|
PLATE BROAD COMPRESSION 10H
|
Facility
|
OP
|
$5,426.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,628.08 |
| Max. Negotiated Rate |
$5,209.86 |
| Rate for Payer: Aetna Commercial |
$4,178.74
|
| Rate for Payer: Anthem Medicaid |
$1,866.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,233.01
|
| Rate for Payer: Cash Price |
$2,713.47
|
| Rate for Payer: Cigna Commercial |
$4,504.36
|
| Rate for Payer: First Health Commercial |
$5,155.59
|
| Rate for Payer: Humana Commercial |
$4,612.90
|
| Rate for Payer: Humana KY Medicaid |
$1,866.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,450.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,005.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,628.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,903.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,070.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,341.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.59
|
| Rate for Payer: PHCS Commercial |
$5,209.86
|
| Rate for Payer: United Healthcare All Payer |
$4,775.71
|
|
|
PLATE BROAD COMPRESSION 10H
|
Facility
|
IP
|
$5,426.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,628.08 |
| Max. Negotiated Rate |
$5,209.86 |
| Rate for Payer: Aetna Commercial |
$4,178.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,233.01
|
| Rate for Payer: Cash Price |
$2,713.47
|
| Rate for Payer: Cigna Commercial |
$4,504.36
|
| Rate for Payer: First Health Commercial |
$5,155.59
|
| Rate for Payer: Humana Commercial |
$4,612.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,450.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,005.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,628.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,070.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,341.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.59
|
| Rate for Payer: PHCS Commercial |
$5,209.86
|
| Rate for Payer: United Healthcare All Payer |
$4,775.71
|
|
|
PLATE BROAD COMPRESSION 12 H
|
Facility
|
IP
|
$5,426.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,628.08 |
| Max. Negotiated Rate |
$5,209.86 |
| Rate for Payer: Aetna Commercial |
$4,178.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,233.01
|
| Rate for Payer: Cash Price |
$2,713.47
|
| Rate for Payer: Cigna Commercial |
$4,504.36
|
| Rate for Payer: First Health Commercial |
$5,155.59
|
| Rate for Payer: Humana Commercial |
$4,612.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,450.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,005.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,628.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,070.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,341.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.59
|
| Rate for Payer: PHCS Commercial |
$5,209.86
|
| Rate for Payer: United Healthcare All Payer |
$4,775.71
|
|
|
PLATE BROAD COMPRESSION 12 H
|
Facility
|
OP
|
$5,426.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,628.08 |
| Max. Negotiated Rate |
$5,209.86 |
| Rate for Payer: Aetna Commercial |
$4,178.74
|
| Rate for Payer: Anthem Medicaid |
$1,866.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,233.01
|
| Rate for Payer: Cash Price |
$2,713.47
|
| Rate for Payer: Cigna Commercial |
$4,504.36
|
| Rate for Payer: First Health Commercial |
$5,155.59
|
| Rate for Payer: Humana Commercial |
$4,612.90
|
| Rate for Payer: Humana KY Medicaid |
$1,866.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,450.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,005.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,628.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,903.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,775.71
|
| Rate for Payer: Ohio Health Group HMO |
$4,070.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,341.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,721.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,744.59
|
| Rate for Payer: PHCS Commercial |
$5,209.86
|
| Rate for Payer: United Healthcare All Payer |
$4,775.71
|
|
|
PLATE BROAD CP 4.5MM 10X180MM
|
Facility
|
OP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem Medicaid |
$1,087.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Humana KY Medicaid |
$1,087.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE BROAD CP 4.5MM 10X180MM
|
Facility
|
IP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE BROAD CP 4.5MM 11X198MM
|
Facility
|
IP
|
$3,460.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.19 |
| Max. Negotiated Rate |
$3,322.20 |
| Rate for Payer: Aetna Commercial |
