|
PLATE BROAD 4.5MM 6H 123MM
|
Facility
|
OP
|
$2,068.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.93 |
| Max. Negotiated Rate |
$1,985.97 |
| Rate for Payer: Aetna Commercial |
$1,592.91
|
| Rate for Payer: Anthem Medicaid |
$711.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.60
|
| Rate for Payer: Cash Price |
$1,034.36
|
| Rate for Payer: Cigna Commercial |
$1,717.04
|
| Rate for Payer: First Health Commercial |
$1,965.28
|
| Rate for Payer: Humana Commercial |
$1,758.41
|
| Rate for Payer: Humana KY Medicaid |
$711.43
|
| Rate for Payer: Kentucky WC Medicaid |
$718.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.30
|
| Rate for Payer: PHCS Commercial |
$1,985.97
|
| Rate for Payer: United Healthcare All Payer |
$1,820.47
|
|
|
PLATE BROAD 4.5MM 6H 123MM
|
Facility
|
IP
|
$2,068.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.93 |
| Max. Negotiated Rate |
$1,985.97 |
| Rate for Payer: Aetna Commercial |
$1,592.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.60
|
| Rate for Payer: Cash Price |
$1,034.36
|
| Rate for Payer: Cigna Commercial |
$1,717.04
|
| Rate for Payer: First Health Commercial |
$1,965.28
|
| Rate for Payer: Humana Commercial |
$1,758.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.30
|
| Rate for Payer: PHCS Commercial |
$1,985.97
|
| Rate for Payer: United Healthcare All Payer |
$1,820.47
|
|
|
PLATE BROAD 4.5MM 7H 141MM
|
Facility
|
OP
|
$2,068.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.93 |
| Max. Negotiated Rate |
$1,985.97 |
| Rate for Payer: Aetna Commercial |
$1,592.91
|
| Rate for Payer: Anthem Medicaid |
$711.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.60
|
| Rate for Payer: Cash Price |
$1,034.36
|
| Rate for Payer: Cigna Commercial |
$1,717.04
|
| Rate for Payer: First Health Commercial |
$1,965.28
|
| Rate for Payer: Humana Commercial |
$1,758.41
|
| Rate for Payer: Humana KY Medicaid |
$711.43
|
| Rate for Payer: Kentucky WC Medicaid |
$718.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.30
|
| Rate for Payer: PHCS Commercial |
$1,985.97
|
| Rate for Payer: United Healthcare All Payer |
$1,820.47
|
|
|
PLATE BROAD 4.5MM 7H 141MM
|
Facility
|
IP
|
$2,068.72
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.93 |
| Max. Negotiated Rate |
$1,985.97 |
| Rate for Payer: Aetna Commercial |
$1,592.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,613.60
|
| Rate for Payer: Cash Price |
$1,034.36
|
| Rate for Payer: Cigna Commercial |
$1,717.04
|
| Rate for Payer: First Health Commercial |
$1,965.28
|
| Rate for Payer: Humana Commercial |
$1,758.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,696.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,820.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,551.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$641.30
|
| Rate for Payer: PHCS Commercial |
$1,985.97
|
| Rate for Payer: United Healthcare All Payer |
$1,820.47
|
|
|
PLATE BROAD 4.5MM 8H 159MM
|
Facility
|
IP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
|
|
PLATE BROAD 4.5MM 8H 159MM
|
Facility
|
OP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem Medicaid |
$1,063.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Humana KY Medicaid |
$1,063.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
|
|
PLATE BROAD 4.5MM 9H 177MM
|
Facility
|
OP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem Medicaid |
$1,063.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Humana KY Medicaid |
$1,063.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,085.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
|
|
PLATE BROAD 4.5MM 9H 177MM
|
Facility
|
IP
|
$3,093.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$402.16 |
| Max. Negotiated Rate |
$2,969.81 |
| Rate for Payer: Aetna Commercial |
$2,382.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,412.97
|
| Rate for Payer: Cash Price |
$1,546.78
|
| Rate for Payer: Cigna Commercial |
$2,567.65
|
| Rate for Payer: First Health Commercial |
$2,938.87
|
| Rate for Payer: Humana Commercial |
$2,629.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,536.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,283.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$928.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,722.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,320.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$618.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$402.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$959.00
|
| Rate for Payer: PHCS Commercial |
$2,969.81
|
| Rate for Payer: United Healthcare All Payer |
$2,722.32
|
|
|
PLATE BROAD COMPRESSION 10H
|
Facility
|
OP
|
$5,398.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$5,182.54 |
| Rate for Payer: Aetna Commercial |
$4,156.83
|
| Rate for Payer: Anthem Medicaid |
$1,856.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,210.81
|
| Rate for Payer: Cash Price |
$2,699.24
|
