|
PLATE METTARSALPHALENGEL R REV
|
Facility
|
OP
|
$3,293.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem Medicaid |
$1,132.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Humana KY Medicaid |
$1,132.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,144.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
PLATE MIDSHAFT 97MM 8H
|
Facility
|
IP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE MIDSHAFT 97MM 8H
|
Facility
|
OP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem Medicaid |
$1,813.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Humana KY Medicaid |
$1,813.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE MIDSHIFT COMPRESS 10H
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESS 10H
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESS 12H
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESS 12H
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESSION 4H
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESSION 4H
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESSION 6H
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESSION 6H
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESSION 8H
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MIDSHIFT COMPRESSION 8H
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MINI 1.5MM 4H
|
Facility
|
OP
|
$4,265.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,279.50 |
| Max. Negotiated Rate |
$4,094.40 |
| Rate for Payer: Aetna Commercial |
$3,284.05
|
| Rate for Payer: Anthem Medicaid |
$1,466.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,326.70
|
| Rate for Payer: Cash Price |
$2,132.50
|
| Rate for Payer: Cigna Commercial |
$3,539.95
|
| Rate for Payer: First Health Commercial |
$4,051.75
|
| Rate for Payer: Humana Commercial |
$3,625.25
|
| Rate for Payer: Humana KY Medicaid |
$1,466.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,481.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,497.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,147.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,496.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,753.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,710.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.85
|
| Rate for Payer: PHCS Commercial |
$4,094.40
|
| Rate for Payer: United Healthcare All Payer |
$3,753.20
|
|
|
PLATE MINI 1.5MM 4H
|
Facility
|
IP
|
$4,265.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,279.50 |
| Max. Negotiated Rate |
$4,094.40 |
| Rate for Payer: Aetna Commercial |
$3,284.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,326.70
|
| Rate for Payer: Cash Price |
$2,132.50
|
| Rate for Payer: Cigna Commercial |
$3,539.95
|
| Rate for Payer: First Health Commercial |
$4,051.75
|
| Rate for Payer: Humana Commercial |
$3,625.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,497.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,147.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,753.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,710.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.85
|
| Rate for Payer: PHCS Commercial |
$4,094.40
|
| Rate for Payer: United Healthcare All Payer |
$3,753.20
|
|
|
PLATE MINI 1.5MM 4H W/BAR
|
Facility
|
OP
|
$4,636.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,390.88 |
| Max. Negotiated Rate |
$4,450.80 |
| Rate for Payer: Aetna Commercial |
$3,569.91
|
| Rate for Payer: Anthem Medicaid |
$1,594.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,616.28
|
| Rate for Payer: Cash Price |
$2,318.12
|
| Rate for Payer: Cigna Commercial |
$3,848.09
|
| Rate for Payer: First Health Commercial |
$4,404.44
|
| Rate for Payer: Humana Commercial |
$3,940.81
|
| Rate for Payer: Humana KY Medicaid |
$1,594.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,610.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,801.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,421.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,626.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,079.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,477.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,709.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,033.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,199.01
|
| Rate for Payer: PHCS Commercial |
$4,450.80
|
| Rate for Payer: United Healthcare All Payer |
$4,079.90
|
|
|
PLATE MINI 1.5MM 4H W/BAR
|
Facility
|
IP
|
$4,636.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,390.88 |
| Max. Negotiated Rate |
$4,450.80 |
| Rate for Payer: Aetna Commercial |
$3,569.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,616.28
|
| Rate for Payer: Cash Price |
$2,318.12
|
| Rate for Payer: Cigna Commercial |
$3,848.09
|
| Rate for Payer: First Health Commercial |
$4,404.44
|
| Rate for Payer: Humana Commercial |
$3,940.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,801.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,421.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,390.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,079.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,477.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,709.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,033.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,199.01
|
| Rate for Payer: PHCS Commercial |
$4,450.80
|
| Rate for Payer: United Healthcare All Payer |
$4,079.90
|
|
|
PLATE MINI 1.5MM 6H
|
Facility
|
OP
|
$5,116.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,534.88 |
| Max. Negotiated Rate |
$4,911.60 |
| Rate for Payer: Aetna Commercial |
$3,939.51
|
| Rate for Payer: Anthem Medicaid |
$1,759.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,990.68
|
| Rate for Payer: Cash Price |
$2,558.12
|
| Rate for Payer: Cigna Commercial |
$4,246.49
|
| Rate for Payer: First Health Commercial |
$4,860.44
|
| Rate for Payer: Humana Commercial |
$4,348.81
|
| Rate for Payer: Humana KY Medicaid |
$1,759.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,777.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,195.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,775.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,534.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,794.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,502.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,837.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,093.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,451.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,530.21
|
| Rate for Payer: PHCS Commercial |
$4,911.60
|
| Rate for Payer: United Healthcare All Payer |
$4,502.30
|
|
|
PLATE MINI 1.5MM 6H
|
Facility
|
IP
|
$5,116.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,534.88 |
| Max. Negotiated Rate |
$4,911.60 |
| Rate for Payer: Aetna Commercial |
$3,939.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,990.68