$2,664.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,699.28
|
| Rate for Payer: Cash Price |
$1,730.31
|
| Rate for Payer: Cigna Commercial |
$2,872.31
|
| Rate for Payer: First Health Commercial |
$3,287.59
|
| Rate for Payer: Humana Commercial |
$2,941.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,045.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,768.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,010.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.83
|
| Rate for Payer: PHCS Commercial |
$3,322.20
|
| Rate for Payer: United Healthcare All Payer |
$3,045.35
|
|
|
PLATE BROAD CP 4.5MM 11X198MM
|
Facility
|
OP
|
$3,460.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.19 |
| Max. Negotiated Rate |
$3,322.20 |
| Rate for Payer: Aetna Commercial |
$2,664.68
|
| Rate for Payer: Anthem Medicaid |
$1,190.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,699.28
|
| Rate for Payer: Cash Price |
$1,730.31
|
| Rate for Payer: Cigna Commercial |
$2,872.31
|
| Rate for Payer: First Health Commercial |
$3,287.59
|
| Rate for Payer: Humana Commercial |
$2,941.53
|
| Rate for Payer: Humana KY Medicaid |
$1,190.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,202.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,837.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,553.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,038.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,213.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,045.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,595.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,768.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,010.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,387.83
|
| Rate for Payer: PHCS Commercial |
$3,322.20
|
| Rate for Payer: United Healthcare All Payer |
$3,045.35
|
|
|
PLATE BROAD CP 4.5MM 12X216MM
|
Facility
|
OP
|
$3,245.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.61 |
| Max. Negotiated Rate |
$3,115.56 |
| Rate for Payer: Aetna Commercial |
$2,498.94
|
| Rate for Payer: Anthem Medicaid |
$1,116.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.40
|
| Rate for Payer: Cash Price |
$1,622.69
|
| Rate for Payer: Cigna Commercial |
$2,693.67
|
| Rate for Payer: First Health Commercial |
$3,083.11
|
| Rate for Payer: Humana Commercial |
$2,758.57
|
| Rate for Payer: Humana KY Medicaid |
$1,116.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.31
|
| Rate for Payer: PHCS Commercial |
$3,115.56
|
| Rate for Payer: United Healthcare All Payer |
$2,855.93
|
|
|
PLATE BROAD CP 4.5MM 12X216MM
|
Facility
|
IP
|
$3,245.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.61 |
| Max. Negotiated Rate |
$3,115.56 |
| Rate for Payer: Aetna Commercial |
$2,498.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.40
|
| Rate for Payer: Cash Price |
$1,622.69
|
| Rate for Payer: Cigna Commercial |
$2,693.67
|
| Rate for Payer: First Health Commercial |
$3,083.11
|
| Rate for Payer: Humana Commercial |
$2,758.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.31
|
| Rate for Payer: PHCS Commercial |
$3,115.56
|
| Rate for Payer: United Healthcare All Payer |
$2,855.93
|
|
|
PLATE BROAD CP 4.5MM 14X252MM
|
Facility
|
IP
|
$3,245.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.61 |
| Max. Negotiated Rate |
$3,115.56 |
| Rate for Payer: Aetna Commercial |
$2,498.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.40
|
| Rate for Payer: Cash Price |
$1,622.69
|
| Rate for Payer: Cigna Commercial |
$2,693.67
|
| Rate for Payer: First Health Commercial |
$3,083.11
|
| Rate for Payer: Humana Commercial |
$2,758.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.31
|
| Rate for Payer: PHCS Commercial |
$3,115.56
|
| Rate for Payer: United Healthcare All Payer |
$2,855.93
|
|
|
PLATE BROAD CP 4.5MM 14X252MM
|
Facility
|
OP
|
$3,245.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.61 |
| Max. Negotiated Rate |
$3,115.56 |
| Rate for Payer: Aetna Commercial |
$2,498.94
|
| Rate for Payer: Anthem Medicaid |
$1,116.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,531.40
|
| Rate for Payer: Cash Price |
$1,622.69
|
| Rate for Payer: Cigna Commercial |
$2,693.67
|
| Rate for Payer: First Health Commercial |
$3,083.11
|
| Rate for Payer: Humana Commercial |
$2,758.57
|
| Rate for Payer: Humana KY Medicaid |
$1,116.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,661.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,855.93
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,596.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,823.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,239.31
