|
PLATE RECON 3.5MM 9X106MM
|
Facility
|
OP
|
$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 Medicaid |
$1,301.90
|
| 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: Humana KY Medicaid |
$1,301.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,315.15
|
| 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: Molina Healthcare Medicaid |
$1,328.02
|
| 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
|
|
|
PLATE RECON 4.5MM 10X157MM
|
Facility
|
OP
|
$4,409.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.29 |
| Max. Negotiated Rate |
$4,233.50 |
| Rate for Payer: Aetna Commercial |
$3,395.62
|
| Rate for Payer: Anthem Medicaid |
$1,516.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,439.72
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cigna Commercial |
$3,660.22
|
| Rate for Payer: First Health Commercial |
$4,189.40
|
| Rate for Payer: Humana Commercial |
$3,748.42
|
| Rate for Payer: Humana KY Medicaid |
$1,516.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,616.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,254.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,322.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,546.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,880.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,307.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.07
|
| Rate for Payer: PHCS Commercial |
$4,233.50
|
| Rate for Payer: United Healthcare All Payer |
$3,880.71
|
|
|
PLATE RECON 4.5MM 10X157MM
|
Facility
|
IP
|
$4,409.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.29 |
| Max. Negotiated Rate |
$4,233.50 |
| Rate for Payer: Aetna Commercial |
$3,395.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,439.72
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cigna Commercial |
$3,660.22
|
| Rate for Payer: First Health Commercial |
$4,189.40
|
| Rate for Payer: Humana Commercial |
$3,748.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,616.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,254.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,322.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,880.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,307.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$881.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.07
|
| Rate for Payer: PHCS Commercial |
$4,233.50
|
| Rate for Payer: United Healthcare All Payer |
$3,880.71
|
|
|
PLATE RECON 4.5MM 11X173MM
|
Facility
|
OP
|
$4,467.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.75 |
| Max. Negotiated Rate |
$4,288.61 |
| Rate for Payer: Humana Commercial |
$3,797.20
|
| Rate for Payer: Humana KY Medicaid |
$1,536.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,551.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.86
|
| Rate for Payer: PHCS Commercial |
$4,288.61
|
| Rate for Payer: United Healthcare All Payer |
$3,931.22
|
| Rate for Payer: Aetna Commercial |
$3,439.82
|
| Rate for Payer: Anthem Medicaid |
$1,536.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.49
|
| Rate for Payer: Cash Price |
$2,233.65
|
| Rate for Payer: Cigna Commercial |
$3,707.86
|
| Rate for Payer: First Health Commercial |
$4,243.94
|
|
|
PLATE RECON 4.5MM 11X173MM
|
Facility
|
IP
|
$4,467.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.75 |
| Max. Negotiated Rate |
$4,288.61 |
| Rate for Payer: Aetna Commercial |
$3,439.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,484.49
|
| Rate for Payer: Cash Price |
$2,233.65
|
| Rate for Payer: Cigna Commercial |
$3,707.86
|
| Rate for Payer: First Health Commercial |
$4,243.94
|
| Rate for Payer: Humana Commercial |
$3,797.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,296.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,350.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,384.86
|
| Rate for Payer: PHCS Commercial |
$4,288.61
|
| Rate for Payer: United Healthcare All Payer |
$3,931.22
|
|
|
PLATE RECON 4.5MM 12X189MM
|
Facility
|
OP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem Medicaid |
$1,430.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Humana KY Medicaid |
$1,430.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,444.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,458.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE RECON 4.5MM 12X189MM
|
Facility
|
IP
|
$4,158.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$540.64 |
| Max. Negotiated Rate |
$3,992.42 |
| Rate for Payer: Aetna Commercial |
$3,202.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,243.84
|
| Rate for Payer: Cash Price |
$2,079.39
|
| Rate for Payer: Cigna Commercial |
$3,451.78
|
| Rate for Payer: First Health Commercial |
$3,950.83
|
| Rate for Payer: Humana Commercial |
$3,534.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,410.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,069.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,247.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,659.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,119.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$831.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$540.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,289.22
|
| Rate for Payer: PHCS Commercial |
$3,992.42
|
| Rate for Payer: United Healthcare All Payer |
