|
PLATE SM LT JONES FX
|
Facility
|
OP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem Medicaid |
$2,883.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Humana KY Medicaid |
$2,883.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE SM LT JONES FX
|
Facility
|
IP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE SM RECON 3.5M 2X25M
|
Facility
|
IP
|
$1,794.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.33 |
| Max. Negotiated Rate |
$1,723.06 |
| Rate for Payer: Aetna Commercial |
$1,382.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.98
|
| Rate for Payer: Cash Price |
$897.42
|
| Rate for Payer: Cigna Commercial |
$1,489.73
|
| Rate for Payer: First Health Commercial |
$1,705.11
|
| Rate for Payer: Humana Commercial |
$1,525.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,346.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.40
|
| Rate for Payer: PHCS Commercial |
$1,723.06
|
| Rate for Payer: United Healthcare All Payer |
$1,579.47
|
|
|
PLATE SM RECON 3.5M 2X25M
|
Facility
|
OP
|
$1,794.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$233.33 |
| Max. Negotiated Rate |
$1,723.06 |
| Rate for Payer: Aetna Commercial |
$1,382.03
|
| Rate for Payer: Anthem Medicaid |
$617.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,399.98
|
| Rate for Payer: Cash Price |
$897.42
|
| Rate for Payer: Cigna Commercial |
$1,489.73
|
| Rate for Payer: First Health Commercial |
$1,705.11
|
| Rate for Payer: Humana Commercial |
$1,525.62
|
| Rate for Payer: Humana KY Medicaid |
$617.25
|
| Rate for Payer: Kentucky WC Medicaid |
$623.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,471.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,324.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$538.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$629.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,579.47
|
| Rate for Payer: Ohio Health Group HMO |
$1,346.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$358.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$233.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$556.40
|
| Rate for Payer: PHCS Commercial |
$1,723.06
|
| Rate for Payer: United Healthcare All Payer |
$1,579.47
|
|
|
PLATE SM RECON 3.5M 3X37M
|
Facility
|
OP
|
$1,816.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.13 |
| Max. Negotiated Rate |
$1,743.72 |
| Rate for Payer: Aetna Commercial |
$1,398.61
|
| Rate for Payer: Anthem Medicaid |
$624.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.78
|
| Rate for Payer: Cash Price |
$908.19
|
| Rate for Payer: Cigna Commercial |
$1,507.60
|
| Rate for Payer: First Health Commercial |
$1,725.56
|
| Rate for Payer: Humana Commercial |
$1,543.92
|
| Rate for Payer: Humana KY Medicaid |
$624.65
|
| Rate for Payer: Kentucky WC Medicaid |
$631.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$637.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.08
|
| Rate for Payer: PHCS Commercial |
$1,743.72
|
| Rate for Payer: United Healthcare All Payer |
$1,598.41
|
|
|
PLATE SM RECON 3.5M 3X37M
|
Facility
|
IP
|
$1,816.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$236.13 |
| Max. Negotiated Rate |
$1,743.72 |
| Rate for Payer: Aetna Commercial |
$1,398.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,416.78
|
| Rate for Payer: Cash Price |
$908.19
|
| Rate for Payer: Cigna Commercial |
$1,507.60
|
| Rate for Payer: First Health Commercial |
$1,725.56
|
| Rate for Payer: Humana Commercial |
$1,543.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,489.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,340.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,598.41
|
| Rate for Payer: Ohio Health Group HMO |
$1,362.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$363.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$236.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$563.08
|
| Rate for Payer: PHCS Commercial |
$1,743.72
|
| Rate for Payer: United Healthcare All Payer |
$1,598.41
|
|
|
PLATE SM RECON 3.5M 4*49M
|
Facility
|
IP
|
$1,823.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.06 |
| Max. Negotiated Rate |
$1,750.61 |
| Rate for Payer: Aetna Commercial |
$1,404.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.37
|
| Rate for Payer: Cash Price |
$911.78
|
| Rate for Payer: Cigna Commercial |
$1,513.55
|
| Rate for Payer: First Health Commercial |
$1,732.37
|
| Rate for Payer: Humana Commercial |
$1,550.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.30
|
| Rate for Payer: PHCS Commercial |
$1,750.61
|
| Rate for Payer: United Healthcare All Payer |
$1,604.72
|
|
|
PLATE SM RECON 3.5M 4*49M
|
Facility
|
OP
|
$1,823.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$237.06 |
| Max. Negotiated Rate |
$1,750.61 |
| Rate for Payer: Aetna Commercial |
$1,404.13
|
| Rate for Payer: Anthem Medicaid |
$627.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,422.37
|
| Rate for Payer: Cash Price |
$911.78
|
| Rate for Payer: Cigna Commercial |
$1,513.55
|
| Rate for Payer: First Health Commercial |
$1,732.37
|
| Rate for Payer: Humana Commercial |
$1,550.02
|
| Rate for Payer: Humana KY Medicaid |
$627.12
|
| Rate for Payer: Kentucky WC Medicaid |
