|
PLATE RECON 3.5*142 12H
|
Facility
|
OP
|
$3,773.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.55 |
| Max. Negotiated Rate |
$3,622.49 |
| Rate for Payer: Aetna Commercial |
$2,905.54
|
| Rate for Payer: Anthem Medicaid |
$1,297.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,943.28
|
| Rate for Payer: Cash Price |
$1,886.71
|
| Rate for Payer: Cigna Commercial |
$3,131.95
|
| Rate for Payer: First Health Commercial |
$3,584.76
|
| Rate for Payer: Humana Commercial |
$3,207.42
|
| Rate for Payer: Humana KY Medicaid |
$1,297.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,310.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,784.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,323.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,320.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.76
|
| Rate for Payer: PHCS Commercial |
$3,622.49
|
| Rate for Payer: United Healthcare All Payer |
$3,320.62
|
|
|
PLATE RECON 3.5*166 14H
|
Facility
|
IP
|
$3,928.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.75 |
| Max. Negotiated Rate |
$3,771.67 |
| Rate for Payer: Aetna Commercial |
$3,025.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.48
|
| Rate for Payer: Cash Price |
$1,964.41
|
| Rate for Payer: Cigna Commercial |
$3,260.92
|
| Rate for Payer: First Health Commercial |
$3,732.38
|
| Rate for Payer: Humana Commercial |
$3,339.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.93
|
| Rate for Payer: PHCS Commercial |
$3,771.67
|
| Rate for Payer: United Healthcare All Payer |
$3,457.36
|
|
|
PLATE RECON 3.5*166 14H
|
Facility
|
OP
|
$3,928.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.75 |
| Max. Negotiated Rate |
$3,771.67 |
| Rate for Payer: Aetna Commercial |
$3,025.19
|
| Rate for Payer: Anthem Medicaid |
$1,351.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.48
|
| Rate for Payer: Cash Price |
$1,964.41
|
| Rate for Payer: Cigna Commercial |
$3,260.92
|
| Rate for Payer: First Health Commercial |
$3,732.38
|
| Rate for Payer: Humana Commercial |
$3,339.50
|
| Rate for Payer: Humana KY Medicaid |
$1,351.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,364.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,378.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.93
|
| Rate for Payer: PHCS Commercial |
$3,771.67
|
| Rate for Payer: United Healthcare All Payer |
$3,457.36
|
|
|
PLATE RECON 3.5*46 4H
|
Facility
|
OP
|
$3,300.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$3,168.72 |
| Rate for Payer: Aetna Commercial |
$2,541.58
|
| Rate for Payer: Anthem Medicaid |
$1,135.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.58
|
| Rate for Payer: Cash Price |
$1,650.38
|
| Rate for Payer: Cigna Commercial |
$2,739.62
|
| Rate for Payer: First Health Commercial |
$3,135.71
|
| Rate for Payer: Humana Commercial |
$2,805.64
|
| Rate for Payer: Humana KY Medicaid |
$1,135.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,146.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,157.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.23
|
| Rate for Payer: PHCS Commercial |
$3,168.72
|
| Rate for Payer: United Healthcare All Payer |
$2,904.66
|
|
|
PLATE RECON 3.5*46 4H
|
Facility
|
IP
|
$3,300.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.10 |
| Max. Negotiated Rate |
$3,168.72 |
| Rate for Payer: Aetna Commercial |
$2,541.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,574.58
|
| Rate for Payer: Cash Price |
$1,650.38
|
| Rate for Payer: Cigna Commercial |
$2,739.62
|
| Rate for Payer: First Health Commercial |
$3,135.71
|
| Rate for Payer: Humana Commercial |
$2,805.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,706.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,435.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,904.66
|
| Rate for Payer: Ohio Health Group HMO |
$2,475.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.23
|
| Rate for Payer: PHCS Commercial |
$3,168.72
|
| Rate for Payer: United Healthcare All Payer |
$2,904.66
|
|
|
PLATE RECON 3.5*70 6H
|
Facility
|
IP
|
$3,482.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.67 |
| Max. Negotiated Rate |
$3,342.77 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.00
|
| Rate for Payer: Cash Price |
$1,741.03
|
| Rate for Payer: Cigna Commercial |
$2,890.10
|
| Rate for Payer: First Health Commercial |
$3,307.95
|
| Rate for Payer: Humana Commercial |
