|
PLATE SM 3.5MM 20X242MM
|
Facility
|
OP
|
$4,052.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.77 |
| Max. Negotiated Rate |
$3,890.46 |
| Rate for Payer: Aetna Commercial |
$3,120.47
|
| Rate for Payer: Anthem Medicaid |
$1,393.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,161.00
|
| Rate for Payer: Cash Price |
$2,026.28
|
| Rate for Payer: Cigna Commercial |
$3,363.62
|
| Rate for Payer: First Health Commercial |
$3,849.93
|
| Rate for Payer: Humana Commercial |
$3,444.68
|
| Rate for Payer: Humana KY Medicaid |
$1,393.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,407.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,323.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,421.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,566.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,242.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,796.27
|
| Rate for Payer: PHCS Commercial |
$3,890.46
|
| Rate for Payer: United Healthcare All Payer |
$3,566.25
|
|
|
PLATE SM 3.5MM 20X242MM
|
Facility
|
IP
|
$4,052.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,215.77 |
| Max. Negotiated Rate |
$3,890.46 |
| Rate for Payer: Aetna Commercial |
$3,120.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,161.00
|
| Rate for Payer: Cash Price |
$2,026.28
|
| Rate for Payer: Cigna Commercial |
$3,363.62
|
| Rate for Payer: First Health Commercial |
$3,849.93
|
| Rate for Payer: Humana Commercial |
$3,444.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,323.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,566.25
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,242.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,525.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,796.27
|
| Rate for Payer: PHCS Commercial |
$3,890.46
|
| Rate for Payer: United Healthcare All Payer |
$3,566.25
|
|
|
PLATE SM 3.5MM 22X265MM
|
Facility
|
IP
|
$4,744.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.33 |
| Max. Negotiated Rate |
$4,554.66 |
| Rate for Payer: Aetna Commercial |
$3,653.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,700.66
|
| Rate for Payer: Cash Price |
$2,372.22
|
| Rate for Payer: Cigna Commercial |
$3,937.89
|
| Rate for Payer: First Health Commercial |
$4,507.22
|
| Rate for Payer: Humana Commercial |
$4,032.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,890.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,501.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,175.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,558.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,795.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,273.66
|
| Rate for Payer: PHCS Commercial |
$4,554.66
|
| Rate for Payer: United Healthcare All Payer |
$4,175.11
|
|
|
PLATE SM 3.5MM 22X265MM
|
Facility
|
OP
|
$4,744.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.33 |
| Max. Negotiated Rate |
$4,554.66 |
| Rate for Payer: Aetna Commercial |
$3,653.22
|
| Rate for Payer: Anthem Medicaid |
$1,631.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,700.66
|
| Rate for Payer: Cash Price |
$2,372.22
|
| Rate for Payer: Cigna Commercial |
$3,937.89
|
| Rate for Payer: First Health Commercial |
$4,507.22
|
| Rate for Payer: Humana Commercial |
$4,032.77
|
| Rate for Payer: Humana KY Medicaid |
$1,631.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,648.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,890.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,501.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,664.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,175.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,558.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,795.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,273.66
|
| Rate for Payer: PHCS Commercial |
$4,554.66
|
| Rate for Payer: United Healthcare All Payer |
$4,175.11
|
|
|
PLATE SMALL CANCANEAL
|
Facility
|
OP
|
$3,594.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.41 |
| Max. Negotiated Rate |
$3,450.90 |
| Rate for Payer: Aetna Commercial |
$2,767.91
|
| Rate for Payer: Anthem Medicaid |
$1,236.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.86
|
| Rate for Payer: Cash Price |
$1,797.34
|
| Rate for Payer: Cigna Commercial |
$2,983.59
|
| Rate for Payer: First Health Commercial |
$3,414.96
|
| Rate for Payer: Humana Commercial |
$3,055.49
|
| Rate for Payer: Humana KY Medicaid |
$1,236.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,248.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,947.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,261.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,163.33
|
| Rate for Payer: Ohio Health Group HMO |
