|
PLATE RECON 3.5MM 16X190MM
|
Facility
|
IP
|
$4,316.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.16 |
| Max. Negotiated Rate |
$4,143.96 |
| Rate for Payer: Aetna Commercial |
$3,323.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.96
|
| Rate for Payer: Cash Price |
$2,158.31
|
| Rate for Payer: Cigna Commercial |
$3,582.79
|
| Rate for Payer: First Health Commercial |
$4,100.79
|
| Rate for Payer: Humana Commercial |
$3,669.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,185.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,798.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,237.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$863.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.15
|
| Rate for Payer: PHCS Commercial |
$4,143.96
|
| Rate for Payer: United Healthcare All Payer |
$3,798.63
|
|
|
PLATE RECON 3.5MM 16X190MM
|
Facility
|
OP
|
$4,316.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$561.16 |
| Max. Negotiated Rate |
$4,143.96 |
| Rate for Payer: Aetna Commercial |
$3,323.80
|
| Rate for Payer: Anthem Medicaid |
$1,484.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,366.96
|
| Rate for Payer: Cash Price |
$2,158.31
|
| Rate for Payer: Cigna Commercial |
$3,582.79
|
| Rate for Payer: First Health Commercial |
$4,100.79
|
| Rate for Payer: Humana Commercial |
$3,669.13
|
| Rate for Payer: Humana KY Medicaid |
$1,484.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,499.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,185.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,294.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,514.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,798.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,237.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$863.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$561.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,338.15
|
| Rate for Payer: PHCS Commercial |
$4,143.96
|
| Rate for Payer: United Healthcare All Payer |
$3,798.63
|
|
|
PLATE RECON 3.5MM 18X214MM
|
Facility
|
IP
|
$4,431.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.08 |
| Max. Negotiated Rate |
$4,254.16 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,633.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,270.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,899.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,323.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$576.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,373.74
|
| Rate for Payer: PHCS Commercial |
$4,254.16
|
| Rate for Payer: United Healthcare All Payer |
$3,899.65
|
| Rate for Payer: Aetna Commercial |
$3,412.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,456.51
|
| Rate for Payer: Cash Price |
$2,215.71
|
| Rate for Payer: Cigna Commercial |
$3,678.08
|
| Rate for Payer: First Health Commercial |
$4,209.85
|
| Rate for Payer: Humana Commercial |
$3,766.71
|
|
|
PLATE RECON 3.5MM 18X214MM
|
Facility
|
OP
|
$4,431.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.08 |
| Max. Negotiated Rate |
$4,254.16 |
| Rate for Payer: Aetna Commercial |
$3,412.19
|
| Rate for Payer: Anthem Medicaid |
$1,523.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,456.51
|
| Rate for Payer: Cash Price |
$2,215.71
|
| Rate for Payer: Cigna Commercial |
$3,678.08
|
| Rate for Payer: First Health Commercial |
$4,209.85
|
| Rate for Payer: Humana Commercial |
$3,766.71
|
| Rate for Payer: Humana KY Medicaid |
$1,523.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,539.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,633.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,270.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,899.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,323.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$576.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,373.74
|
| Rate for Payer: PHCS Commercial |
$4,254.16
|
| Rate for Payer: United Healthcare All Payer |
$3,899.65
|
|
|
PLATE RECON 3.5MM 20X238MM
|
Facility
|
OP
|
$4,912.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.58 |
| Max. Negotiated Rate |
$4,715.66 |
| Rate for Payer: Aetna Commercial |
$3,782.36
|
| Rate for Payer: Anthem Medicaid |
$1,689.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.48
|
| Rate for Payer: Cash Price |
$2,456.07
|
| Rate for Payer: Cigna Commercial |
$4,077.08
|
| Rate for Payer: First Health Commercial |
$4,666.54
|
| Rate for Payer: Humana Commercial |
$4,175.33
|
| Rate for Payer: Humana KY Medicaid |
$1,689.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,027.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,322.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.77
|
| Rate for Payer: PHCS Commercial |
$4,715.66
|
| Rate for Payer: United Healthcare All Payer |
$4,322.69
|
|
|
PLATE RECON 3.5MM 20X238MM
|
Facility
|
IP
|
$4,912.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.58 |
| Max. Negotiated Rate |
$4,715.66 |
| Rate for Payer: Aetna Commercial |
$3,782.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.48
|
| Rate for Payer: Cash Price |
$2,456.07
|
| Rate for Payer: Cigna Commercial |
$4,077.08
|
| Rate for Payer: First Health Commercial |
$4,666.54
|
| Rate for Payer: Humana Commercial |
$4,175.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,027.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,322.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.77
|
| Rate for Payer: PHCS Commercial |
$4,715.66
|
| Rate for Payer: United Healthcare All Payer |
$4,322.69
|
|
|
PLATE RECON 3.5MM 22X263MM
|
Facility
|
OP
|
$5,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$733.72 |
| Max. Negotiated Rate |
$5,418.24 |
| Rate for Payer: Aetna Commercial |
$4,345.88
|
| Rate for Payer: Anthem Medicaid |