| Rate for Payer: Cigna Commercial |
$4,480.74
|
| Rate for Payer: First Health Commercial |
$5,128.56
|
| Rate for Payer: Humana Commercial |
$4,588.71
|
| Rate for Payer: Humana KY Medicaid |
$1,856.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,426.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,750.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.53
|
| Rate for Payer: PHCS Commercial |
$5,182.54
|
| Rate for Payer: United Healthcare All Payer |
$4,750.66
|
|
|
PLATE BROAD COMPRESSION 10H
|
Facility
|
IP
|
$5,398.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$5,182.54 |
| Rate for Payer: Aetna Commercial |
$4,156.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,210.81
|
| Rate for Payer: Cash Price |
$2,699.24
|
| Rate for Payer: Cigna Commercial |
$4,480.74
|
| Rate for Payer: First Health Commercial |
$5,128.56
|
| Rate for Payer: Humana Commercial |
$4,588.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,426.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,750.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.53
|
| Rate for Payer: PHCS Commercial |
$5,182.54
|
| Rate for Payer: United Healthcare All Payer |
$4,750.66
|
|
|
PLATE BROAD COMPRESSION 12 H
|
Facility
|
IP
|
$5,398.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$5,182.54 |
| Rate for Payer: Aetna Commercial |
$4,156.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,210.81
|
| Rate for Payer: Cash Price |
$2,699.24
|
| Rate for Payer: Cigna Commercial |
$4,480.74
|
| Rate for Payer: First Health Commercial |
$5,128.56
|
| Rate for Payer: Humana Commercial |
$4,588.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,426.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,750.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.53
|
| Rate for Payer: PHCS Commercial |
$5,182.54
|
| Rate for Payer: United Healthcare All Payer |
$4,750.66
|
|
|
PLATE BROAD COMPRESSION 12 H
|
Facility
|
OP
|
$5,398.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$701.80 |
| Max. Negotiated Rate |
$5,182.54 |
| Rate for Payer: Aetna Commercial |
$4,156.83
|
| Rate for Payer: Anthem Medicaid |
$1,856.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,210.81
|
| Rate for Payer: Cash Price |
$2,699.24
|
| Rate for Payer: Cigna Commercial |
$4,480.74
|
| Rate for Payer: First Health Commercial |
$5,128.56
|
| Rate for Payer: Humana Commercial |
$4,588.71
|
| Rate for Payer: Humana KY Medicaid |
$1,856.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,426.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,750.66
|
| Rate for Payer: Ohio Health Group HMO |
$4,048.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,079.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$701.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,673.53
|
| Rate for Payer: PHCS Commercial |
$5,182.54
|
| Rate for Payer: United Healthcare All Payer |
$4,750.66
|
|
|
PLATE BROAD CP 4.5MM 10X180MM
|
Facility
|
IP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
|
|
PLATE BROAD CP 4.5MM 10X180MM
|
Facility
|
OP
|
$3,283.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.85 |
| Max. Negotiated Rate |
$3,152.09 |
| Rate for Payer: Humana Commercial |
$2,790.92
|
| Rate for Payer: Humana KY Medicaid |
$1,129.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,151.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,889.42
|
| Rate for Payer: Ohio Health Group HMO |
$2,462.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,017.86
|
| Rate for Payer: PHCS Commercial |
$3,152.09
|
| Rate for Payer: United Healthcare All Payer |
$2,889.42
|
| Rate for Payer: Aetna Commercial |
$2,528.24
|
| Rate for Payer: Anthem Medicaid |
$1,129.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.08
|
| Rate for Payer: Cash Price |
$1,641.71
|
| Rate for Payer: Cigna Commercial |
$2,725.25
|
| Rate for Payer: First Health Commercial |
$3,119.26
|
|
|
PLATE BROAD CP 4.5MM 11X198MM
|
Facility
|
IP
|
$3,563.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.22 |
| Max. Negotiated Rate |
$3,420.72 |
| Rate for Payer: Aetna Commercial |
$2,743.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,779.34
|
| Rate for Payer: Cash Price |
$1,781.62
|
| Rate for Payer: Cigna Commercial |
$2,957.50
|
| Rate for Payer: First Health Commercial |
$3,385.09
|
| Rate for Payer: Humana Commercial |
$3,028.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,921.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,629.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,068.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,135.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,672.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.61
|
| Rate for Payer: PHCS Commercial |
$3,420.72
|
| Rate for Payer: United Healthcare All Payer |
$3,135.66
|
|
|
PLATE BROAD CP 4.5MM 11X198MM
|
Facility
|
OP
|
$3,563.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$463.22 |
| Max. Negotiated Rate |
$3,420.72 |