$2,696.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,127.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.34
|
| Rate for Payer: PHCS Commercial |
$3,450.90
|
| Rate for Payer: United Healthcare All Payer |
$3,163.33
|
|
|
PLATE SMALL CANCANEAL
|
Facility
|
IP
|
$3,594.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.41 |
| Max. Negotiated Rate |
$3,450.90 |
| Rate for Payer: Aetna Commercial |
$2,767.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.86
|
| Rate for Payer: Cash Price |
$1,797.34
|
| Rate for Payer: Cigna Commercial |
$2,983.59
|
| Rate for Payer: First Health Commercial |
$3,414.96
|
| Rate for Payer: Humana Commercial |
$3,055.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,947.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,163.33
|
| Rate for Payer: Ohio Health Group HMO |
$2,696.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,127.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.34
|
| Rate for Payer: PHCS Commercial |
$3,450.90
|
| Rate for Payer: United Healthcare All Payer |
$3,163.33
|
|
|
PLATE SMARTLOCK HYBRID MMF
|
Facility
|
OP
|
$3,157.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.34 |
| Max. Negotiated Rate |
$3,031.50 |
| Rate for Payer: Aetna Commercial |
$2,431.51
|
| Rate for Payer: Anthem Medicaid |
$1,085.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,463.09
|
| Rate for Payer: Cash Price |
$1,578.91
|
| Rate for Payer: Cigna Commercial |
$2,620.98
|
| Rate for Payer: First Health Commercial |
$2,999.92
|
| Rate for Payer: Humana Commercial |
$2,684.14
|
| Rate for Payer: Humana KY Medicaid |
$1,085.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,097.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,589.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$947.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,107.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,778.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,368.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,526.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,747.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.89
|
| Rate for Payer: PHCS Commercial |
$3,031.50
|
| Rate for Payer: United Healthcare All Payer |
$2,778.87
|
|
|
PLATE SMARTLOCK HYBRID MMF
|
Facility
|
IP
|
$3,157.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$947.34 |
| Max. Negotiated Rate |
$3,031.50 |
| Rate for Payer: Aetna Commercial |
$2,431.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,463.09
|
| Rate for Payer: Cash Price |
$1,578.91
|
| Rate for Payer: Cigna Commercial |
$2,620.98
|
| Rate for Payer: First Health Commercial |
$2,999.92
|
| Rate for Payer: Humana Commercial |
$2,684.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,589.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,330.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$947.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,778.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,368.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,526.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,747.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,178.89
|
| Rate for Payer: PHCS Commercial |
$3,031.50
|
| Rate for Payer: United Healthcare All Payer |
$2,778.87
|
|
|
PLATE SMARTLOCK HYBRID MMF SM
|
Facility
|
OP
|
$3,256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.88 |
| Max. Negotiated Rate |
$3,126.00 |
| Rate for Payer: Aetna Commercial |
$2,507.31
|
| Rate for Payer: Anthem Medicaid |
$1,119.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,539.88
|
| Rate for Payer: Cash Price |
$1,628.12
|
| Rate for Payer: Cigna Commercial |
$2,702.69
|
| Rate for Payer: First Health Commercial |
$3,093.44
|
| Rate for Payer: Humana Commercial |
$2,767.81
|
| Rate for Payer: Humana KY Medicaid |
$1,119.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,131.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,670.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,403.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,142.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,865.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,442.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,605.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,832.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,246.81
|
| Rate for Payer: PHCS Commercial |
$3,126.00
|
| Rate for Payer: United Healthcare All Payer |
$2,865.50
|
|
|
PLATE SMARTLOCK HYBRID MMF SM
|
Facility
|
IP
|
$3,256.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$976.88 |
| Max. Negotiated Rate |
$3,126.00 |
| Rate for Payer: Aetna Commercial |
$2,507.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,539.88
|
| Rate for Payer: Cash Price |
$1,628.12
|
