|
PLATE SPOON 6 HOLE 120MM
|
Facility
|
IP
|
$3,214.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.39 |
| Max. Negotiated Rate |
$3,086.04 |
| Rate for Payer: Aetna Commercial |
$2,475.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.40
|
| Rate for Payer: Cash Price |
$1,607.31
|
| Rate for Payer: Cigna Commercial |
$2,668.13
|
| Rate for Payer: First Health Commercial |
$3,053.89
|
| Rate for Payer: Humana Commercial |
$2,732.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,571.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,796.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.09
|
| Rate for Payer: PHCS Commercial |
$3,086.04
|
| Rate for Payer: United Healthcare All Payer |
$2,828.87
|
|
|
PLATE SPOON 6 HOLE 120MM
|
Facility
|
OP
|
$3,214.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$964.39 |
| Max. Negotiated Rate |
$3,086.04 |
| Rate for Payer: Aetna Commercial |
$2,475.26
|
| Rate for Payer: Anthem Medicaid |
$1,105.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,507.40
|
| Rate for Payer: Cash Price |
$1,607.31
|
| Rate for Payer: Cigna Commercial |
$2,668.13
|
| Rate for Payer: First Health Commercial |
$3,053.89
|
| Rate for Payer: Humana Commercial |
$2,732.43
|
| Rate for Payer: Humana KY Medicaid |
$1,105.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,116.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,635.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,372.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$964.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,127.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,828.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,410.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,571.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,796.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,218.09
|
| Rate for Payer: PHCS Commercial |
$3,086.04
|
| Rate for Payer: United Healthcare All Payer |
$2,828.87
|
|
|
PLATE SS 2 HOLE
|
Facility
|
OP
|
$5,346.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.06 |
| Max. Negotiated Rate |
$5,133.00 |
| Rate for Payer: Aetna Commercial |
$4,117.10
|
| Rate for Payer: Anthem Medicaid |
$1,838.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,170.57
|
| Rate for Payer: Cash Price |
$2,673.44
|
| Rate for Payer: Cigna Commercial |
$4,437.91
|
| Rate for Payer: First Health Commercial |
$5,079.54
|
| Rate for Payer: Humana Commercial |
$4,544.85
|
| Rate for Payer: Humana KY Medicaid |
$1,838.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,857.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,384.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,946.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,875.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,705.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,010.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,277.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,651.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,689.35
|
| Rate for Payer: PHCS Commercial |
$5,133.00
|
| Rate for Payer: United Healthcare All Payer |
$4,705.25
|
|
|
PLATE SS 2 HOLE
|
Facility
|
IP
|
$5,346.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.06 |
| Max. Negotiated Rate |
$5,133.00 |
| Rate for Payer: Aetna Commercial |
$4,117.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,170.57
|
| Rate for Payer: Cash Price |
$2,673.44
|
| Rate for Payer: Cigna Commercial |
$4,437.91
|
| Rate for Payer: First Health Commercial |
$5,079.54
|
| Rate for Payer: Humana Commercial |
$4,544.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,384.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,946.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,705.25
|
| Rate for Payer: Ohio Health Group HMO |
$4,010.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,277.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,651.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,689.35
|
| Rate for Payer: PHCS Commercial |
$5,133.00
|
| Rate for Payer: United Healthcare All Payer |
$4,705.25
|
|
|
PLATE STANDARD 95 10 SLOT
|
Facility
|
OP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem Medicaid |
$1,524.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Humana KY Medicaid |
$1,524.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
PLATE STANDARD 95 10 SLOT
|
Facility
|
IP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
PLATE STANDARD 95 12 SLOT
|
Facility
|
OP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem Medicaid |
$1,524.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Humana KY Medicaid |
$1,524.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
PLATE STANDARD 95 12 SLOT
|
Facility
|
IP
|
$4,433.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,330.12 |
| Max. Negotiated Rate |
$4,256.40 |
| Rate for Payer: Aetna Commercial |
$3,413.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,458.32
|
| Rate for Payer: Cash Price |
$2,216.88
|
| Rate for Payer: Cigna Commercial |
$3,680.01
|
| Rate for Payer: First Health Commercial |
$4,212.06
|
| Rate for Payer: Humana Commercial |
$3,768.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,272.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,330.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,325.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,547.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,857.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,059.29
|
| Rate for Payer: PHCS Commercial |