|
| Rate for Payer: PHCS Commercial |
$3,115.56
|
| Rate for Payer: United Healthcare All Payer |
$2,855.93
|
|
|
PLATE BROAD CP 4.5MM 18X324MM
|
Facility
|
IP
|
$3,837.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.19 |
| Max. Negotiated Rate |
$3,683.82 |
| Rate for Payer: Aetna Commercial |
$2,954.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.10
|
| Rate for Payer: Cash Price |
$1,918.66
|
| Rate for Payer: Cigna Commercial |
$3,184.97
|
| Rate for Payer: First Health Commercial |
$3,645.44
|
| Rate for Payer: Humana Commercial |
$3,261.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,831.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,376.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,877.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,069.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.74
|
| Rate for Payer: PHCS Commercial |
$3,683.82
|
| Rate for Payer: United Healthcare All Payer |
$3,376.83
|
|
|
PLATE BROAD CP 4.5MM 18X324MM
|
Facility
|
OP
|
$3,837.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,151.19 |
| Max. Negotiated Rate |
$3,683.82 |
| Rate for Payer: Aetna Commercial |
$2,954.73
|
| Rate for Payer: Anthem Medicaid |
$1,319.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,993.10
|
| Rate for Payer: Cash Price |
$1,918.66
|
| Rate for Payer: Cigna Commercial |
$3,184.97
|
| Rate for Payer: First Health Commercial |
$3,645.44
|
| Rate for Payer: Humana Commercial |
$3,261.71
|
| Rate for Payer: Humana KY Medicaid |
$1,319.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,333.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,146.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,831.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,151.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,346.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,376.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,877.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,069.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,338.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,647.74
|
| Rate for Payer: PHCS Commercial |
$3,683.82
|
| Rate for Payer: United Healthcare All Payer |
$3,376.83
|
|
|
PLATE BROAD CP 4.5MM 22X396MM
|
Facility
|
IP
|
$4,775.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.56 |
| Max. Negotiated Rate |
$4,584.18 |
| Rate for Payer: Aetna Commercial |
$3,676.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,724.65
|
| Rate for Payer: Cash Price |
$2,387.59
|
| Rate for Payer: Cigna Commercial |
$3,963.41
|
| Rate for Payer: First Health Commercial |
$4,536.43
|
| Rate for Payer: Humana Commercial |
$4,058.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,915.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,581.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,820.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,154.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,294.88
|
| Rate for Payer: PHCS Commercial |
$4,584.18
|
| Rate for Payer: United Healthcare All Payer |
$4,202.17
|
|
|
PLATE BROAD CP 4.5MM 22X396MM
|
Facility
|
OP
|
$4,775.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.56 |
| Max. Negotiated Rate |
$4,584.18 |
| Rate for Payer: Aetna Commercial |
$3,676.90
|
| Rate for Payer: Anthem Medicaid |
$1,642.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,724.65
|
| Rate for Payer: Cash Price |
$2,387.59
|
| Rate for Payer: Cigna Commercial |
$3,963.41
|
| Rate for Payer: First Health Commercial |
$4,536.43
|
| Rate for Payer: Humana Commercial |
$4,058.91
|
| Rate for Payer: Humana KY Medicaid |
$1,642.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,658.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,915.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,524.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,432.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,675.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,202.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,581.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,820.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,154.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,294.88
|
| Rate for Payer: PHCS Commercial |
$4,584.18
|
| Rate for Payer: United Healthcare All Payer |
$4,202.17
|
|
|
PLATE BROAD CP 4.5MM 6X108MM
|
Facility
|
IP
|
$2,242.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.78 |
| Max. Negotiated Rate |
$2,152.89 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.22
|
| Rate for Payer: Cash Price |
$1,121.30
|
| Rate for Payer: Cigna Commercial |
$1,861.35
|
