|
PLATE RECON 11 HOLE
|
Facility
|
IP
|
$12,873.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,861.95 |
| Max. Negotiated Rate |
$12,358.25 |
| Rate for Payer: Aetna Commercial |
$9,912.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,041.08
|
| Rate for Payer: Cash Price |
$6,436.59
|
| Rate for Payer: Cigna Commercial |
$10,684.74
|
| Rate for Payer: First Health Commercial |
$12,229.52
|
| Rate for Payer: Humana Commercial |
$10,942.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,556.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,500.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,861.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,328.40
|
| Rate for Payer: Ohio Health Group HMO |
$9,654.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,298.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,199.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,882.49
|
| Rate for Payer: PHCS Commercial |
$12,358.25
|
| Rate for Payer: United Healthcare All Payer |
$11,328.40
|
|
|
PLATE RECON 11H W/TEMP
|
Facility
|
OP
|
$4,431.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.43 |
| Max. Negotiated Rate |
$4,254.16 |
| Rate for Payer: Aetna Commercial |
$3,412.19
|
| Rate for Payer: Anthem Medicaid |
$1,523.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,456.51
|
| Rate for Payer: Cash Price |
$2,215.71
|
| Rate for Payer: Cigna Commercial |
$3,678.08
|
| Rate for Payer: First Health Commercial |
$4,209.85
|
| Rate for Payer: Humana Commercial |
$3,766.71
|
| Rate for Payer: Humana KY Medicaid |
$1,523.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,539.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,633.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,270.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,899.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,323.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,855.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.68
|
| Rate for Payer: PHCS Commercial |
$4,254.16
|
| Rate for Payer: United Healthcare All Payer |
$3,899.65
|
|
|
PLATE RECON 11H W/TEMP
|
Facility
|
IP
|
$4,431.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.43 |
| Max. Negotiated Rate |
$4,254.16 |
| Rate for Payer: Aetna Commercial |
$3,412.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,456.51
|
| Rate for Payer: Cash Price |
$2,215.71
|
| Rate for Payer: Cigna Commercial |
$3,678.08
|
| Rate for Payer: First Health Commercial |
$4,209.85
|
| Rate for Payer: Humana Commercial |
$3,766.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,633.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,270.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,899.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,323.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,855.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.68
|
| Rate for Payer: PHCS Commercial |
$4,254.16
|
| Rate for Payer: United Healthcare All Payer |
$3,899.65
|
|
|
PLATE RECON 17 HOLE
|
Facility
|
IP
|
$15,914.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,774.32 |
| Max. Negotiated Rate |
$15,277.82 |
| Rate for Payer: Aetna Commercial |
$12,254.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,413.23
|
| Rate for Payer: Cash Price |
$7,957.20
|
| Rate for Payer: Cigna Commercial |
$13,208.95
|
| Rate for Payer: First Health Commercial |
$15,118.68
|
| Rate for Payer: Humana Commercial |
$13,527.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,049.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,744.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,774.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,004.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,935.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,731.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,845.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,980.94
|
| Rate for Payer: PHCS Commercial |
$15,277.82
|
| Rate for Payer: United Healthcare All Payer |
$14,004.67
|
|
|
PLATE RECON 17 HOLE
|
Facility
|
OP
|
$15,914.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,774.32 |
| Max. Negotiated Rate |
$15,277.82 |
| Rate for Payer: Aetna Commercial |
$12,254.09
|
| Rate for Payer: Anthem Medicaid |
$5,472.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,413.23
|
| Rate for Payer: Cash Price |
$7,957.20
|
| Rate for Payer: Cigna Commercial |
$13,208.95
|
| Rate for Payer: First Health Commercial |
$15,118.68
|
| Rate for Payer: Humana Commercial |
$13,527.24
|
| Rate for Payer: Humana KY Medicaid |
$5,472.96
|
| Rate for Payer: Kentucky WC Medicaid |
$5,528.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,049.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,744.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,774.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,582.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,004.67