$3,659.72
|
|
|
PLATE RECON 4.5MM 13X205MM
|
Facility
|
OP
|
$4,761.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.99 |
| Max. Negotiated Rate |
$4,571.02 |
| Rate for Payer: Aetna Commercial |
$3,666.34
|
| Rate for Payer: Anthem Medicaid |
$1,637.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,713.95
|
| Rate for Payer: Cash Price |
$2,380.74
|
| Rate for Payer: Cigna Commercial |
$3,952.03
|
| Rate for Payer: First Health Commercial |
$4,523.41
|
| Rate for Payer: Humana Commercial |
$4,047.26
|
| Rate for Payer: Humana KY Medicaid |
$1,637.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,654.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,904.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,513.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,670.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,190.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,571.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.06
|
| Rate for Payer: PHCS Commercial |
$4,571.02
|
| Rate for Payer: United Healthcare All Payer |
$4,190.10
|
|
|
PLATE RECON 4.5MM 13X205MM
|
Facility
|
IP
|
$4,761.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$618.99 |
| Max. Negotiated Rate |
$4,571.02 |
| Rate for Payer: Aetna Commercial |
$3,666.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,713.95
|
| Rate for Payer: Cash Price |
$2,380.74
|
| Rate for Payer: Cigna Commercial |
$3,952.03
|
| Rate for Payer: First Health Commercial |
$4,523.41
|
| Rate for Payer: Humana Commercial |
$4,047.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,904.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,513.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,428.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,190.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,571.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$952.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$618.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,476.06
|
| Rate for Payer: PHCS Commercial |
$4,571.02
|
| Rate for Payer: United Healthcare All Payer |
$4,190.10
|
|
|
PLATE RECON 4.5MM 14X221MM
|
Facility
|
IP
|
$4,345.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.89 |
| Max. Negotiated Rate |
$4,171.51 |
| Rate for Payer: Aetna Commercial |
$3,345.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.35
|
| Rate for Payer: Cash Price |
$2,172.66
|
| Rate for Payer: Cigna Commercial |
$3,606.62
|
| Rate for Payer: First Health Commercial |
$4,128.05
|
| Rate for Payer: Humana Commercial |
$3,693.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,206.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,823.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,258.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.05
|
| Rate for Payer: PHCS Commercial |
$4,171.51
|
| Rate for Payer: United Healthcare All Payer |
$3,823.88
|
|
|
PLATE RECON 4.5MM 14X221MM
|
Facility
|
OP
|
$4,345.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.89 |
| Max. Negotiated Rate |
$4,171.51 |
| Rate for Payer: Aetna Commercial |
$3,345.90
|
| Rate for Payer: Anthem Medicaid |
$1,494.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.35
|
| Rate for Payer: Cash Price |
$2,172.66
|
| Rate for Payer: Cigna Commercial |
$3,606.62
|
| Rate for Payer: First Health Commercial |
$4,128.05
|
| Rate for Payer: Humana Commercial |
$3,693.52
|
| Rate for Payer: Humana KY Medicaid |
$1,494.36
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,563.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,206.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,524.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,823.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,258.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$869.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$564.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,347.05
|
| Rate for Payer: PHCS Commercial |
$4,171.51
|
| Rate for Payer: United Healthcare All Payer |
$3,823.88
|
|
|
PLATE RECON 4.5MM 15X237MM
|
Facility
|
IP
|
$4,919.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.51 |
| Max. Negotiated Rate |
$4,722.55 |
| Rate for Payer: Aetna Commercial |
$3,787.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.07
|
| Rate for Payer: Cash Price |
$2,459.66
|
| Rate for Payer: Cigna Commercial |
$4,083.04
|
| Rate for Payer: First Health Commercial |
$4,673.35
|
| Rate for Payer: Humana Commercial |
$4,181.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,033.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,630.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,475.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,329.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,689.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$983.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,524.99
|
| Rate for Payer: PHCS Commercial |
$4,722.55
|
| Rate for Payer: United Healthcare All Payer |
$4,329.00
|
|
|
PLATE RECON 4.5MM 15X237MM
|
Facility
|
OP
|
$4,919.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$639.51 |
| Max. Negotiated Rate |
$4,722.55 |
| Rate for Payer: Aetna Commercial |
$3,787.88
|
| Rate for Payer: Anthem Medicaid |
$1,691.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,837.07
|
| Rate for Payer: Cash Price |