$1,940.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,402.32
|
| Rate for Payer: Cash Price |
$2,822.00
|
| Rate for Payer: Cigna Commercial |
$4,684.52
|
| Rate for Payer: First Health Commercial |
$5,361.80
|
| Rate for Payer: Humana Commercial |
$4,797.40
|
| Rate for Payer: Humana KY Medicaid |
$1,940.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,960.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,628.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,165.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,693.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,979.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,966.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,233.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,749.64
|
| Rate for Payer: PHCS Commercial |
$5,418.24
|
| Rate for Payer: United Healthcare All Payer |
$4,966.72
|
|
|
PLATE RECON 3.5MM 22X263MM
|
Facility
|
IP
|
$5,644.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$733.72 |
| Max. Negotiated Rate |
$5,418.24 |
| Rate for Payer: Aetna Commercial |
$4,345.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,402.32
|
| Rate for Payer: Cash Price |
$2,822.00
|
| Rate for Payer: Cigna Commercial |
$4,684.52
|
| Rate for Payer: First Health Commercial |
$5,361.80
|
| Rate for Payer: Humana Commercial |
$4,797.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,628.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,165.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,693.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,966.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,233.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,128.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$733.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,749.64
|
| Rate for Payer: PHCS Commercial |
$5,418.24
|
| Rate for Payer: United Healthcare All Payer |
$4,966.72
|
|
|
PLATE RECON 3.5MM 4H 46MM
|
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 3.5MM 4H 46MM
|
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 3.5MM 4X46MM
|
Facility
|
OP
|
$3,520.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.63 |
| Max. Negotiated Rate |
$3,379.39 |
| Rate for Payer: Kentucky WC Medicaid |
$1,222.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,886.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,597.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,234.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,097.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.26
|
| Rate for Payer: PHCS Commercial |
$3,379.39
|
| Rate for Payer: United Healthcare All Payer |
$3,097.78
|
| Rate for Payer: Aetna Commercial |
$2,710.55
|
| Rate for Payer: Anthem Medicaid |
$1,210.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,745.76
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$2,921.77
|
| Rate for Payer: First Health Commercial |
$3,344.19
|
| Rate for Payer: Humana Commercial |
$2,992.17
|
| Rate for Payer: Humana KY Medicaid |
$1,210.60
|
|
|
PLATE RECON 3.5MM 4X46MM
|
Facility
|
IP
|
$3,520.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.63 |
| Max. Negotiated Rate |
$3,379.39 |
| Rate for Payer: Aetna Commercial |
$2,710.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,745.76
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$2,921.77
|
| Rate for Payer: First Health Commercial |
$3,344.19
|
| Rate for Payer: Humana Commercial |
$2,992.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,886.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,597.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,056.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,097.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,640.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$704.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,091.26
|
| Rate for Payer: PHCS Commercial |
$3,379.39
|
| Rate for Payer: United Healthcare All Payer |
$3,097.78
|
|
|
PLATE RECON 3.5MM 5X58MM
|
Facility
|
OP
|
$3,426.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$3,289.85 |
| Rate for Payer: Aetna Commercial |
$2,638.74
|
| Rate for Payer: Anthem Medicaid |
$1,178.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,673.01
|
| Rate for Payer: Cash Price |
$1,713.46
|
| Rate for Payer: Cigna Commercial |
$2,844.35
|
| Rate for Payer: First Health Commercial |
$3,255.58
|
| Rate for Payer: Humana Commercial |
$2,912.89
|
| Rate for Payer: Humana KY Medicaid |
$1,178.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,190.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,810.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,529.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,202.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,015.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,570.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.35
|
| Rate for Payer: PHCS Commercial |
$3,289.85
|
| Rate for Payer: United Healthcare All Payer |
$3,015.70
|
|
|
PLATE RECON 3.5MM 5X58MM
|
Facility
|
IP
|
$3,426.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$445.50 |
| Max. Negotiated Rate |
$3,289.85 |
| Rate for Payer: Aetna Commercial |
$2,638.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,673.01
|
| Rate for Payer: Cash Price |
$1,713.46
|
| Rate for Payer: Cigna Commercial |
$2,844.35
|
| Rate for Payer: First Health Commercial |
$3,255.58
|
| Rate for Payer: Humana Commercial |
$2,912.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,810.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,529.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,015.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,570.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$685.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$445.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,062.35