| Rate for Payer: First Health Commercial |
$2,130.46
|
| Rate for Payer: Humana Commercial |
$1,906.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.39
|
| Rate for Payer: PHCS Commercial |
$2,152.89
|
| Rate for Payer: United Healthcare All Payer |
$1,973.48
|
|
|
PLATE BROAD CP 4.5MM 6X108MM
|
Facility
|
OP
|
$2,242.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.78 |
| Max. Negotiated Rate |
$2,152.89 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Anthem Medicaid |
$771.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.22
|
| Rate for Payer: Cash Price |
$1,121.30
|
| Rate for Payer: Cigna Commercial |
$1,861.35
|
| Rate for Payer: First Health Commercial |
$2,130.46
|
| Rate for Payer: Humana Commercial |
$1,906.20
|
| Rate for Payer: Humana KY Medicaid |
$771.23
|
| Rate for Payer: Kentucky WC Medicaid |
$779.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$786.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.39
|
| Rate for Payer: PHCS Commercial |
$2,152.89
|
| Rate for Payer: United Healthcare All Payer |
$1,973.48
|
|
|
PLATE BROAD CP 4.5MM 7X126MM
|
Facility
|
IP
|
$2,242.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.78 |
| Max. Negotiated Rate |
$2,152.89 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.22
|
| Rate for Payer: Cash Price |
$1,121.30
|
| Rate for Payer: Cigna Commercial |
$1,861.35
|
| Rate for Payer: First Health Commercial |
$2,130.46
|
| Rate for Payer: Humana Commercial |
$1,906.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.39
|
| Rate for Payer: PHCS Commercial |
$2,152.89
|
| Rate for Payer: United Healthcare All Payer |
$1,973.48
|
|
|
PLATE BROAD CP 4.5MM 7X126MM
|
Facility
|
OP
|
$2,242.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$672.78 |
| Max. Negotiated Rate |
$2,152.89 |
| Rate for Payer: Aetna Commercial |
$1,726.79
|
| Rate for Payer: Anthem Medicaid |
$771.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,749.22
|
| Rate for Payer: Cash Price |
$1,121.30
|
| Rate for Payer: Cigna Commercial |
$1,861.35
|
| Rate for Payer: First Health Commercial |
$2,130.46
|
| Rate for Payer: Humana Commercial |
$1,906.20
|
| Rate for Payer: Humana KY Medicaid |
$771.23
|
| Rate for Payer: Kentucky WC Medicaid |
$779.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,838.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,655.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$672.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$786.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,973.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,681.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,951.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,547.39
|
| Rate for Payer: PHCS Commercial |
$2,152.89
|
| Rate for Payer: United Healthcare All Payer |
$1,973.48
|
|
|
PLATE BROAD CP 4.5MM 8X144MM
|
Facility
|
IP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE BROAD CP 4.5MM 8X144MM
|
Facility
|
OP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem Medicaid |
$1,087.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Humana KY Medicaid |
$1,087.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE BROAD CP 4.5MM 9X162MM
|
Facility
|
IP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE BROAD CP 4.5MM 9X162MM
|
Facility
|
OP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem Medicaid |
$1,087.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Humana KY Medicaid |
$1,087.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE BSRD LCKG CMP 4.5MM 10H
|
Facility
|
OP
|
$4,317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.25 |
| Max. Negotiated Rate |
$4,144.80 |
| Rate for Payer: Aetna Commercial |
$3,324.47
|
| Rate for Payer: Anthem Medicaid |
$1,484.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.65
|
| Rate for Payer: Cash Price |
$2,158.75
|
| Rate for Payer: Cigna Commercial |
$3,583.53
|
| Rate for Payer: First Health Commercial |
$4,101.62
|
| Rate for Payer: Humana Commercial |
$3,669.88
|
| Rate for Payer: Humana KY Medicaid |
$1,484.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,540.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,186.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,295.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,514.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,799.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,238.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,454.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,979.07
|
| Rate for Payer: PHCS Commercial |
$4,144.80
|
| Rate for Payer: United Healthcare All Payer |
$3,799.40
|
|