| Rate for Payer: Aetna Commercial |
$2,743.70
|
| Rate for Payer: Anthem Medicaid |
$1,225.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,779.34
|
| Rate for Payer: Cash Price |
$1,781.62
|
| Rate for Payer: Cigna Commercial |
$2,957.50
|
| Rate for Payer: First Health Commercial |
$3,385.09
|
| Rate for Payer: Humana Commercial |
$3,028.76
|
| Rate for Payer: Humana KY Medicaid |
$1,225.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,237.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,921.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,629.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,068.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,249.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,135.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,672.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$712.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$463.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,104.61
|
| Rate for Payer: PHCS Commercial |
$3,420.72
|
| Rate for Payer: United Healthcare All Payer |
$3,135.66
|
|
|
PLATE BROAD CP 4.5MM 12X216MM
|
Facility
|
IP
|
$3,362.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.11 |
| Max. Negotiated Rate |
$3,227.86 |
| Rate for Payer: Aetna Commercial |
$2,589.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,622.63
|
| Rate for Payer: Cash Price |
$1,681.17
|
| Rate for Payer: Cigna Commercial |
$2,790.75
|
| Rate for Payer: First Health Commercial |
$3,194.23
|
| Rate for Payer: Humana Commercial |
$2,858.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,757.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,481.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,008.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,958.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,521.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,042.33
|
| Rate for Payer: PHCS Commercial |
$3,227.86
|
| Rate for Payer: United Healthcare All Payer |
$2,958.87
|
|
|
PLATE BROAD CP 4.5MM 12X216MM
|
Facility
|
OP
|
$3,362.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.11 |
| Max. Negotiated Rate |
$3,227.86 |
| Rate for Payer: Aetna Commercial |
$2,589.01
|
| Rate for Payer: Anthem Medicaid |
$1,156.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,622.63
|
| Rate for Payer: Cash Price |
$1,681.17
|
| Rate for Payer: Cigna Commercial |
$2,790.75
|
| Rate for Payer: First Health Commercial |
$3,194.23
|
| Rate for Payer: Humana Commercial |
$2,858.00
|
| Rate for Payer: Humana KY Medicaid |
$1,156.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,757.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,481.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,008.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,958.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,521.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,042.33
|
| Rate for Payer: PHCS Commercial |
$3,227.86
|
| Rate for Payer: United Healthcare All Payer |
$2,958.87
|
|
|
PLATE BROAD CP 4.5MM 14X252MM
|
Facility
|
IP
|
$3,362.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.11 |
| Max. Negotiated Rate |
$3,227.86 |
| Rate for Payer: Aetna Commercial |
$2,589.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,622.63
|
| Rate for Payer: Cash Price |
$1,681.17
|
| Rate for Payer: Cigna Commercial |
$2,790.75
|
| Rate for Payer: First Health Commercial |
$3,194.23
|
| Rate for Payer: Humana Commercial |
$2,858.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,757.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,481.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,008.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,958.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,521.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,042.33
|
| Rate for Payer: PHCS Commercial |
$3,227.86
|
| Rate for Payer: United Healthcare All Payer |
$2,958.87
|
|
|
PLATE BROAD CP 4.5MM 14X252MM
|
Facility
|
OP
|
$3,362.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$437.11 |
| Max. Negotiated Rate |
$3,227.86 |
| Rate for Payer: Aetna Commercial |
$2,589.01
|
| Rate for Payer: Anthem Medicaid |
$1,156.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,622.63
|
| Rate for Payer: Cash Price |
$1,681.17
|
| Rate for Payer: Cigna Commercial |
$2,790.75
|
| Rate for Payer: First Health Commercial |
$3,194.23
|
| Rate for Payer: Humana Commercial |
$2,858.00
|
| Rate for Payer: Humana KY Medicaid |
$1,156.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,168.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,757.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,481.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,008.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,179.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,958.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,521.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$672.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$437.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,042.33
