|
PLATE RECON 4.5MM 8X125MM
|
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 8X125MM
|
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 9X141MM
|
Facility
|
OP
|
$4,295.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.36 |
| Max. Negotiated Rate |
$4,123.30 |
| Rate for Payer: Aetna Commercial |
$3,307.23
|
| Rate for Payer: Anthem Medicaid |
$1,477.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,350.18
|
| Rate for Payer: Cash Price |
$2,147.55
|
| Rate for Payer: Cigna Commercial |
$3,564.93
|
| Rate for Payer: First Health Commercial |
$4,080.34
|
| Rate for Payer: Humana Commercial |
$3,650.84
|
| Rate for Payer: Humana KY Medicaid |
$1,477.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,492.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,506.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,779.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,221.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,331.48
|
| Rate for Payer: PHCS Commercial |
$4,123.30
|
| Rate for Payer: United Healthcare All Payer |
$3,779.69
|
|
|
PLATE RECON 4.5MM 9X141MM
|
Facility
|
IP
|
$4,295.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.36 |
| Max. Negotiated Rate |
$4,123.30 |
| Rate for Payer: Aetna Commercial |
$3,307.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,350.18
|
| Rate for Payer: Cash Price |
$2,147.55
|
| Rate for Payer: Cigna Commercial |
$3,564.93
|
| Rate for Payer: First Health Commercial |
$4,080.34
|
| Rate for Payer: Humana Commercial |
$3,650.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,521.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,169.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,288.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,779.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,221.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$859.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$558.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,331.48
|
| Rate for Payer: PHCS Commercial |
$4,123.30
|
| Rate for Payer: United Healthcare All Payer |
$3,779.69
|
|
|
PLATE RECON 4H 3.5*70 71829514
|
Facility
|
OP
|
$3,316.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.14 |
| Max. Negotiated Rate |
$3,183.84 |
| Rate for Payer: Aetna Commercial |
$2,553.70
|
| Rate for Payer: Anthem Medicaid |
$1,140.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.87
|
| Rate for Payer: Cash Price |
$1,658.25
|
| Rate for Payer: Cigna Commercial |
$2,752.70
|
| Rate for Payer: First Health Commercial |
$3,150.68
|
| Rate for Payer: Humana Commercial |
$2,819.02
|
| Rate for Payer: Humana KY Medicaid |
$1,140.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,152.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,163.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,918.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,487.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.12
|
| Rate for Payer: PHCS Commercial |
$3,183.84
|
| Rate for Payer: United Healthcare All Payer |
$2,918.52
|
|
|
PLATE RECON 4H 3.5*70 71829514
|
Facility
|
IP
|
$3,316.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.14 |
| Max. Negotiated Rate |
$3,183.84 |
| Rate for Payer: Aetna Commercial |
$2,553.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.87
|
| Rate for Payer: Cash Price |
$1,658.25
|
| Rate for Payer: Cigna Commercial |
$2,752.70
|
| Rate for Payer: First Health Commercial |
$3,150.68
|
| Rate for Payer: Humana Commercial |
$2,819.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,918.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,487.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.12
|
| Rate for Payer: PHCS Commercial |
$3,183.84
|
| Rate for Payer: United Healthcare All Payer |
$2,918.52
|
|
|
PLATE RECON 6H 3.5*70 71829516
|
Facility
|
IP
|
$3,505.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.72 |
| Max. Negotiated Rate |
$3,365.28 |
| Rate for Payer: Aetna Commercial |
$2,699.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Cash Price |
$1,752.75
|
| Rate for Payer: Cigna Commercial |
$2,909.56
|
| Rate for Payer: First Health Commercial |
$3,330.22
|
| Rate for Payer: Humana Commercial |
$2,979.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.70
|
| Rate for Payer: PHCS Commercial |
$3,365.28
|
| Rate for Payer: United Healthcare All Payer |
$3,084.84
|
|
|
PLATE RECON 6H 3.5*70 71829516
|
Facility
|
OP
|
$3,505.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$455.72 |
| Max. Negotiated Rate |
$3,365.28 |
| Rate for Payer: Aetna Commercial |
$2,699.24
|
| Rate for Payer: Anthem Medicaid |
$1,205.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.29
|
| Rate for Payer: Cash Price |
$1,752.75
|
| Rate for Payer: Cigna Commercial |
$2,909.56
|
| Rate for Payer: First Health Commercial |
$3,330.22
|
| Rate for Payer: Humana Commercial |
$2,979.68
|
| Rate for Payer: Humana KY Medicaid |
$1,205.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.84
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$701.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$455.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,086.70
|
| Rate for Payer: PHCS Commercial |
$3,365.28
|
| Rate for Payer: United Healthcare All Payer |
$3,084.84
|
|
|
PLATE RECON 6 HOLE - STERILE
|
Facility
|
IP
|
$4,804.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.52 |
| Max. Negotiated Rate |
$4,611.84 |
| Rate for Payer: Aetna Commercial |
$3,699.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,747.12
|
| Rate for Payer: Cash Price |
$2,402.00
|
| Rate for Payer: Cigna Commercial |
$3,987.32
|
| Rate for Payer: First Health Commercial |
$4,563.80
|