$2,459.66
|
| Rate for Payer: Cigna Commercial |
$4,083.04
|
| Rate for Payer: First Health Commercial |
$4,673.35
|
| Rate for Payer: Humana Commercial |
$4,181.42
|
| Rate for Payer: Humana KY Medicaid |
$1,691.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,708.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,033.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,630.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,475.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,725.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,329.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,689.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$983.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$639.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,524.99
|
| Rate for Payer: PHCS Commercial |
$4,722.55
|
| Rate for Payer: United Healthcare All Payer |
$4,329.00
|
|
|
PLATE RECON 4.5MM 16X253MM
|
Facility
|
IP
|
$5,019.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.57 |
| Max. Negotiated Rate |
$4,818.98 |
| Rate for Payer: Aetna Commercial |
$3,865.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,915.42
|
| Rate for Payer: Cash Price |
$2,509.89
|
| Rate for Payer: Cigna Commercial |
$4,166.41
|
| Rate for Payer: First Health Commercial |
$4,768.78
|
| Rate for Payer: Humana Commercial |
$4,266.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,116.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,704.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,417.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,764.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,556.13
|
| Rate for Payer: PHCS Commercial |
$4,818.98
|
| Rate for Payer: United Healthcare All Payer |
$4,417.40
|
|
|
PLATE RECON 4.5MM 16X253MM
|
Facility
|
OP
|
$5,019.77
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.57 |
| Max. Negotiated Rate |
$4,818.98 |
| Rate for Payer: Aetna Commercial |
$3,865.22
|
| Rate for Payer: Anthem Medicaid |
$1,726.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,915.42
|
| Rate for Payer: Cash Price |
$2,509.89
|
| Rate for Payer: Cigna Commercial |
$4,166.41
|
| Rate for Payer: First Health Commercial |
$4,768.78
|
| Rate for Payer: Humana Commercial |
$4,266.80
|
| Rate for Payer: Humana KY Medicaid |
$1,726.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,743.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,116.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,704.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,505.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,760.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,417.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,764.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,003.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$652.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,556.13
|
| Rate for Payer: PHCS Commercial |
$4,818.98
|
| Rate for Payer: United Healthcare All Payer |
$4,417.40
|
|
|
PLATE RECON 4.5MM 3X45MM
|
Facility
|
IP
|
$3,405.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.70 |
| Max. Negotiated Rate |
$3,269.18 |
| Rate for Payer: Aetna Commercial |
$2,622.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.21
|
| Rate for Payer: Cash Price |
$1,702.70
|
| Rate for Payer: Cigna Commercial |
$2,826.48
|
| Rate for Payer: First Health Commercial |
$3,235.13
|
| Rate for Payer: Humana Commercial |
$2,894.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,792.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,996.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.67
|
| Rate for Payer: PHCS Commercial |
$3,269.18
|
| Rate for Payer: United Healthcare All Payer |
$2,996.75
|
|
|
PLATE RECON 4.5MM 3X45MM
|
Facility
|
OP
|
$3,405.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.70 |
| Max. Negotiated Rate |
$3,269.18 |
| Rate for Payer: Aetna Commercial |
$2,622.16
|
| Rate for Payer: Anthem Medicaid |
$1,171.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,656.21
|
| Rate for Payer: Cash Price |
$1,702.70
|
| Rate for Payer: Cigna Commercial |
$2,826.48
|
| Rate for Payer: First Health Commercial |
$3,235.13
|
| Rate for Payer: Humana Commercial |
$2,894.59
|
| Rate for Payer: Humana KY Medicaid |
$1,171.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,792.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,513.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,996.75
|
| Rate for Payer: Ohio Health Group HMO |
$2,554.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.67
|
| Rate for Payer: PHCS Commercial |
$3,269.18
|
| Rate for Payer: United Healthcare All Payer |
$2,996.75
|
|
|
PLATE RECON 4.5MM 4X61MM
|
Facility
|
OP
|
$3,477.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.03 |
| Max. Negotiated Rate |
$3,338.06 |
| Rate for Payer: Aetna Commercial |
$2,677.41
|
| Rate for Payer: Anthem Medicaid |
$1,195.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.18
|
| Rate for Payer: Cash Price |
$1,738.58
|
| Rate for Payer: Cigna Commercial |
$2,886.03
|
| Rate for Payer: First Health Commercial |
$3,303.29
|
| Rate for Payer: Humana Commercial |
$2,955.58
|
| Rate for Payer: Humana KY Medicaid |