$4,256.40
|
| Rate for Payer: United Healthcare All Payer |
$3,901.70
|
|
|
PLATE STANDARD 95 14 SLOT
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
PLATE STANDARD 95 14 SLOT
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
PLATE STANDARD 95 6 SLOT
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
|
PLATE STANDARD 95 6 SLOT
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem Medicaid |
$1,371.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Humana KY Medicaid |
$1,371.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
|
PLATE STANDARD 95 8 SLOT
|
Facility
|
IP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
|
PLATE STANDARD 95 8 SLOT
|
Facility
|
OP
|
$3,987.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.25 |
| Max. Negotiated Rate |
$3,828.00 |
| Rate for Payer: Aetna Commercial |
$3,070.38
|
| Rate for Payer: Anthem Medicaid |
$1,371.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,110.25
|
| Rate for Payer: Cash Price |
$1,993.75
|
| Rate for Payer: Cigna Commercial |
$3,309.62
|
| Rate for Payer: First Health Commercial |
$3,788.12
|
| Rate for Payer: Humana Commercial |
$3,389.38
|
| Rate for Payer: Humana KY Medicaid |
$1,371.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,385.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,269.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,942.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,196.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,398.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,509.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,990.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,190.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,469.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,751.38
|
| Rate for Payer: PHCS Commercial |
$3,828.00
|
| Rate for Payer: United Healthcare All Payer |
$3,509.00
|
|
|
PLATE STD BARL KEYLESS 130^ 3H
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.00 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna Commercial |
$4,057.90
|
| Rate for Payer: Anthem Medicaid |
$1,812.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,110.60
|
| Rate for Payer: Cash Price |
$2,635.00
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$5,006.50
|
| Rate for Payer: Humana Commercial |
$4,479.50
|
| Rate for Payer: Humana KY Medicaid |
$1,812.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,830.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,889.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,581.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,848.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,637.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,584.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.30
|
| Rate for Payer: PHCS Commercial |
$5,059.20
|
| Rate for Payer: United Healthcare All Payer |
$4,637.60
|
|
|
PLATE STD BARL KEYLESS 130^ 3H
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.00 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna Commercial |
$4,057.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,110.60
|
| Rate for Payer: Cash Price |
$2,635.00
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$5,006.50
|
| Rate for Payer: Humana Commercial |
$4,479.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,889.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,581.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,637.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,584.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.30
|
| Rate for Payer: PHCS Commercial |
$5,059.20
|
| Rate for Payer: United Healthcare All Payer |
$4,637.60
|
|
|
PLATE STD BARL KEYLESS 135^ 2H
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.00 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna Commercial |
$4,057.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,110.60
|
| Rate for Payer: Cash Price |
$2,635.00
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$5,006.50
|
| Rate for Payer: Humana Commercial |
$4,479.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,889.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,581.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,637.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,584.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.30
|
| Rate for Payer: PHCS Commercial |
$5,059.20
|
| Rate for Payer: United Healthcare All Payer |
$4,637.60
|
|
|
PLATE STD BARL KEYLESS 135^ 2H
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.00 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna Commercial |
$4,057.90
|
| Rate for Payer: Anthem Medicaid |
$1,812.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,110.60
|
| Rate for Payer: Cash Price |
$2,635.00
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$5,006.50
|
| Rate for Payer: Humana Commercial |
$4,479.50
|
| Rate for Payer: Humana KY Medicaid |
$1,812.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,830.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,889.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,581.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,848.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,637.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,584.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.30
|
| Rate for Payer: PHCS Commercial |
$5,059.20
|
| Rate for Payer: United Healthcare All Payer |
$4,637.60
|
|
|
PLATE STD BARL KEYLESS 135^ 3H
|
Facility
|