|
| Rate for Payer: Ohio Health Group HMO |
$11,935.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,731.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,845.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,980.94
|
| Rate for Payer: PHCS Commercial |
$15,277.82
|
| Rate for Payer: United Healthcare All Payer |
$14,004.67
|
|
|
PLATE RECON 17H W/TEMP
|
Facility
|
IP
|
$4,431.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.42 |
| Max. Negotiated Rate |
$4,254.13 |
| Rate for Payer: Aetna Commercial |
$3,412.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,456.48
|
| Rate for Payer: Cash Price |
$2,215.69
|
| Rate for Payer: Cigna Commercial |
$3,678.05
|
| Rate for Payer: First Health Commercial |
$4,209.82
|
| Rate for Payer: Humana Commercial |
$3,766.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,633.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,270.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,899.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,323.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,855.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.66
|
| Rate for Payer: PHCS Commercial |
$4,254.13
|
| Rate for Payer: United Healthcare All Payer |
$3,899.62
|
|
|
PLATE RECON 17H W/TEMP
|
Facility
|
OP
|
$4,431.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.42 |
| Max. Negotiated Rate |
$4,254.13 |
| Rate for Payer: Aetna Commercial |
$3,412.17
|
| Rate for Payer: Anthem Medicaid |
$1,523.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,456.48
|
| Rate for Payer: Cash Price |
$2,215.69
|
| Rate for Payer: Cigna Commercial |
$3,678.05
|
| Rate for Payer: First Health Commercial |
$4,209.82
|
| Rate for Payer: Humana Commercial |
$3,766.68
|
| Rate for Payer: Humana KY Medicaid |
$1,523.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,539.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,633.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,270.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,899.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,323.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,545.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,855.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,057.66
|
| Rate for Payer: PHCS Commercial |
$4,254.13
|
| Rate for Payer: United Healthcare All Payer |
$3,899.62
|
|
|
PLATE RECON 3.5*118 10H
|
Facility
|
IP
|
$3,554.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.20 |
| Max. Negotiated Rate |
$3,411.84 |
| Rate for Payer: Aetna Commercial |
$2,736.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,772.12
|
| Rate for Payer: Cash Price |
$1,777.00
|
| Rate for Payer: Cigna Commercial |
$2,949.82
|
| Rate for Payer: First Health Commercial |
$3,376.30
|
| Rate for Payer: Humana Commercial |
$3,020.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,914.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,622.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,127.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,665.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.26
|
| Rate for Payer: PHCS Commercial |
$3,411.84
|
| Rate for Payer: United Healthcare All Payer |
$3,127.52
|
|
|
PLATE RECON 3.5*118 10H
|
Facility
|
OP
|
$3,554.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.20 |
| Max. Negotiated Rate |
$3,411.84 |
| Rate for Payer: Aetna Commercial |
$2,736.58
|
| Rate for Payer: Anthem Medicaid |
$1,222.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,772.12
|
| Rate for Payer: Cash Price |
$1,777.00
|
| Rate for Payer: Cigna Commercial |
$2,949.82
|
| Rate for Payer: First Health Commercial |
$3,376.30
|
| Rate for Payer: Humana Commercial |
$3,020.90
|
| Rate for Payer: Humana KY Medicaid |
$1,222.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,234.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,914.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,622.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,246.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,127.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,665.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.26
|
| Rate for Payer: PHCS Commercial |
$3,411.84
|
| Rate for Payer: United Healthcare All Payer |
$3,127.52
|
|
|
PLATE RECON 3.5*142 12H
|
Facility
|
IP
|
$3,685.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.74 |
| Max. Negotiated Rate |
$3,538.38 |
| Rate for Payer: Aetna Commercial |
$2,838.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,874.93
|
| Rate for Payer: Cash Price |
$1,842.91
|
| Rate for Payer: Cigna Commercial |
$3,059.22
|