$2,959.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,855.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,064.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,611.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.44
|
| Rate for Payer: PHCS Commercial |
$3,342.77
|
| Rate for Payer: United Healthcare All Payer |
$3,064.20
|
|
|
PLATE RECON 3.5*70 6H
|
Facility
|
OP
|
$3,482.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.67 |
| Max. Negotiated Rate |
$3,342.77 |
| Rate for Payer: Aetna Commercial |
$2,681.18
|
| Rate for Payer: Anthem Medicaid |
$1,197.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,716.00
|
| Rate for Payer: Cash Price |
$1,741.03
|
| Rate for Payer: Cigna Commercial |
$2,890.10
|
| Rate for Payer: First Health Commercial |
$3,307.95
|
| Rate for Payer: Humana Commercial |
$2,959.74
|
| Rate for Payer: Humana KY Medicaid |
$1,197.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,855.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,064.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,611.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$696.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,079.44
|
| Rate for Payer: PHCS Commercial |
$3,342.77
|
| Rate for Payer: United Healthcare All Payer |
$3,064.20
|
|
|
PLATE RECON 3.5*94 8H
|
Facility
|
IP
|
$3,605.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.66 |
| Max. Negotiated Rate |
$3,460.87 |
| Rate for Payer: Aetna Commercial |
$2,775.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.95
|
| Rate for Payer: Cash Price |
$1,802.54
|
| Rate for Payer: Cigna Commercial |
$2,992.21
|
| Rate for Payer: First Health Commercial |
$3,424.82
|
| Rate for Payer: Humana Commercial |
$3,064.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,956.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,660.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,172.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$721.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.57
|
| Rate for Payer: PHCS Commercial |
$3,460.87
|
| Rate for Payer: United Healthcare All Payer |
$3,172.46
|
|
|
PLATE RECON 3.5*94 8H
|
Facility
|
OP
|
$3,605.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$468.66 |
| Max. Negotiated Rate |
$3,460.87 |
| Rate for Payer: Aetna Commercial |
$2,775.90
|
| Rate for Payer: Anthem Medicaid |
$1,239.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,811.95
|
| Rate for Payer: Cash Price |
$1,802.54
|
| Rate for Payer: Cigna Commercial |
$2,992.21
|
| Rate for Payer: First Health Commercial |
$3,424.82
|
| Rate for Payer: Humana Commercial |
$3,064.31
|
| Rate for Payer: Humana KY Medicaid |
$1,239.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,252.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,956.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,660.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,081.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,264.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,172.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,703.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$721.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$468.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,117.57
|
| Rate for Payer: PHCS Commercial |
$3,460.87
|
| Rate for Payer: United Healthcare All Payer |
$3,172.46
|
|
|
PLATE RECON 3.5MM 10H 118MM
|
Facility
|
IP
|
$3,650.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.55 |
| Max. Negotiated Rate |
$3,504.38 |
| Rate for Payer: Aetna Commercial |
$2,810.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.31
|
| Rate for Payer: Cash Price |
$1,825.20
|
| Rate for Payer: Cigna Commercial |
$3,029.83
|
| Rate for Payer: First Health Commercial |
$3,467.88
|
| Rate for Payer: Humana Commercial |
$3,102.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,694.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.62
|
| Rate for Payer: PHCS Commercial |
$3,504.38
|
| Rate for Payer: United Healthcare All Payer |
$3,212.35
|
|
|
PLATE RECON 3.5MM 10H 118MM
|
Facility
|
OP
|
$3,650.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.55 |
| Max. Negotiated Rate |
$3,504.38 |
| Rate for Payer: Aetna Commercial |
$2,810.81
|
| Rate for Payer: Anthem Medicaid |
$1,255.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,847.31
|
| Rate for Payer: Cash Price |
$1,825.20
|
| Rate for Payer: Cigna Commercial |
$3,029.83
|
| Rate for Payer: First Health Commercial |
$3,467.88
|
| Rate for Payer: Humana Commercial |
$3,102.84
|
| Rate for Payer: Humana KY Medicaid |