| Rate for Payer: Humana Commercial |
$4,083.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,939.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,545.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,441.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,227.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,603.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.24
|
| Rate for Payer: PHCS Commercial |
$4,611.84
|
| Rate for Payer: United Healthcare All Payer |
$4,227.52
|
|
|
PLATE RECON 6 HOLE - STERILE
|
Facility
|
OP
|
$4,804.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.52 |
| Max. Negotiated Rate |
$4,611.84 |
| Rate for Payer: Aetna Commercial |
$3,699.08
|
| Rate for Payer: Anthem Medicaid |
$1,652.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,747.12
|
| Rate for Payer: Cash Price |
$2,402.00
|
| Rate for Payer: Cigna Commercial |
$3,987.32
|
| Rate for Payer: First Health Commercial |
$4,563.80
|
| Rate for Payer: Humana Commercial |
$4,083.40
|
| Rate for Payer: Humana KY Medicaid |
$1,652.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,668.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,939.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,545.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,441.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,685.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,227.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,603.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$960.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,489.24
|
| Rate for Payer: PHCS Commercial |
$4,611.84
|
| Rate for Payer: United Healthcare All Payer |
$4,227.52
|
|
|
PLATE RECON 7 HOLE - STERILE
|
Facility
|
OP
|
$4,129.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.80 |
| Max. Negotiated Rate |
$3,964.03 |
| Rate for Payer: Aetna Commercial |
$3,179.48
|
| Rate for Payer: Anthem Medicaid |
$1,420.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,220.78
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cigna Commercial |
$3,427.24
|
| Rate for Payer: First Health Commercial |
$3,922.74
|
| Rate for Payer: Humana Commercial |
$3,509.82
|
| Rate for Payer: Humana KY Medicaid |
$1,420.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,434.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,385.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,448.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,633.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,096.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,280.05
|
| Rate for Payer: PHCS Commercial |
$3,964.03
|
| Rate for Payer: United Healthcare All Payer |
$3,633.70
|
|
|
PLATE RECON 7 HOLE - STERILE
|
Facility
|
IP
|
$4,129.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$536.80 |
| Max. Negotiated Rate |
$3,964.03 |
| Rate for Payer: Humana Commercial |
$3,509.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,385.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,633.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,096.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$825.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$536.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,280.05
|
| Rate for Payer: PHCS Commercial |
$3,964.03
|
| Rate for Payer: United Healthcare All Payer |
$3,633.70
|
| Rate for Payer: Aetna Commercial |
$3,179.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,220.78
|
| Rate for Payer: Cash Price |
$2,064.60
|
| Rate for Payer: Cigna Commercial |
$3,427.24
|
| Rate for Payer: First Health Commercial |
$3,922.74
|
|
|
PLATE RECON 8H 3.5*94 71829518
|
Facility
|
OP
|
$3,628.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.64 |
| Max. Negotiated Rate |
$3,482.88 |
| Rate for Payer: Aetna Commercial |
$2,793.56
|
| Rate for Payer: Anthem Medicaid |
$1,247.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.84
|
| Rate for Payer: Cash Price |
$1,814.00
|
| Rate for Payer: Cigna Commercial |
$3,011.24
|
| Rate for Payer: First Health Commercial |
$3,446.60
|
| Rate for Payer: Humana Commercial |
$3,083.80
|
| Rate for Payer: Humana KY Medicaid |
$1,247.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,260.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,272.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,721.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.68
|
| Rate for Payer: PHCS Commercial |
$3,482.88
|
| Rate for Payer: United Healthcare All Payer |
$3,192.64
|
|
|
PLATE RECON 8H 3.5*94 71829518
|
Facility
|
IP
|
$3,628.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.64 |
| Max. Negotiated Rate |
$3,482.88 |
| Rate for Payer: Aetna Commercial |
$2,793.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,829.84
|
| Rate for Payer: Cash Price |
$1,814.00
|
| Rate for Payer: Cigna Commercial |
$3,011.24
|
| Rate for Payer: First Health Commercial |
$3,446.60
|
| Rate for Payer: Humana Commercial |
$3,083.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,974.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,677.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,088.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,192.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,721.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$725.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$471.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,124.68
|
| Rate for Payer: PHCS Commercial |
$3,482.88
|
| Rate for Payer: United Healthcare All Payer |
$3,192.64
|
|
|
PLATE RECON 8 HOLE - STERILE
|
Facility
|
IP
|
$4,210.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.35 |
| Max. Negotiated Rate |
$4,041.98 |
| Rate for Payer: Aetna Commercial |