| Rate for Payer: Cigna Commercial |
$2,702.69
|
| Rate for Payer: First Health Commercial |
$3,093.44
|
| Rate for Payer: Humana Commercial |
$2,767.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,670.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,403.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$976.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,865.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,442.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,605.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,832.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,246.81
|
| Rate for Payer: PHCS Commercial |
$3,126.00
|
| Rate for Payer: United Healthcare All Payer |
$2,865.50
|
|
|
PLATE SM CP 3.5MM 10X130MM
|
Facility
|
OP
|
$2,071.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$1,988.36 |
| Rate for Payer: Aetna Commercial |
$1,594.83
|
| Rate for Payer: Anthem Medicaid |
$712.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.54
|
| Rate for Payer: Cash Price |
$1,035.61
|
| Rate for Payer: Cigna Commercial |
$1,719.10
|
| Rate for Payer: First Health Commercial |
$1,967.65
|
| Rate for Payer: Humana Commercial |
$1,760.53
|
| Rate for Payer: Humana KY Medicaid |
$712.29
|
| Rate for Payer: Kentucky WC Medicaid |
$719.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.13
|
| Rate for Payer: PHCS Commercial |
$1,988.36
|
| Rate for Payer: United Healthcare All Payer |
$1,822.66
|
|
|
PLATE SM CP 3.5MM 10X130MM
|
Facility
|
IP
|
$2,071.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$1,988.36 |
| Rate for Payer: Aetna Commercial |
$1,594.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.54
|
| Rate for Payer: Cash Price |
$1,035.61
|
| Rate for Payer: Cigna Commercial |
$1,719.10
|
| Rate for Payer: First Health Commercial |
$1,967.65
|
| Rate for Payer: Humana Commercial |
$1,760.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.13
|
| Rate for Payer: PHCS Commercial |
$1,988.36
|
| Rate for Payer: United Healthcare All Payer |
$1,822.66
|
|
|
PLATE SM CP 3.5MM 11X143MM
|
Facility
|
IP
|
$2,071.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$1,988.36 |
| Rate for Payer: Aetna Commercial |
$1,594.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.54
|
| Rate for Payer: Cash Price |
$1,035.61
|
| Rate for Payer: Cigna Commercial |
$1,719.10
|
| Rate for Payer: First Health Commercial |
$1,967.65
|
| Rate for Payer: Humana Commercial |
$1,760.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.13
|
| Rate for Payer: PHCS Commercial |
$1,988.36
|
| Rate for Payer: United Healthcare All Payer |
$1,822.66
|
|
|
PLATE SM CP 3.5MM 11X143MM
|
Facility
|
OP
|
$2,071.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$1,988.36 |
| Rate for Payer: Aetna Commercial |
$1,594.83
|
| Rate for Payer: Anthem Medicaid |
$712.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.54
|
| Rate for Payer: Cash Price |
$1,035.61
|
| Rate for Payer: Cigna Commercial |
$1,719.10
|
| Rate for Payer: First Health Commercial |
$1,967.65
|
| Rate for Payer: Humana Commercial |
$1,760.53
|
| Rate for Payer: Humana KY Medicaid |
$712.29
|
| Rate for Payer: Kentucky WC Medicaid |
$719.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.13
|
| Rate for Payer: PHCS Commercial |
$1,988.36
|
| Rate for Payer: United Healthcare All Payer |
$1,822.66
|
|
|
PLATE SM CP 3.5MM 12X156MM
|
Facility
|
IP
|
$2,071.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$1,988.36 |
| Rate for Payer: Aetna Commercial |
$1,594.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.54
|
| Rate for Payer: Cash Price |
$1,035.61
|
| Rate for Payer: Cigna Commercial |
$1,719.10
|
| Rate for Payer: First Health Commercial |
$1,967.65
|
| Rate for Payer: Humana Commercial |
$1,760.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.13
|
| Rate for Payer: PHCS Commercial |
$1,988.36
|
| Rate for Payer: United Healthcare All Payer |
$1,822.66
|
|
|
PLATE SM CP 3.5MM 12X156MM
|
Facility
|
OP
|
$2,071.21
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.36 |
| Max. Negotiated Rate |
$1,988.36 |
| Rate for Payer: Aetna Commercial |
$1,594.83
|
| Rate for Payer: Anthem Medicaid |
$712.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.54
|
| Rate for Payer: Cash Price |
$1,035.61
|
| Rate for Payer: Cigna Commercial |
$1,719.10
|
| Rate for Payer: First Health Commercial |
$1,967.65
|
| Rate for Payer: Humana Commercial |
$1,760.53
|
| Rate for Payer: Humana KY Medicaid |
$712.29
|
| Rate for Payer: Kentucky WC Medicaid |
$719.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,656.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,801.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.13
|
| Rate for Payer: PHCS Commercial |
$1,988.36