$1,255.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,993.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,694.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,280.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,212.35
|
| Rate for Payer: Ohio Health Group HMO |
$2,737.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$730.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$474.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,131.62
|
| Rate for Payer: PHCS Commercial |
$3,504.38
|
| Rate for Payer: United Healthcare All Payer |
$3,212.35
|
|
|
PLATE RECON 3.5MM 10X118MM
|
Facility
|
OP
|
$3,936.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.73 |
| Max. Negotiated Rate |
$3,778.90 |
| Rate for Payer: Aetna Commercial |
$3,030.99
|
| Rate for Payer: Anthem Medicaid |
$1,353.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.35
|
| Rate for Payer: Cash Price |
$1,968.17
|
| Rate for Payer: Cigna Commercial |
$3,267.17
|
| Rate for Payer: First Health Commercial |
$3,739.53
|
| Rate for Payer: Humana Commercial |
$3,345.90
|
| Rate for Payer: Humana KY Medicaid |
$1,353.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,367.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,380.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.27
|
| Rate for Payer: PHCS Commercial |
$3,778.90
|
| Rate for Payer: United Healthcare All Payer |
$3,463.99
|
|
|
PLATE RECON 3.5MM 10X118MM
|
Facility
|
IP
|
$3,936.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.73 |
| Max. Negotiated Rate |
$3,778.90 |
| Rate for Payer: Aetna Commercial |
$3,030.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,070.35
|
| Rate for Payer: Cash Price |
$1,968.17
|
| Rate for Payer: Cigna Commercial |
$3,267.17
|
| Rate for Payer: First Health Commercial |
$3,739.53
|
| Rate for Payer: Humana Commercial |
$3,345.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,227.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,905.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,180.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,463.99
|
| Rate for Payer: Ohio Health Group HMO |
$2,952.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$787.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,220.27
|
| Rate for Payer: PHCS Commercial |
$3,778.90
|
| Rate for Payer: United Healthcare All Payer |
$3,463.99
|
|
|
PLATE RECON 3.5MM 11X130MM
|
Facility
|
IP
|
$3,886.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$3,730.68 |
| Rate for Payer: Aetna Commercial |
$2,992.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.17
|
| Rate for Payer: Cash Price |
$1,943.06
|
| Rate for Payer: Cigna Commercial |
$3,225.48
|
| Rate for Payer: First Health Commercial |
$3,691.81
|
| Rate for Payer: Humana Commercial |
$3,303.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.70
|
| Rate for Payer: PHCS Commercial |
$3,730.68
|
| Rate for Payer: United Healthcare All Payer |
$3,419.79
|
|
|
PLATE RECON 3.5MM 11X130MM
|
Facility
|
OP
|
$3,886.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.20 |
| Max. Negotiated Rate |
$3,730.68 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,031.17
|
| Rate for Payer: Cash Price |
$1,943.06
|
| Rate for Payer: Cigna Commercial |
$3,225.48
|
| Rate for Payer: First Health Commercial |
$3,691.81
|
| Rate for Payer: Humana Commercial |
$3,303.20
|
| Rate for Payer: Humana KY Medicaid |
$1,336.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,350.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,186.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,867.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,363.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,419.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,914.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$777.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$505.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,204.70
|
| Rate for Payer: PHCS Commercial |
$3,730.68
|
| Rate for Payer: United Healthcare All Payer |
$3,419.79
|
| Rate for Payer: Aetna Commercial |
$2,992.31
|
| Rate for Payer: Anthem Medicaid |
$1,336.44
|
|
|
PLATE RECON 3.5MM 12H 142MM
|
Facility
|
IP
|
$3,773.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.55 |
| Max. Negotiated Rate |
$3,622.49 |
| Rate for Payer: Aetna Commercial |
$2,905.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,943.28
|
| Rate for Payer: Cash Price |
$1,886.71
|
| Rate for Payer: Cigna Commercial |
$3,131.95
|
| Rate for Payer: First Health Commercial |
