|
|
|
PLATE L 2.4MM 2H TI 3H RT
|
Facility
|
OP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem Medicaid |
$1,584.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Humana KY Medicaid |
$1,584.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,615.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE L 2.4MM 2H TI 3H RT
|
Facility
|
IP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