|
| Rate for Payer: United Healthcare All Payer |
$1,822.66
|
|
|
PLATE SM CP 3.5MM 14X182MM
|
Facility
|
OP
|
$3,906.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,171.95 |
| Max. Negotiated Rate |
$3,750.24 |
| Rate for Payer: Aetna Commercial |
$3,008.01
|
| Rate for Payer: Anthem Medicaid |
$1,343.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.07
|
| Rate for Payer: Cash Price |
$1,953.25
|
| Rate for Payer: Cigna Commercial |
$3,242.39
|
| Rate for Payer: First Health Commercial |
$3,711.18
|
| Rate for Payer: Humana Commercial |
$3,320.53
|
| Rate for Payer: Humana KY Medicaid |
$1,343.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,171.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,437.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,929.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,398.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.49
|
| Rate for Payer: PHCS Commercial |
$3,750.24
|
| Rate for Payer: United Healthcare All Payer |
$3,437.72
|
|
|
PLATE SM CP 3.5MM 14X182MM
|
Facility
|
IP
|
$3,906.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,171.95 |
| Max. Negotiated Rate |
$3,750.24 |
| Rate for Payer: Aetna Commercial |
$3,008.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,047.07
|
| Rate for Payer: Cash Price |
$1,953.25
|
| Rate for Payer: Cigna Commercial |
$3,242.39
|
| Rate for Payer: First Health Commercial |
$3,711.18
|
| Rate for Payer: Humana Commercial |
$3,320.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,203.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,171.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,437.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,929.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,125.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,398.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,695.49
|
| Rate for Payer: PHCS Commercial |
$3,750.24
|
| Rate for Payer: United Healthcare All Payer |
$3,437.72
|
|
|
PLATE SM CP 3.5MM 15X195MM
|
Facility
|
OP
|
$3,991.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.32 |
| Max. Negotiated Rate |
$3,831.42 |
| Rate for Payer: Aetna Commercial |
$3,073.12
|
| Rate for Payer: Anthem Medicaid |
$1,372.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,113.03
|
| Rate for Payer: Cash Price |
$1,995.53
|
| Rate for Payer: Cigna Commercial |
$3,312.58
|
| Rate for Payer: First Health Commercial |
$3,791.51
|
| Rate for Payer: Humana Commercial |
$3,392.40
|
| Rate for Payer: Humana KY Medicaid |
$1,372.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,386.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,272.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,945.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,197.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,400.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,512.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,993.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,192.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,472.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,753.83
|
| Rate for Payer: PHCS Commercial |
$3,831.42
|
| Rate for Payer: United Healthcare All Payer |
$3,512.13
|
|
|
PLATE SM CP 3.5MM 15X195MM
|
Facility
|
IP
|
$3,991.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,197.32 |
| Max. Negotiated Rate |
$3,831.42 |
| Rate for Payer: Aetna Commercial |
$3,073.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,113.03
|
| Rate for Payer: Cash Price |
$1,995.53
|
| Rate for Payer: Cigna Commercial |
$3,312.58
|
| Rate for Payer: First Health Commercial |
$3,791.51
|
| Rate for Payer: Humana Commercial |
$3,392.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,272.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,945.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,197.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,512.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,993.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,192.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,472.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,753.83
|
| Rate for Payer: PHCS Commercial |
$3,831.42
|
| Rate for Payer: United Healthcare All Payer |
$3,512.13
|
|
|
PLATE SM CP 3.5MM 16X208MM
|
Facility
|
OP
|
$4,198.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.59 |
| Max. Negotiated Rate |
$4,030.68 |
| Rate for Payer: Aetna Commercial |
$3,232.94
|
| Rate for Payer: Anthem Medicaid |
$1,443.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,274.92
|
| Rate for Payer: Cash Price |
$2,099.31
|
| Rate for Payer: Cigna Commercial |
$3,484.85
|
| Rate for Payer: First Health Commercial |
$3,988.69
|
| Rate for Payer: Humana Commercial |