$1,195.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,207.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,219.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,059.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,607.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.92
|
| Rate for Payer: PHCS Commercial |
$3,338.06
|
| Rate for Payer: United Healthcare All Payer |
$3,059.89
|
|
|
PLATE RECON 4.5MM 4X61MM
|
Facility
|
IP
|
$3,477.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.03 |
| Max. Negotiated Rate |
$3,338.06 |
| Rate for Payer: Aetna Commercial |
$2,677.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.18
|
| Rate for Payer: Cash Price |
$1,738.58
|
| Rate for Payer: Cigna Commercial |
$2,886.03
|
| Rate for Payer: First Health Commercial |
$3,303.29
|
| Rate for Payer: Humana Commercial |
$2,955.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,059.89
|
| Rate for Payer: Ohio Health Group HMO |
$2,607.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.92
|
| Rate for Payer: PHCS Commercial |
$3,338.06
|
| Rate for Payer: United Healthcare All Payer |
$3,059.89
|
|
|
PLATE RECON 4.5MM 5X77MM
|
Facility
|
OP
|
$3,570.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.16 |
| Max. Negotiated Rate |
$3,427.61 |
| Rate for Payer: Aetna Commercial |
$2,749.23
|
| Rate for Payer: Anthem Medicaid |
$1,227.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,784.94
|
| Rate for Payer: Cash Price |
$1,785.21
|
| Rate for Payer: Cigna Commercial |
$2,963.46
|
| Rate for Payer: First Health Commercial |
$3,391.91
|
| Rate for Payer: Humana Commercial |
$3,034.87
|
| Rate for Payer: Humana KY Medicaid |
$1,227.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,240.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,927.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,252.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,141.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,677.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.83
|
| Rate for Payer: PHCS Commercial |
$3,427.61
|
| Rate for Payer: United Healthcare All Payer |
$3,141.98
|
|
|
PLATE RECON 4.5MM 5X77MM
|
Facility
|
IP
|
$3,570.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$464.16 |
| Max. Negotiated Rate |
$3,427.61 |
| Rate for Payer: Aetna Commercial |
$2,749.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,784.94
|
| Rate for Payer: Cash Price |
$1,785.21
|
| Rate for Payer: Cigna Commercial |
$2,963.46
|
| Rate for Payer: First Health Commercial |
$3,391.91
|
| Rate for Payer: Humana Commercial |
$3,034.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,927.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,634.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,071.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,141.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,677.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$714.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$464.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,106.83
|
| Rate for Payer: PHCS Commercial |
$3,427.61
|
| Rate for Payer: United Healthcare All Payer |
$3,141.98
|
|
|
PLATE RECON 4.5MM 6X93MM
|
Facility
|
IP
|
$3,663.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$3,517.15 |
| Rate for Payer: Aetna Commercial |
$2,821.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,857.69
|
| Rate for Payer: Cash Price |
$1,831.85
|
| Rate for Payer: Cigna Commercial |
$3,040.87
|
| Rate for Payer: First Health Commercial |
$3,480.52
|
| Rate for Payer: Humana Commercial |
$3,114.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,004.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,703.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,099.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,224.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,747.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,135.75
|
| Rate for Payer: PHCS Commercial |
$3,517.15
|
| Rate for Payer: United Healthcare All Payer |
$3,224.06
|
|
|
PLATE RECON 4.5MM 6X93MM
|
Facility
|
OP
|
$3,663.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.28 |
| Max. Negotiated Rate |
$3,517.15 |
| Rate for Payer: Anthem Medicaid |
$1,259.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,857.69
|
| Rate for Payer: Cash Price |
$1,831.85
|
| Rate for Payer: Cigna Commercial |
$3,040.87
|
| Rate for Payer: First Health Commercial |
$3,480.52
|
| Rate for Payer: Humana Commercial |
$3,114.14
|
| Rate for Payer: Humana KY Medicaid |
$1,259.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,272.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,004.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,703.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,099.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,285.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,224.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,747.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$732.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$476.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,135.75
|
| Rate for Payer: PHCS Commercial |
$3,517.15
|
| Rate for Payer: United Healthcare All Payer |
$3,224.06
|
| Rate for Payer: Aetna Commercial |
$2,821.05
|
|
|
PLATE RECON 4.5MM 7X109MM
|
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 4.5MM 7X109MM
|
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
|
|