|
| Rate for Payer: PHCS Commercial |
$3,227.86
|
| Rate for Payer: United Healthcare All Payer |
$2,958.87
|
|
|
PLATE BROAD CP 4.5MM 18X324MM
|
Facility
|
OP
|
$3,914.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.93 |
| Max. Negotiated Rate |
$3,758.23 |
| Rate for Payer: Aetna Commercial |
$3,014.41
|
| Rate for Payer: Anthem Medicaid |
$1,346.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.56
|
| Rate for Payer: Cash Price |
$1,957.41
|
| Rate for Payer: Cigna Commercial |
$3,249.30
|
| Rate for Payer: First Health Commercial |
$3,719.08
|
| Rate for Payer: Humana Commercial |
$3,327.60
|
| Rate for Payer: Humana KY Medicaid |
$1,346.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,360.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.59
|
| Rate for Payer: PHCS Commercial |
$3,758.23
|
| Rate for Payer: United Healthcare All Payer |
$3,445.04
|
|
|
PLATE BROAD CP 4.5MM 18X324MM
|
Facility
|
IP
|
$3,914.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.93 |
| Max. Negotiated Rate |
$3,758.23 |
| Rate for Payer: Aetna Commercial |
$3,014.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.56
|
| Rate for Payer: Cash Price |
$1,957.41
|
| Rate for Payer: Cigna Commercial |
$3,249.30
|
| Rate for Payer: First Health Commercial |
$3,719.08
|
| Rate for Payer: Humana Commercial |
$3,327.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,210.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,889.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,445.04
|
| Rate for Payer: Ohio Health Group HMO |
$2,936.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$782.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$508.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,213.59
|
| Rate for Payer: PHCS Commercial |
$3,758.23
|
| Rate for Payer: United Healthcare All Payer |
$3,445.04
|
|
|
PLATE BROAD CP 4.5MM 22X396MM
|
Facility
|
OP
|
$4,790.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.72 |
| Max. Negotiated Rate |
$4,598.57 |
| Rate for Payer: Aetna Commercial |
$3,688.44
|
| Rate for Payer: Anthem Medicaid |
$1,647.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,736.34
|
| Rate for Payer: Cash Price |
$2,395.09
|
| Rate for Payer: Cigna Commercial |
$3,975.85
|
| Rate for Payer: First Health Commercial |
$4,550.67
|
| Rate for Payer: Humana Commercial |
$4,071.65
|
| Rate for Payer: Humana KY Medicaid |
$1,647.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,664.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,927.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,535.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,680.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,215.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,592.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,484.96
|
| Rate for Payer: PHCS Commercial |
$4,598.57
|
| Rate for Payer: United Healthcare All Payer |
$4,215.36
|
|
|
PLATE BROAD CP 4.5MM 22X396MM
|
Facility
|
IP
|
$4,790.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.72 |
| Max. Negotiated Rate |
$4,598.57 |
| Rate for Payer: Aetna Commercial |
$3,688.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,736.34
|
| Rate for Payer: Cash Price |
$2,395.09
|
| Rate for Payer: Cigna Commercial |
$3,975.85
|
| Rate for Payer: First Health Commercial |
$4,550.67
|
| Rate for Payer: Humana Commercial |
$4,071.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,927.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,535.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,215.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,592.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$622.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,484.96
|
| Rate for Payer: PHCS Commercial |
$4,598.57
|
| Rate for Payer: United Healthcare All Payer |
$4,215.36
|
|
|
PLATE BROAD CP 4.5MM 6X108MM
|
Facility
|
IP
|
$2,218.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$288.36 |
| Max. Negotiated Rate |
$2,129.45 |
| Rate for Payer: Aetna Commercial |
$1,708.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,730.18
|
| Rate for Payer: Cash Price |
$1,109.09
|
| Rate for Payer: Cigna Commercial |
$1,841.09
|
| Rate for Payer: First Health Commercial |
$2,107.27
|
| Rate for Payer: Humana Commercial |
$1,885.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,818.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,637.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$665.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,952.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,663.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$443.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$288.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$687.64
|
| Rate for Payer: PHCS Commercial |
$2,129.45
|
| Rate for Payer: United Healthcare All Payer |
$1,952.00
|
|