| Rate for Payer: First Health Commercial |
$3,501.52
|
| Rate for Payer: Humana Commercial |
$3,132.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,022.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,720.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,243.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,764.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,948.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,206.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,543.21
|
| Rate for Payer: PHCS Commercial |
$3,538.38
|
| Rate for Payer: United Healthcare All Payer |
$3,243.51
|
|
|
PLATE RECON 3.5*142 12H
|
Facility
|
OP
|
$3,685.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.74 |
| Max. Negotiated Rate |
$3,538.38 |
| Rate for Payer: Aetna Commercial |
$2,838.07
|
| Rate for Payer: Anthem Medicaid |
$1,267.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,874.93
|
| Rate for Payer: Cash Price |
$1,842.91
|
| Rate for Payer: Cigna Commercial |
$3,059.22
|
| Rate for Payer: First Health Commercial |
$3,501.52
|
| Rate for Payer: Humana Commercial |
$3,132.94
|
| Rate for Payer: Humana KY Medicaid |
$1,267.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,280.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,022.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,720.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,105.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,292.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,243.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,764.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,948.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,206.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,543.21
|
| Rate for Payer: PHCS Commercial |
$3,538.38
|
| Rate for Payer: United Healthcare All Payer |
$3,243.51
|
|
|
PLATE RECON 3.5*166 14H
|
Facility
|
OP
|
$3,852.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$3,698.22 |
| Rate for Payer: Aetna Commercial |
$2,966.28
|
| Rate for Payer: Anthem Medicaid |
$1,324.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.80
|
| Rate for Payer: Cash Price |
$1,926.16
|
| Rate for Payer: Cigna Commercial |
$3,197.42
|
| Rate for Payer: First Health Commercial |
$3,659.69
|
| Rate for Payer: Humana Commercial |
$3,274.46
|
| Rate for Payer: Humana KY Medicaid |
$1,324.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,338.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,843.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,351.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,390.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.09
|
| Rate for Payer: PHCS Commercial |
$3,698.22
|
| Rate for Payer: United Healthcare All Payer |
$3,390.03
|
|
|
PLATE RECON 3.5*166 14H
|
Facility
|
IP
|
$3,852.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$3,698.22 |
| Rate for Payer: Aetna Commercial |
$2,966.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.80
|
| Rate for Payer: Cash Price |
$1,926.16
|
| Rate for Payer: Cigna Commercial |
$3,197.42
|
| Rate for Payer: First Health Commercial |
$3,659.69
|
| Rate for Payer: Humana Commercial |
$3,274.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,843.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,390.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.09
|
| Rate for Payer: PHCS Commercial |
$3,698.22
|
| Rate for Payer: United Healthcare All Payer |
$3,390.03
|
|
|
PLATE RECON 3.5*46 4H
|
Facility
|
IP
|
$3,179.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.81 |
| Max. Negotiated Rate |
$3,052.20 |
| Rate for Payer: Aetna Commercial |
$2,448.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,479.92
|
| Rate for Payer: Cash Price |
$1,589.69
|
| Rate for Payer: Cigna Commercial |
$2,638.89
|
| Rate for Payer: First Health Commercial |
$3,020.41
|
| Rate for Payer: Humana Commercial |
$2,702.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,797.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,384.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,543.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,766.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,193.77
|
| Rate for Payer: PHCS Commercial |
$3,052.20
|
| Rate for Payer: United Healthcare All Payer |
$2,797.85
|
|
|
PLATE RECON 3.5*46 4H
|
Facility
|
OP
|
$3,179.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$953.81 |
| Max. Negotiated Rate |
$3,052.20 |
| Rate for Payer: Aetna Commercial |
$2,448.12
|
| Rate for Payer: Anthem Medicaid |
$1,093.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,479.92
|
| Rate for Payer: Cash Price |
$1,589.69
|
| Rate for Payer: Cigna Commercial |
$2,638.89
|
| Rate for Payer: First Health Commercial |
$3,020.41
|
| Rate for Payer: Humana Commercial |