$3,242.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,284.11
|
| Rate for Payer: Cash Price |
$2,105.20
|
| Rate for Payer: Cigna Commercial |
$3,494.63
|
| Rate for Payer: First Health Commercial |
$3,999.88
|
| Rate for Payer: Humana Commercial |
$3,578.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,452.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,107.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,705.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,157.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.22
|
| Rate for Payer: PHCS Commercial |
$4,041.98
|
| Rate for Payer: United Healthcare All Payer |
$3,705.15
|
|
|
PLATE RECON 8 HOLE - STERILE
|
Facility
|
OP
|
$4,210.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$547.35 |
| Max. Negotiated Rate |
$4,041.98 |
| Rate for Payer: Aetna Commercial |
$3,242.01
|
| Rate for Payer: Anthem Medicaid |
$1,447.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,284.11
|
| Rate for Payer: Cash Price |
$2,105.20
|
| Rate for Payer: Cigna Commercial |
$3,494.63
|
| Rate for Payer: First Health Commercial |
$3,999.88
|
| Rate for Payer: Humana Commercial |
$3,578.84
|
| Rate for Payer: Humana KY Medicaid |
$1,447.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,462.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,452.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,107.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,263.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,477.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,705.15
|
| Rate for Payer: Ohio Health Group HMO |
$3,157.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$842.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$547.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.22
|
| Rate for Payer: PHCS Commercial |
$4,041.98
|
| Rate for Payer: United Healthcare All Payer |
$3,705.15
|
|
|
PLATE RECON FULL MAND 5528930
|
Facility
|
OP
|
$7,715.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.97 |
| Max. Negotiated Rate |
$7,406.55 |
| Rate for Payer: Aetna Commercial |
$5,940.67
|
| Rate for Payer: Anthem Medicaid |
$2,653.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,017.82
|
| Rate for Payer: Cash Price |
$3,857.58
|
| Rate for Payer: Cigna Commercial |
$6,403.58
|
| Rate for Payer: First Health Commercial |
$7,329.40
|
| Rate for Payer: Humana Commercial |
$6,557.89
|
| Rate for Payer: Humana KY Medicaid |
$2,653.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,680.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,326.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,693.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,314.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,706.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,789.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,786.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,543.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.70
|
| Rate for Payer: PHCS Commercial |
$7,406.55
|
| Rate for Payer: United Healthcare All Payer |
$6,789.34
|
|
|
PLATE RECON FULL MAND 5528930
|
Facility
|
IP
|
$7,715.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.97 |
| Max. Negotiated Rate |
$7,406.55 |
| Rate for Payer: Aetna Commercial |
$5,940.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,017.82
|
| Rate for Payer: Cash Price |
$3,857.58
|
| Rate for Payer: Cigna Commercial |
$6,403.58
|
| Rate for Payer: First Health Commercial |
$7,329.40
|
| Rate for Payer: Humana Commercial |
$6,557.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,326.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,693.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,314.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,789.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,786.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,543.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,002.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,391.70
|
| Rate for Payer: PHCS Commercial |
$7,406.55
|
| Rate for Payer: United Healthcare All Payer |
$6,789.34
|
|
|
PLATE RECON FULL MAND 5528934
|
Facility
|
IP
|
$7,533.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.31 |
| Max. Negotiated Rate |
$7,231.81 |
| Rate for Payer: Aetna Commercial |
$5,800.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,875.85
|
| Rate for Payer: Cash Price |
$3,766.57
|
| Rate for Payer: Cigna Commercial |
$6,252.51
|
| Rate for Payer: First Health Commercial |
$7,156.48
|
| Rate for Payer: Humana Commercial |
$6,403.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,177.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,559.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,259.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,629.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,649.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,335.27
|
| Rate for Payer: PHCS Commercial |
$7,231.81
|
| Rate for Payer: United Healthcare All Payer |
$6,629.16
|
|
|
PLATE RECON FULL MAND 5528934
|
Facility
|
OP
|
$7,533.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.31 |
| Max. Negotiated Rate |
$7,231.81 |
| Rate for Payer: Humana Commercial |
$6,403.17
|
| Rate for Payer: Humana KY Medicaid |
$2,590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,617.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,177.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,559.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,259.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,642.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,629.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,649.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,335.27