$633.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,495.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,345.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$547.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$639.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,604.72
|
| Rate for Payer: Ohio Health Group HMO |
$1,367.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$364.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$237.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$565.30
|
| Rate for Payer: PHCS Commercial |
$1,750.61
|
| Rate for Payer: United Healthcare All Payer |
$1,604.72
|
|
|
PLATE SM RECON 3.5MM 10X121MM
|
Facility
|
IP
|
$1,988.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.52 |
| Max. Negotiated Rate |
$1,909.04 |
| Rate for Payer: Humana Commercial |
$1,690.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,749.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.46
|
| Rate for Payer: PHCS Commercial |
$1,909.04
|
| Rate for Payer: United Healthcare All Payer |
$1,749.95
|
| Rate for Payer: Aetna Commercial |
$1,531.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.09
|
| Rate for Payer: Cash Price |
$994.29
|
| Rate for Payer: Cigna Commercial |
$1,650.52
|
| Rate for Payer: First Health Commercial |
$1,889.15
|
|
|
PLATE SM RECON 3.5MM 10X121MM
|
Facility
|
OP
|
$1,988.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.52 |
| Max. Negotiated Rate |
$1,909.04 |
| Rate for Payer: Aetna Commercial |
$1,531.21
|
| Rate for Payer: Anthem Medicaid |
$683.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,551.09
|
| Rate for Payer: Cash Price |
$994.29
|
| Rate for Payer: Cigna Commercial |
$1,650.52
|
| Rate for Payer: First Health Commercial |
$1,889.15
|
| Rate for Payer: Humana Commercial |
$1,690.29
|
| Rate for Payer: Humana KY Medicaid |
$683.87
|
| Rate for Payer: Kentucky WC Medicaid |
$690.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,630.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,467.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$596.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$697.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,749.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,491.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$397.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$616.46
|
| Rate for Payer: PHCS Commercial |
$1,909.04
|
| Rate for Payer: United Healthcare All Payer |
$1,749.95
|
|
|
PLATE SM RECON 3.5MM 12X145MM
|
Facility
|
IP
|
$2,067.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$1,984.80 |
| Rate for Payer: Aetna Commercial |
$1,591.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.65
|
| Rate for Payer: Cash Price |
$1,033.75
|
| Rate for Payer: Cigna Commercial |
$1,716.02
|
| Rate for Payer: First Health Commercial |
$1,964.12
|
| Rate for Payer: Humana Commercial |
$1,757.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.92
|
| Rate for Payer: PHCS Commercial |
$1,984.80
|
| Rate for Payer: United Healthcare All Payer |
$1,819.40
|
|
|
PLATE SM RECON 3.5MM 12X145MM
|
Facility
|
OP
|
$2,067.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$1,984.80 |
| Rate for Payer: Aetna Commercial |
$1,591.98
|
| Rate for Payer: Anthem Medicaid |
$711.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,612.65
|
| Rate for Payer: Cash Price |
$1,033.75
|
| Rate for Payer: Cigna Commercial |
$1,716.02
|
| Rate for Payer: First Health Commercial |
$1,964.12
|
| Rate for Payer: Humana Commercial |
$1,757.38
|
| Rate for Payer: Humana KY Medicaid |
$711.01
|
| Rate for Payer: Kentucky WC Medicaid |
$718.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,695.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,525.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$620.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$725.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,819.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,550.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$413.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$268.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$640.92
|
| Rate for Payer: PHCS Commercial |
$1,984.80
|
| Rate for Payer: United Healthcare All Payer |
$1,819.40
|
|
|
PLATE SM RECON 3.5MM 5X61MM
|
Facility
|
OP
|
$1,866.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.66 |
| Max. Negotiated Rate |
$1,791.94 |
| Rate for Payer: Aetna Commercial |
$1,437.28
|
| Rate for Payer: Anthem Medicaid |
$641.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,455.95
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: First Health Commercial |
$1,773.27
|
| Rate for Payer: Humana Commercial |
$1,586.61
|
| Rate for Payer: Humana KY Medicaid |
$641.92
|
| Rate for Payer: Kentucky WC Medicaid |
$648.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,530.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,377.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$654.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,642.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,399.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.65
|
| Rate for Payer: PHCS Commercial |
$1,791.94
|
| Rate for Payer: United Healthcare All Payer |
$1,642.61
|
|
|