$2,702.47
|
| Rate for Payer: Humana KY Medicaid |
$1,093.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,104.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,607.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,346.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$953.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,797.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,384.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,543.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,766.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,193.77
|
| Rate for Payer: PHCS Commercial |
$3,052.20
|
| Rate for Payer: United Healthcare All Payer |
$2,797.85
|
|
|
PLATE RECON 3.5*70 6H
|
Facility
|
OP
|
$3,373.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.09 |
| Max. Negotiated Rate |
$3,238.68 |
| Rate for Payer: Aetna Commercial |
$2,597.69
|
| Rate for Payer: Anthem Medicaid |
$1,160.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,631.42
|
| Rate for Payer: Cash Price |
$1,686.81
|
| Rate for Payer: Cigna Commercial |
$2,800.10
|
| Rate for Payer: First Health Commercial |
$3,204.94
|
| Rate for Payer: Humana Commercial |
$2,867.58
|
| Rate for Payer: Humana KY Medicaid |
$1,160.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,172.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,766.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,489.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,183.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,968.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,530.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,698.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,935.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,327.80
|
| Rate for Payer: PHCS Commercial |
$3,238.68
|
| Rate for Payer: United Healthcare All Payer |
$2,968.79
|
|
|
PLATE RECON 3.5*70 6H
|
Facility
|
IP
|
$3,373.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,012.09 |
| Max. Negotiated Rate |
$3,238.68 |
| Rate for Payer: Aetna Commercial |
$2,597.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,631.42
|
| Rate for Payer: Cash Price |
$1,686.81
|
| Rate for Payer: Cigna Commercial |
$2,800.10
|
| Rate for Payer: First Health Commercial |
$3,204.94
|
| Rate for Payer: Humana Commercial |
$2,867.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,766.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,489.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,012.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,968.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,530.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,698.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,935.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,327.80
|
| Rate for Payer: PHCS Commercial |
$3,238.68
|
| Rate for Payer: United Healthcare All Payer |
$2,968.79
|
|
|
PLATE RECON 3.5*94 8H
|
Facility
|
OP
|
$3,505.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.63 |
| Max. Negotiated Rate |
$3,365.22 |
| Rate for Payer: Aetna Commercial |
$2,699.19
|
| Rate for Payer: Anthem Medicaid |
$1,205.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.24
|
| Rate for Payer: Cash Price |
$1,752.72
|
| Rate for Payer: Cigna Commercial |
$2,909.52
|
| Rate for Payer: First Health Commercial |
$3,330.17
|
| Rate for Payer: Humana Commercial |
$2,979.62
|
| Rate for Payer: Humana KY Medicaid |
$1,205.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,804.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,049.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.75
|
| Rate for Payer: PHCS Commercial |
$3,365.22
|
| Rate for Payer: United Healthcare All Payer |
$3,084.79
|
|
|
PLATE RECON 3.5*94 8H
|
Facility
|
IP
|
$3,505.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.63 |
| Max. Negotiated Rate |
$3,365.22 |
| Rate for Payer: Aetna Commercial |
$2,699.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,734.24
|
| Rate for Payer: Cash Price |
$1,752.72
|
| Rate for Payer: Cigna Commercial |
$2,909.52
|
| Rate for Payer: First Health Commercial |
$3,330.17
|
| Rate for Payer: Humana Commercial |
$2,979.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,874.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,587.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,084.79
|
| Rate for Payer: Ohio Health Group HMO |
$2,629.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,804.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,049.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.75
|
| Rate for Payer: PHCS Commercial |
$3,365.22
|
| Rate for Payer: United Healthcare All Payer |
$3,084.79
|
|
|
PLATE RECON 3.5MM 10H 118MM
|
Facility
|
OP
|
$3,554.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.20 |