$3,584.76
|
| Rate for Payer: Humana Commercial |
$3,207.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,784.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,320.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.76
|
| Rate for Payer: PHCS Commercial |
$3,622.49
|
| Rate for Payer: United Healthcare All Payer |
$3,320.62
|
|
|
PLATE RECON 3.5MM 12H 142MM
|
Facility
|
OP
|
$3,773.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.55 |
| Max. Negotiated Rate |
$3,622.49 |
| Rate for Payer: Aetna Commercial |
$2,905.54
|
| Rate for Payer: Anthem Medicaid |
$1,297.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,943.28
|
| Rate for Payer: Cash Price |
$1,886.71
|
| Rate for Payer: Cigna Commercial |
$3,131.95
|
| Rate for Payer: First Health Commercial |
$3,584.76
|
| Rate for Payer: Humana Commercial |
$3,207.42
|
| Rate for Payer: Humana KY Medicaid |
$1,297.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,310.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,094.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,784.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,323.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,320.62
|
| Rate for Payer: Ohio Health Group HMO |
$2,830.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$754.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.76
|
| Rate for Payer: PHCS Commercial |
$3,622.49
|
| Rate for Payer: United Healthcare All Payer |
$3,320.62
|
|
|
PLATE RECON 3.5MM 12X142MM
|
Facility
|
IP
|
$4,101.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.18 |
| Max. Negotiated Rate |
$3,937.32 |
| Rate for Payer: Aetna Commercial |
$3,158.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,199.08
|
| Rate for Payer: Cash Price |
$2,050.69
|
| Rate for Payer: Cigna Commercial |
$3,404.15
|
| Rate for Payer: First Health Commercial |
$3,896.31
|
| Rate for Payer: Humana Commercial |
$3,486.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,363.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,026.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,609.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.43
|
| Rate for Payer: PHCS Commercial |
$3,937.32
|
| Rate for Payer: United Healthcare All Payer |
$3,609.21
|
|
|
PLATE RECON 3.5MM 12X142MM
|
Facility
|
OP
|
$4,101.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.18 |
| Max. Negotiated Rate |
$3,937.32 |
| Rate for Payer: Aetna Commercial |
$3,158.06
|
| Rate for Payer: Anthem Medicaid |
$1,410.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,199.08
|
| Rate for Payer: Cash Price |
$2,050.69
|
| Rate for Payer: Cigna Commercial |
$3,404.15
|
| Rate for Payer: First Health Commercial |
$3,896.31
|
| Rate for Payer: Humana Commercial |
$3,486.17
|
| Rate for Payer: Humana KY Medicaid |
$1,410.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,363.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,026.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,609.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.43
|
| Rate for Payer: PHCS Commercial |
$3,937.32
|
| Rate for Payer: United Healthcare All Payer |
$3,609.21
|
|
|
PLATE RECON 3.5MM 13X154MM
|
Facility
|
IP
|
$4,452.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.88 |
| Max. Negotiated Rate |
$4,274.83 |
| Rate for Payer: Aetna Commercial |
$3,428.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,473.30
|
| Rate for Payer: Cash Price |
$2,226.48
|
| Rate for Payer: Cigna Commercial |
$3,695.95
|
| Rate for Payer: First Health Commercial |
$4,230.30
|
| Rate for Payer: Humana Commercial |
$3,785.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,651.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,286.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,335.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,918.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,339.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$890.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$578.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.41
|
| Rate for Payer: PHCS Commercial |
$4,274.83
|
| Rate for Payer: United Healthcare All Payer |
$3,918.60
|
|
|
PLATE RECON 3.5MM 13X154MM
|
Facility
|
OP
|
$4,452.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$578.88 |
| Max. Negotiated Rate |
$4,274.83 |
| Rate for Payer: Aetna Commercial |
$3,428.77
|
| Rate for Payer: Anthem Medicaid |
$1,531.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,473.30
|
| Rate for Payer: Cash Price |
$2,226.48
|