$3,568.83
|
| Rate for Payer: Humana KY Medicaid |
$1,443.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,458.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,442.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,098.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,259.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,472.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,694.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,148.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,652.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.05
|
| Rate for Payer: PHCS Commercial |
$4,030.68
|
| Rate for Payer: United Healthcare All Payer |
$3,694.79
|
|
|
PLATE SM CP 3.5MM 16X208MM
|
Facility
|
IP
|
$4,198.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,259.59 |
| Max. Negotiated Rate |
$4,030.68 |
| Rate for Payer: Aetna Commercial |
$3,232.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,274.92
|
| Rate for Payer: Cash Price |
$2,099.31
|
| Rate for Payer: Cigna Commercial |
$3,484.85
|
| Rate for Payer: First Health Commercial |
$3,988.69
|
| Rate for Payer: Humana Commercial |
$3,568.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,442.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,098.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,259.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,694.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,148.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,358.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,652.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,897.05
|
| Rate for Payer: PHCS Commercial |
$4,030.68
|
| Rate for Payer: United Healthcare All Payer |
$3,694.79
|
|
|
PLATE SM CP 3.5MM 18X234MM
|
Facility
|
OP
|
$4,444.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.39 |
| Max. Negotiated Rate |
$4,266.84 |
| Rate for Payer: Aetna Commercial |
$3,422.36
|
| Rate for Payer: Anthem Medicaid |
$1,528.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,466.80
|
| Rate for Payer: Cash Price |
$2,222.31
|
| Rate for Payer: Cigna Commercial |
$3,689.03
|
| Rate for Payer: First Health Commercial |
$4,222.39
|
| Rate for Payer: Humana Commercial |
$3,777.93
|
| Rate for Payer: Humana KY Medicaid |
$1,528.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,544.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,559.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,555.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,866.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,066.79
|
| Rate for Payer: PHCS Commercial |
$4,266.84
|
| Rate for Payer: United Healthcare All Payer |
$3,911.27
|
|
|
PLATE SM CP 3.5MM 18X234MM
|
Facility
|
IP
|
$4,444.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,333.39 |
| Max. Negotiated Rate |
$4,266.84 |
| Rate for Payer: Aetna Commercial |
$3,422.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,466.80
|
| Rate for Payer: Cash Price |
$2,222.31
|
| Rate for Payer: Cigna Commercial |
$3,689.03
|
| Rate for Payer: First Health Commercial |
$4,222.39
|
| Rate for Payer: Humana Commercial |
$3,777.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,644.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,280.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,333.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,911.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,333.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,555.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,866.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,066.79
|
| Rate for Payer: PHCS Commercial |
$4,266.84
|
| Rate for Payer: United Healthcare All Payer |
$3,911.27
|
|
|
PLATE SM CP 3.5MM 20X260MM
|
Facility
|
IP
|
$4,759.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,427.94 |
| Max. Negotiated Rate |
$4,569.42 |
| Rate for Payer: Aetna Commercial |
$3,665.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,712.65
|
| Rate for Payer: Cash Price |
$2,379.91
|
| Rate for Payer: Cigna Commercial |
$3,950.64
|
| Rate for Payer: First Health Commercial |
$4,521.82
|
| Rate for Payer: Humana Commercial |
$4,045.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,903.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,512.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,427.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,188.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,569.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,807.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,141.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,284.27
|
| Rate for Payer: PHCS Commercial |
$4,569.42
|
| Rate for Payer: United Healthcare All Payer |
$4,188.63
|
|