|
| Rate for Payer: PHCS Commercial |
$7,231.81
|
| Rate for Payer: United Healthcare All Payer |
$6,629.16
|
| Rate for Payer: Aetna Commercial |
$5,800.52
|
| Rate for Payer: Anthem Medicaid |
$2,590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,875.85
|
| Rate for Payer: Cash Price |
$3,766.57
|
| Rate for Payer: Cigna Commercial |
$6,252.51
|
| Rate for Payer: First Health Commercial |
$7,156.48
|
|
|
PLATE RECON HEMI 6*17 H 34D L
|
Facility
|
OP
|
$12,391.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.90 |
| Max. Negotiated Rate |
$11,895.87 |
| Rate for Payer: Aetna Commercial |
$9,541.48
|
| Rate for Payer: Anthem Medicaid |
$4,261.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,665.39
|
| Rate for Payer: Cash Price |
$6,195.76
|
| Rate for Payer: Cigna Commercial |
$10,284.97
|
| Rate for Payer: First Health Commercial |
$11,771.95
|
| Rate for Payer: Humana Commercial |
$10,532.80
|
| Rate for Payer: Humana KY Medicaid |
$4,261.45
|
| Rate for Payer: Kentucky WC Medicaid |
$4,304.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,161.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,144.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,717.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,346.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,904.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,293.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,478.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.37
|
| Rate for Payer: PHCS Commercial |
$11,895.87
|
| Rate for Payer: United Healthcare All Payer |
$10,904.55
|
|
|
PLATE RECON HEMI 6*17 H 34D L
|
Facility
|
IP
|
$12,391.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.90 |
| Max. Negotiated Rate |
$11,895.87 |
| Rate for Payer: Aetna Commercial |
$9,541.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,665.39
|
| Rate for Payer: Cash Price |
$6,195.76
|
| Rate for Payer: Cigna Commercial |
$10,284.97
|
| Rate for Payer: First Health Commercial |
$11,771.95
|
| Rate for Payer: Humana Commercial |
$10,532.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,161.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,144.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,717.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,904.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,293.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,478.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.37
|
| Rate for Payer: PHCS Commercial |
$11,895.87
|
| Rate for Payer: United Healthcare All Payer |
$10,904.55
|
|
|
PLATE RECON HEMI 6*17 H 34D R
|
Facility
|
IP
|
$12,391.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.90 |
| Max. Negotiated Rate |
$11,895.87 |
| Rate for Payer: Aetna Commercial |
$9,541.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,665.39
|
| Rate for Payer: Cash Price |
$6,195.76
|
| Rate for Payer: Cigna Commercial |
$10,284.97
|
| Rate for Payer: First Health Commercial |
$11,771.95
|
| Rate for Payer: Humana Commercial |
$10,532.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,161.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,144.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,717.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,904.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,293.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,478.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.37
|
| Rate for Payer: PHCS Commercial |
$11,895.87
|
| Rate for Payer: United Healthcare All Payer |
$10,904.55
|
|
|
PLATE RECON HEMI 6*17 H 34D R
|
Facility
|
OP
|
$12,391.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.90 |
| Max. Negotiated Rate |
$11,895.87 |
| Rate for Payer: Aetna Commercial |
$9,541.48
|
| Rate for Payer: Anthem Medicaid |
$4,261.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,665.39
|
| Rate for Payer: Cash Price |
$6,195.76
|
| Rate for Payer: Cigna Commercial |
$10,284.97
|
| Rate for Payer: First Health Commercial |
$11,771.95
|
| Rate for Payer: Humana Commercial |
$10,532.80
|
| Rate for Payer: Humana KY Medicaid |
$4,261.45
|
| Rate for Payer: Kentucky WC Medicaid |
$4,304.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,161.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,144.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,717.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,346.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,904.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,293.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,478.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,841.37
|
| Rate for Payer: PHCS Commercial |
$11,895.87
|
| Rate for Payer: United Healthcare All Payer |
$10,904.55
|
|
|
PLATE RECON HEMI MAND 5528922
|
Facility
|
OP
|
$6,804.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.64 |
| Max. Negotiated Rate |
$6,532.76 |
| Rate for Payer: Aetna Commercial |
$5,239.82
|
| Rate for Payer: Anthem Medicaid |
$2,340.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,307.87
|
| Rate for Payer: Cash Price |
$3,402.48
|
| Rate for Payer: Cigna Commercial |
$5,648.12
|
| Rate for Payer: First Health Commercial |
$6,464.71
|
| Rate for Payer: Humana Commercial |
$5,784.22
|
| Rate for Payer: Humana KY Medicaid |
$2,340.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,364.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,387.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,103.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.54
|
| Rate for Payer: PHCS Commercial |
$6,532.76
|
| Rate for Payer: United Healthcare All Payer |
$5,988.36
|
|