PLATE SM RECON 3.5MM 5X61MM
|
Facility
|
IP
|
$1,866.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$242.66 |
| Max. Negotiated Rate |
$1,791.94 |
| Rate for Payer: Aetna Commercial |
$1,437.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,455.95
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: First Health Commercial |
$1,773.27
|
| Rate for Payer: Humana Commercial |
$1,586.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,530.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,377.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$559.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,642.61
|
| Rate for Payer: Ohio Health Group HMO |
$1,399.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$373.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$242.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$578.65
|
| Rate for Payer: PHCS Commercial |
$1,791.94
|
| Rate for Payer: United Healthcare All Payer |
$1,642.61
|
|
|
PLATE SM RECON 3.5MM 6X73MM
|
Facility
|
OP
|
$1,895.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.39 |
| Max. Negotiated Rate |
$1,819.49 |
| Rate for Payer: Aetna Commercial |
$1,459.38
|
| Rate for Payer: Anthem Medicaid |
$651.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.33
|
| Rate for Payer: Cash Price |
$947.65
|
| Rate for Payer: Cigna Commercial |
$1,573.10
|
| Rate for Payer: First Health Commercial |
$1,800.54
|
| Rate for Payer: Humana Commercial |
$1,611.00
|
| Rate for Payer: Humana KY Medicaid |
$651.79
|
| Rate for Payer: Kentucky WC Medicaid |
$658.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$664.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.54
|
| Rate for Payer: PHCS Commercial |
$1,819.49
|
| Rate for Payer: United Healthcare All Payer |
$1,667.86
|
|
|
PLATE SM RECON 3.5MM 6X73MM
|
Facility
|
IP
|
$1,895.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$246.39 |
| Max. Negotiated Rate |
$1,819.49 |
| Rate for Payer: Aetna Commercial |
$1,459.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,478.33
|
| Rate for Payer: Cash Price |
$947.65
|
| Rate for Payer: Cigna Commercial |
$1,573.10
|
| Rate for Payer: First Health Commercial |
$1,800.54
|
| Rate for Payer: Humana Commercial |
$1,611.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,554.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,398.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$568.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,667.86
|
| Rate for Payer: Ohio Health Group HMO |
$1,421.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$379.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$246.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$587.54
|
| Rate for Payer: PHCS Commercial |
$1,819.49
|
| Rate for Payer: United Healthcare All Payer |
$1,667.86
|
|
|
PLATE SM RECON 3.5MM 7X85MM
|
Facility
|
OP
|
$1,916.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$1,840.16 |
| Rate for Payer: Humana Commercial |
$1,629.31
|
| Rate for Payer: Humana KY Medicaid |
$659.20
|
| Rate for Payer: Kentucky WC Medicaid |
$665.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$672.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.22
|
| Rate for Payer: PHCS Commercial |
$1,840.16
|
| Rate for Payer: United Healthcare All Payer |
$1,686.81
|
| Rate for Payer: Aetna Commercial |
$1,475.96
|
| Rate for Payer: Anthem Medicaid |
$659.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.13
|
| Rate for Payer: Cash Price |
$958.41
|
| Rate for Payer: Cigna Commercial |
$1,590.97
|
| Rate for Payer: First Health Commercial |
$1,820.99
|
|
|
PLATE SM RECON 3.5MM 7X85MM
|
Facility
|
IP
|
$1,916.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$1,840.16 |
| Rate for Payer: Aetna Commercial |
$1,475.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,495.13
|
| Rate for Payer: Cash Price |
$958.41
|
| Rate for Payer: Cigna Commercial |
$1,590.97
|
| Rate for Payer: First Health Commercial |
$1,820.99
|
| Rate for Payer: Humana Commercial |
$1,629.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,571.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,414.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$575.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,686.81
|
| Rate for Payer: Ohio Health Group HMO |
$1,437.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$383.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$249.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$594.22
|
| Rate for Payer: PHCS Commercial |
$1,840.16
|
| Rate for Payer: United Healthcare All Payer |
$1,686.81
|
|
|
PLATE SM RECON 3.5MM 8X97MM
|
Facility
|
OP
|
$1,959.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.78 |
| Max. Negotiated Rate |
$1,881.48 |
| Rate for Payer: Aetna Commercial |
$1,509.11
|
| Rate for Payer: Anthem Medicaid |
$674.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.71
|
| Rate for Payer: Cash Price |
$979.94
|
| Rate for Payer: Cigna Commercial |
$1,626.70
|
| Rate for Payer: First Health Commercial |
$1,861.89
|
| Rate for Payer: Humana Commercial |
$1,665.90
|
| Rate for Payer: Humana KY Medicaid |
$674.00
|
| Rate for Payer: Kentucky WC Medicaid |