|
| Rate for Payer: Cash Price |
$2,558.12
|
| Rate for Payer: Cigna Commercial |
$4,246.49
|
| Rate for Payer: First Health Commercial |
$4,860.44
|
| Rate for Payer: Humana Commercial |
$4,348.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,195.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,775.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,534.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,502.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,837.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,093.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,451.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,530.21
|
| Rate for Payer: PHCS Commercial |
$4,911.60
|
| Rate for Payer: United Healthcare All Payer |
$4,502.30
|
|
|
PLATE MINI 16H
|
Facility
|
IP
|
$5,517.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.25 |
| Max. Negotiated Rate |
$5,296.80 |
| Rate for Payer: Aetna Commercial |
$4,248.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,303.65
|
| Rate for Payer: Cash Price |
$2,758.75
|
| Rate for Payer: Cigna Commercial |
$4,579.52
|
| Rate for Payer: First Health Commercial |
$5,241.62
|
| Rate for Payer: Humana Commercial |
$4,689.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,524.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,071.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,655.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,855.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,138.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,414.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,800.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,807.07
|
| Rate for Payer: PHCS Commercial |
$5,296.80
|
| Rate for Payer: United Healthcare All Payer |
$4,855.40
|
|
|
PLATE MINI 16H
|
Facility
|
OP
|
$5,517.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,655.25 |
| Max. Negotiated Rate |
$5,296.80 |
| Rate for Payer: Aetna Commercial |
$4,248.48
|
| Rate for Payer: Anthem Medicaid |
$1,897.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,303.65
|
| Rate for Payer: Cash Price |
$2,758.75
|
| Rate for Payer: Cigna Commercial |
$4,579.52
|
| Rate for Payer: First Health Commercial |
$5,241.62
|
| Rate for Payer: Humana Commercial |
$4,689.88
|
| Rate for Payer: Humana KY Medicaid |
$1,897.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,916.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,524.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,071.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,655.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,935.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,855.40
|
| Rate for Payer: Ohio Health Group HMO |
$4,138.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,414.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,800.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,807.07
|
| Rate for Payer: PHCS Commercial |
$5,296.80
|
| Rate for Payer: United Healthcare All Payer |
$4,855.40
|
|
|
PLATE MINI 2*3H 3-D RECTANGLE
|
Facility
|
OP
|
$3,192.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.76 |
| Max. Negotiated Rate |
$3,064.84 |
| Rate for Payer: Aetna Commercial |
$2,458.26
|
| Rate for Payer: Anthem Medicaid |
$1,097.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.18
|
| Rate for Payer: Cash Price |
$1,596.27
|
| Rate for Payer: Cigna Commercial |
$2,649.81
|
| Rate for Payer: First Health Commercial |
$3,032.91
|
| Rate for Payer: Humana Commercial |
$2,713.66
|
| Rate for Payer: Humana KY Medicaid |
$1,097.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,109.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,617.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,119.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,777.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.85
|
| Rate for Payer: PHCS Commercial |
$3,064.84
|
| Rate for Payer: United Healthcare All Payer |
$2,809.44
|
|
|
PLATE MINI 2*3H 3-D RECTANGLE
|
Facility
|
IP
|
$3,192.54
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$957.76 |
| Max. Negotiated Rate |
$3,064.84 |
| Rate for Payer: Aetna Commercial |
$2,458.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,490.18
|
| Rate for Payer: Cash Price |
$1,596.27
|
| Rate for Payer: Cigna Commercial |
$2,649.81
|
| Rate for Payer: First Health Commercial |
$3,032.91
|
| Rate for Payer: Humana Commercial |
$2,713.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,617.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,356.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$957.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,809.44
|
| Rate for Payer: Ohio Health Group HMO |
$2,394.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,554.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,777.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,202.85
|
| Rate for Payer: PHCS Commercial |
$3,064.84
|
| Rate for Payer: United Healthcare All Payer |
$2,809.44
|
|
|
PLATE MINI 2*4H 3-D SQUARE
|
Facility
|
OP
|
$3,339.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.79 |
| Max. Negotiated Rate |
$3,205.74 |
| Rate for Payer: Aetna Commercial |
$2,571.27
|
| Rate for Payer: Anthem Medicaid |
$1,148.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,604.66
|
| Rate for Payer: Cash Price |
$1,669.66
|
| Rate for Payer: Cigna Commercial |
$2,771.63
|
| Rate for Payer: First Health Commercial |
$3,172.34
|
| Rate for Payer: Humana Commercial |
$2,838.41
|
| Rate for Payer: Humana KY Medicaid |
$1,148.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,160.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,171.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,938.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,504.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.12
|
| Rate for Payer: PHCS Commercial |
$3,205.74
|
| Rate for Payer: United Healthcare All Payer |
$2,938.59
|
|
|
PLATE MINI 2*4H 3-D SQUARE
|
Facility
|
IP
|
$3,339.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.79 |
| Max. Negotiated Rate |
$3,205.74 |
| Rate for Payer: Aetna Commercial |
$2,571.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,604.66
|
| Rate for Payer: Cash Price |
$1,669.66
|
| Rate for Payer: Cigna Commercial |
$2,771.63
|
| Rate for Payer: First Health Commercial |
$3,172.34
|
| Rate for Payer: Humana Commercial |
$2,838.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,464.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,938.59
|
| Rate for Payer: Ohio Health Group HMO |
$2,504.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,671.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,905.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,304.12
|
| Rate for Payer: PHCS Commercial |
$3,205.74
|
| Rate for Payer: United Healthcare All Payer |
$2,938.59
|
|