| Rate for Payer: Cigna Commercial |
$3,695.95
|
| Rate for Payer: First Health Commercial |
$4,230.30
|
| Rate for Payer: Humana Commercial |
$3,785.01
|
| Rate for Payer: Humana KY Medicaid |
$1,531.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,546.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,651.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,286.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,335.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,562.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,918.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,339.71
|
| Rate for Payer: Ohio Health Group PPO Differential |
$890.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$578.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,380.41
|
| Rate for Payer: PHCS Commercial |
$4,274.83
|
| Rate for Payer: United Healthcare All Payer |
$3,918.60
|
|
|
PLATE RECON 3.5MM 14X166MM
|
Facility
|
IP
|
$4,280.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$4,109.52 |
| Rate for Payer: Aetna Commercial |
$3,296.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,338.98
|
| Rate for Payer: Cash Price |
$2,140.38
|
| Rate for Payer: Cigna Commercial |
$3,553.02
|
| Rate for Payer: First Health Commercial |
$4,066.71
|
| Rate for Payer: Humana Commercial |
$3,638.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,510.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,159.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,767.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,210.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.03
|
| Rate for Payer: PHCS Commercial |
$4,109.52
|
| Rate for Payer: United Healthcare All Payer |
$3,767.06
|
|
|
PLATE RECON 3.5MM 14X166MM
|
Facility
|
OP
|
$4,280.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.50 |
| Max. Negotiated Rate |
$4,109.52 |
| Rate for Payer: Aetna Commercial |
$3,296.18
|
| Rate for Payer: Anthem Medicaid |
$1,472.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,338.98
|
| Rate for Payer: Cash Price |
$2,140.38
|
| Rate for Payer: Cigna Commercial |
$3,553.02
|
| Rate for Payer: First Health Commercial |
$4,066.71
|
| Rate for Payer: Humana Commercial |
$3,638.64
|
| Rate for Payer: Humana KY Medicaid |
$1,472.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,510.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,159.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,501.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,767.06
|
| Rate for Payer: Ohio Health Group HMO |
$3,210.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.03
|
| Rate for Payer: PHCS Commercial |
$4,109.52
|
| Rate for Payer: United Healthcare All Payer |
$3,767.06
|
|
|
PLATE RECON 3.5MM 15X178MM
|
Facility
|
OP
|
$4,689.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.66 |
| Max. Negotiated Rate |
$4,502.14 |
| Rate for Payer: Aetna Commercial |
$3,611.09
|
| Rate for Payer: Anthem Medicaid |
$1,612.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.99
|
| Rate for Payer: Cash Price |
$2,344.86
|
| Rate for Payer: Cigna Commercial |
$3,892.48
|
| Rate for Payer: First Health Commercial |
$4,455.24
|
| Rate for Payer: Humana Commercial |
$3,986.27
|
| Rate for Payer: Humana KY Medicaid |
$1,612.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,629.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,845.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,461.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,645.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,517.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.82
|
| Rate for Payer: PHCS Commercial |
$4,502.14
|
| Rate for Payer: United Healthcare All Payer |
$4,126.96
|
|
|
PLATE RECON 3.5MM 15X178MM
|
Facility
|
IP
|
$4,689.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.66 |
| Max. Negotiated Rate |
$4,502.14 |
| Rate for Payer: Aetna Commercial |
$3,611.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.99
|
| Rate for Payer: Cash Price |
$2,344.86
|
| Rate for Payer: Cigna Commercial |
$3,892.48
|
| Rate for Payer: First Health Commercial |
$4,455.24
|
| Rate for Payer: Humana Commercial |
$3,986.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,845.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,461.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,517.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.82
|
| Rate for Payer: PHCS Commercial |
$4,502.14
|
| Rate for Payer: United Healthcare All Payer |
$4,126.96
|
|