|
| Rate for Payer: PHCS Commercial |
$3,289.85
|
| Rate for Payer: United Healthcare All Payer |
$3,015.70
|
|
|
PLATE RECON 3.5MM 6H 70MM
|
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 3.5MM 6H 70MM
|
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 3.5MM 6X70MM
|
Facility
|
OP
|
$3,742.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.54 |
| Max. Negotiated Rate |
$3,592.92 |
| Rate for Payer: Aetna Commercial |
$2,881.82
|
| Rate for Payer: Anthem Medicaid |
$1,287.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.24
|
| Rate for Payer: Cash Price |
$1,871.31
|
| Rate for Payer: Cigna Commercial |
$3,106.37
|
| Rate for Payer: First Health Commercial |
$3,555.49
|
| Rate for Payer: Humana Commercial |
$3,181.23
|
| Rate for Payer: Humana KY Medicaid |
$1,287.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,300.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,068.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,312.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,293.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,806.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.21
|
| Rate for Payer: PHCS Commercial |
$3,592.92
|
| Rate for Payer: United Healthcare All Payer |
$3,293.51
|
|
|
PLATE RECON 3.5MM 6X70MM
|
Facility
|
IP
|
$3,742.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.54 |
| Max. Negotiated Rate |
$3,592.92 |
| Rate for Payer: Aetna Commercial |
$2,881.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.24
|
| Rate for Payer: Cash Price |
$1,871.31
|
| Rate for Payer: Cigna Commercial |
$3,106.37
|
| Rate for Payer: First Health Commercial |
$3,555.49
|
| Rate for Payer: Humana Commercial |
$3,181.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,068.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,293.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,806.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.21
|
| Rate for Payer: PHCS Commercial |
$3,592.92
|
| Rate for Payer: United Healthcare All Payer |
$3,293.51
|
|
|
PLATE RECON 3.5MM 7X82MM
|
Facility
|
IP
|
$3,670.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.21 |
| Max. Negotiated Rate |
$3,524.04 |
| Rate for Payer: Aetna Commercial |
$2,826.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,863.29
|
| Rate for Payer: Cash Price |
$1,835.44
|
| Rate for Payer: Cigna Commercial |
$3,046.83
|
| Rate for Payer: First Health Commercial |
$3,487.34
|
| Rate for Payer: Humana Commercial |
$3,120.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,010.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,709.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,230.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,753.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.97
|
| Rate for Payer: PHCS Commercial |
$3,524.04
|
| Rate for Payer: United Healthcare All Payer |
$3,230.37
|
|
|
PLATE RECON 3.5MM 7X82MM
|
Facility
|
OP
|
$3,670.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$477.21 |
| Max. Negotiated Rate |
$3,524.04 |
| Rate for Payer: Aetna Commercial |
$2,826.58
|
| Rate for Payer: Anthem Medicaid |
$1,262.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,863.29
|
| Rate for Payer: Cash Price |
$1,835.44
|
| Rate for Payer: Cigna Commercial |
$3,046.83
|
| Rate for Payer: First Health Commercial |
$3,487.34
|
| Rate for Payer: Humana Commercial |
$3,120.25
|
| Rate for Payer: Humana KY Medicaid |
$1,262.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,275.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,010.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,709.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,101.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,287.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,230.37
|
| Rate for Payer: Ohio Health Group HMO |
$2,753.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$734.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$477.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,137.97
|
| Rate for Payer: PHCS Commercial |
$3,524.04
|
| Rate for Payer: United Healthcare All Payer |
$3,230.37
|
|
|
PLATE RECON 3.5MM 8H 94MM
|
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: 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
|
| 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
|
|
|
PLATE RECON 3.5MM 8H 94MM
|
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 8X94MM
|
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: Aetna Commercial |
$2,992.31
|
| Rate for Payer: Anthem Medicaid |
$1,336.44
|
| 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
|
|
|
PLATE RECON 3.5MM 8X94MM
|
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 9X106MM
|
Facility
|
IP
|
$3,785.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$492.14 |
| Max. Negotiated Rate |
$3,634.25 |
| Rate for Payer: Aetna Commercial |
$2,914.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,952.83
|
| Rate for Payer: Cash Price |
$1,892.84
|
| Rate for Payer: Cigna Commercial |
$3,142.11
|
| Rate for Payer: First Health Commercial |
$3,596.40
|
| Rate for Payer: Humana Commercial |
$3,217.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,104.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,793.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,135.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,331.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,839.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$757.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$492.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,173.56
|
| Rate for Payer: PHCS Commercial |
$3,634.25
|
| Rate for Payer: United Healthcare All Payer |
$3,331.40
|
|