OP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.00 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna Commercial |
$4,057.90
|
| Rate for Payer: Anthem Medicaid |
$1,812.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,110.60
|
| Rate for Payer: Cash Price |
$2,635.00
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$5,006.50
|
| Rate for Payer: Humana Commercial |
$4,479.50
|
| Rate for Payer: Humana KY Medicaid |
$1,812.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,830.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,889.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,581.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,848.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,637.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,584.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.30
|
| Rate for Payer: PHCS Commercial |
$5,059.20
|
| Rate for Payer: United Healthcare All Payer |
$4,637.60
|
|
|
PLATE STD BARL KEYLESS 135^ 3H
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,581.00 |
| Max. Negotiated Rate |
$5,059.20 |
| Rate for Payer: Aetna Commercial |
$4,057.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,110.60
|
| Rate for Payer: Cash Price |
$2,635.00
|
| Rate for Payer: Cigna Commercial |
$4,374.10
|
| Rate for Payer: First Health Commercial |
$5,006.50
|
| Rate for Payer: Humana Commercial |
$4,479.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,321.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,889.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,581.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,637.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,952.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,216.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,584.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,636.30
|
| Rate for Payer: PHCS Commercial |
$5,059.20
|
| Rate for Payer: United Healthcare All Payer |
$4,637.60
|
|
|
PLATE STD GOLD 1.7MM 8H
|
Facility
|
OP
|
$2,992.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.70 |
| Max. Negotiated Rate |
$2,872.63 |
| Rate for Payer: Aetna Commercial |
$2,304.09
|
| Rate for Payer: Anthem Medicaid |
$1,029.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,334.01
|
| Rate for Payer: Cash Price |
$1,496.16
|
| Rate for Payer: Cigna Commercial |
$2,483.63
|
| Rate for Payer: First Health Commercial |
$2,842.70
|
| Rate for Payer: Humana Commercial |
$2,543.47
|
| Rate for Payer: Humana KY Medicaid |
$1,029.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,039.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,453.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,208.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,049.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,633.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,244.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,393.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,603.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.70
|
| Rate for Payer: PHCS Commercial |
$2,872.63
|
| Rate for Payer: United Healthcare All Payer |
$2,633.24
|
|
|
PLATE STD GOLD 1.7MM 8H
|
Facility
|
IP
|
$2,992.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.70 |
| Max. Negotiated Rate |
$2,872.63 |
| Rate for Payer: Aetna Commercial |
$2,304.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,334.01
|
| Rate for Payer: Cash Price |
$1,496.16
|
| Rate for Payer: Cigna Commercial |
$2,483.63
|
| Rate for Payer: First Health Commercial |
$2,842.70
|
| Rate for Payer: Humana Commercial |
$2,543.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,453.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,208.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$897.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,633.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,244.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,393.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,603.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.70
|
| Rate for Payer: PHCS Commercial |
$2,872.63
|
| Rate for Payer: United Healthcare All Payer |
$2,633.24
|
|
|
PLATE STD LCK HD VDR 3H 62MM L
|
Facility
|
OP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem Medicaid |
$1,725.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Humana KY Medicaid |
$1,725.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE STD LCK HD VDR 3H 62MM L
|
Facility
|
IP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
|
PLATE STD LCK HD VDR 3H 62MM R
|
Facility
|
OP
|
$5,017.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,505.34 |
| Max. Negotiated Rate |
$4,817.10 |
| Rate for Payer: Aetna Commercial |
$3,863.71
|
| Rate for Payer: Anthem Medicaid |
$1,725.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,913.89
|
| Rate for Payer: Cash Price |
$2,508.91
|
| Rate for Payer: Cigna Commercial |
$4,164.78
|
| Rate for Payer: First Health Commercial |
$4,766.92
|
| Rate for Payer: Humana Commercial |
$4,265.14
|
| Rate for Payer: Humana KY Medicaid |
$1,725.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,114.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,703.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,415.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,763.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,014.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,365.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,462.29
|
| Rate for Payer: PHCS Commercial |
$4,817.10
|
| Rate for Payer: United Healthcare All Payer |
$4,415.67
|
|