$680.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$587.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$687.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,469.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.56
|
| Rate for Payer: PHCS Commercial |
$1,881.48
|
| Rate for Payer: United Healthcare All Payer |
$1,724.69
|
|
|
PLATE SM RECON 3.5MM 8X97MM
|
Facility
|
IP
|
$1,959.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$254.78 |
| Max. Negotiated Rate |
$1,881.48 |
| Rate for Payer: Aetna Commercial |
$1,509.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,528.71
|
| Rate for Payer: Cash Price |
$979.94
|
| Rate for Payer: Cigna Commercial |
$1,626.70
|
| Rate for Payer: First Health Commercial |
$1,861.89
|
| Rate for Payer: Humana Commercial |
$1,665.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,607.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,446.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$587.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,724.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,469.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$391.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$254.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$607.56
|
| Rate for Payer: PHCS Commercial |
$1,881.48
|
| Rate for Payer: United Healthcare All Payer |
$1,724.69
|
|
|
PLATE SM RECON 3.5MM 9X109MM
|
Facility
|
OP
|
$1,974.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.65 |
| Max. Negotiated Rate |
$1,895.25 |
| Rate for Payer: Aetna Commercial |
$1,520.15
|
| Rate for Payer: Anthem Medicaid |
$678.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,539.89
|
| Rate for Payer: Cash Price |
$987.11
|
| Rate for Payer: Cigna Commercial |
$1,638.60
|
| Rate for Payer: First Health Commercial |
$1,875.51
|
| Rate for Payer: Humana Commercial |
$1,678.09
|
| Rate for Payer: Humana KY Medicaid |
$678.93
|
| Rate for Payer: Kentucky WC Medicaid |
$685.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,618.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$692.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,737.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,480.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.01
|
| Rate for Payer: PHCS Commercial |
$1,895.25
|
| Rate for Payer: United Healthcare All Payer |
$1,737.31
|
|
|
PLATE SM RECON 3.5MM 9X109MM
|
Facility
|
IP
|
$1,974.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.65 |
| Max. Negotiated Rate |
$1,895.25 |
| Rate for Payer: Aetna Commercial |
$1,520.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,539.89
|
| Rate for Payer: Cash Price |
$987.11
|
| Rate for Payer: Cigna Commercial |
$1,638.60
|
| Rate for Payer: First Health Commercial |
$1,875.51
|
| Rate for Payer: Humana Commercial |
$1,678.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,618.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,456.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$592.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,737.31
|
| Rate for Payer: Ohio Health Group HMO |
$1,480.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$394.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$256.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$612.01
|
| Rate for Payer: PHCS Commercial |
$1,895.25
|
| Rate for Payer: United Healthcare All Payer |
$1,737.31
|
|
|
PLATE SM RT JONES FX
|
Facility
|
IP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE SM RT JONES FX
|
Facility
|
OP
|
$8,384.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.98 |
| Max. Negotiated Rate |
$8,049.12 |
| Rate for Payer: Aetna Commercial |
$6,456.06
|
| Rate for Payer: Anthem Medicaid |
$2,883.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,539.91
|
| Rate for Payer: Cash Price |
$4,192.25
|
| Rate for Payer: Cigna Commercial |
$6,959.14
|
| Rate for Payer: First Health Commercial |
$7,965.28
|
| Rate for Payer: Humana Commercial |
$7,126.82
|
| Rate for Payer: Humana KY Medicaid |
$2,883.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,912.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,875.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,187.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,515.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,941.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,378.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,288.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,676.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,089.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,599.20
|
| Rate for Payer: PHCS Commercial |
$8,049.12
|
| Rate for Payer: United Healthcare All Payer |
$7,378.36
|
|
|
PLATE SM UTILITY 2.7MM
|
Facility
|
IP
|
$5,492.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.04 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$4,229.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,284.24
|
| Rate for Payer: Cash Price |
$2,746.31
|
| Rate for Payer: Cigna Commercial |
$4,558.87
|
| Rate for Payer: First Health Commercial |
$5,217.99
|
| Rate for Payer: Humana Commercial |
$4,668.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.71
|
| Rate for Payer: PHCS Commercial |
$5,272.92
|
| Rate for Payer: United Healthcare All Payer |
$4,833.51
|
|