| Max. Negotiated Rate |
$3,411.84 |
| Rate for Payer: Aetna Commercial |
$2,736.58
|
| Rate for Payer: Anthem Medicaid |
$1,222.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,772.12
|
| Rate for Payer: Cash Price |
$1,777.00
|
| Rate for Payer: Cigna Commercial |
$2,949.82
|
| Rate for Payer: First Health Commercial |
$3,376.30
|
| Rate for Payer: Humana Commercial |
$3,020.90
|
| Rate for Payer: Humana KY Medicaid |
$1,222.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,234.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,914.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,622.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,246.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,127.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,665.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.26
|
| Rate for Payer: PHCS Commercial |
$3,411.84
|
| Rate for Payer: United Healthcare All Payer |
$3,127.52
|
|
|
PLATE RECON 3.5MM 10H 118MM
|
Facility
|
IP
|
$3,554.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.20 |
| Max. Negotiated Rate |
$3,411.84 |
| Rate for Payer: Aetna Commercial |
$2,736.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,772.12
|
| Rate for Payer: Cash Price |
$1,777.00
|
| Rate for Payer: Cigna Commercial |
$2,949.82
|
| Rate for Payer: First Health Commercial |
$3,376.30
|
| Rate for Payer: Humana Commercial |
$3,020.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,914.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,622.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,066.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,127.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,665.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,843.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,091.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,452.26
|
| Rate for Payer: PHCS Commercial |
$3,411.84
|
| Rate for Payer: United Healthcare All Payer |
$3,127.52
|
|
|
PLATE RECON 3.5MM 10X118MM
|
Facility
|
IP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE RECON 3.5MM 10X118MM
|
Facility
|
OP
|
$3,860.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,158.11 |
| Max. Negotiated Rate |
$3,705.96 |
| Rate for Payer: Aetna Commercial |
$2,972.49
|
| Rate for Payer: Anthem Medicaid |
$1,327.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,011.10
|
| Rate for Payer: Cash Price |
$1,930.19
|
| Rate for Payer: Cigna Commercial |
$3,204.12
|
| Rate for Payer: First Health Commercial |
$3,667.36
|
| Rate for Payer: Humana Commercial |
$3,281.32
|
| Rate for Payer: Humana KY Medicaid |
$1,327.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,165.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,848.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,397.13
|
| Rate for Payer: Ohio Health Group HMO |
$2,895.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,088.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,358.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,663.66
|
| Rate for Payer: PHCS Commercial |
$3,705.96
|
| Rate for Payer: United Healthcare All Payer |
$3,397.13
|
|
|
PLATE RECON 3.5MM 11X130MM
|
Facility
|
IP
|
$3,806.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.97 |
| Max. Negotiated Rate |
$3,654.30 |
| Rate for Payer: Aetna Commercial |
$2,931.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.12
|
| Rate for Payer: Cash Price |
$1,903.28
|
| Rate for Payer: Cigna Commercial |
$3,159.44
|
| Rate for Payer: First Health Commercial |
$3,616.23
|
| Rate for Payer: Humana Commercial |
$3,235.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,045.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,311.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,626.53
|
| Rate for Payer: PHCS Commercial |
$3,654.30
|
| Rate for Payer: United Healthcare All Payer |
$3,349.77
|
|
|
PLATE RECON 3.5MM 11X130MM
|
Facility
|
OP
|
$3,806.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.97 |
| Max. Negotiated Rate |
$3,654.30 |
| Rate for Payer: Aetna Commercial |
$2,931.05
|
| Rate for Payer: Anthem Medicaid |
$1,309.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.12
|
| Rate for Payer: Cash Price |
$1,903.28
|
| Rate for Payer: Cigna Commercial |
$3,159.44
|
| Rate for Payer: First Health Commercial |
$3,616.23
|
| Rate for Payer: Humana Commercial |
$3,235.58
|
| Rate for Payer: Humana KY Medicaid |
$1,309.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.77
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,045.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,311.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,626.53
|
| Rate for Payer: PHCS Commercial |
$3,654.30
|
| Rate for Payer: United Healthcare All Payer |
$3,349.77
|
|
