|
PLATE RECON 3.5MM 12H 142MM
|
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 3.5MM 12H 142MM
|
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 3.5MM 12X142MM
|
Facility
|
OP
|
$4,037.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.16 |
| Max. Negotiated Rate |
$3,875.70 |
| Rate for Payer: Aetna Commercial |
$3,108.64
|
| Rate for Payer: Anthem Medicaid |
$1,388.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.01
|
| Rate for Payer: Cash Price |
$2,018.59
|
| Rate for Payer: Cigna Commercial |
$3,350.87
|
| Rate for Payer: First Health Commercial |
$3,835.33
|
| Rate for Payer: Humana Commercial |
$3,431.61
|
| Rate for Payer: Humana KY Medicaid |
$1,388.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,512.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.66
|
| Rate for Payer: PHCS Commercial |
$3,875.70
|
| Rate for Payer: United Healthcare All Payer |
$3,552.73
|
|
|
PLATE RECON 3.5MM 12X142MM
|
Facility
|
IP
|
$4,037.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.16 |
| Max. Negotiated Rate |
$3,875.70 |
| Rate for Payer: Aetna Commercial |
$3,108.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.01
|
| Rate for Payer: Cash Price |
$2,018.59
|
| Rate for Payer: Cigna Commercial |
$3,350.87
|
| Rate for Payer: First Health Commercial |
$3,835.33
|
| Rate for Payer: Humana Commercial |
$3,431.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,552.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,027.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,229.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,512.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.66
|
| Rate for Payer: PHCS Commercial |
$3,875.70
|
| Rate for Payer: United Healthcare All Payer |
$3,552.73
|
|
|
PLATE RECON 3.5MM 13X154MM
|
Facility
|
OP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem Medicaid |
$1,517.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Humana KY Medicaid |
$1,517.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,533.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,548.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE RECON 3.5MM 13X154MM
|
Facility
|
IP
|
$4,413.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,324.16 |
| Max. Negotiated Rate |
$4,237.32 |
| Rate for Payer: Aetna Commercial |
$3,398.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,442.83
|
| Rate for Payer: Cash Price |
$2,206.94
|
| Rate for Payer: Cigna Commercial |
$3,663.52
|
| Rate for Payer: First Health Commercial |
$4,193.19
|
| Rate for Payer: Humana Commercial |
$3,751.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,619.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,257.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,324.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,884.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,310.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,531.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,840.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,045.58
|
| Rate for Payer: PHCS Commercial |
$4,237.32
|
| Rate for Payer: United Healthcare All Payer |
$3,884.21
|
|
|
PLATE RECON 3.5MM 14X166MM
|
Facility
|
IP
|
$4,229.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.81 |
| Max. Negotiated Rate |
$4,060.20 |
| Rate for Payer: Aetna Commercial |
$3,256.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,298.92
|
| Rate for Payer: Cash Price |
$2,114.69
|
| Rate for Payer: Cigna Commercial |
$3,510.39
|
| Rate for Payer: First Health Commercial |
$4,017.91
|
| Rate for Payer: Humana Commercial |
$3,594.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,721.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,383.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,679.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,918.27
|
| Rate for Payer: PHCS Commercial |
$4,060.20
|
| Rate for Payer: United Healthcare All Payer |
$3,721.85
|
|
|
PLATE RECON 3.5MM 14X166MM
|
Facility
|
OP
|
$4,229.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.81 |
| Max. Negotiated Rate |
$4,060.20 |
| Rate for Payer: Aetna Commercial |
$3,256.62
|
| Rate for Payer: Anthem Medicaid |
$1,454.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,298.92
|
| Rate for Payer: Cash Price |
$2,114.69
|
| Rate for Payer: Cigna Commercial |
$3,510.39
|
| Rate for Payer: First Health Commercial |
$4,017.91
|
| Rate for Payer: Humana Commercial |
$3,594.97
|
| Rate for Payer: Humana KY Medicaid |
$1,454.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,468.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,121.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,268.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,483.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,721.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,172.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,383.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,679.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,918.27
|
| Rate for Payer: PHCS Commercial |
$4,060.20
|
| Rate for Payer: United Healthcare All Payer |
$3,721.85
|
|
|
PLATE RECON 3.5MM 15X178MM
|
Facility
|
OP
|
$4,667.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,400.27 |
| Max. Negotiated Rate |
$4,480.86 |
| Rate for Payer: Aetna Commercial |
$3,594.02
|
| Rate for Payer: Anthem Medicaid |
$1,605.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.70
|
| Rate for Payer: Cash Price |
$2,333.78
|
| Rate for Payer: Cigna Commercial |
$3,874.07
|
| Rate for Payer: First Health Commercial |
$4,434.18
|
| Rate for Payer: Humana Commercial |
$3,967.43
|
| Rate for Payer: Humana KY Medicaid |
$1,605.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,827.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,107.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,734.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,060.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,220.62
|
| Rate for Payer: PHCS Commercial |
$4,480.86
|
| Rate for Payer: United Healthcare All Payer |
$4,107.45
|
|
|
PLATE RECON 3.5MM 15X178MM
|
Facility
|
IP
|
$4,667.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,400.27 |
| Max. Negotiated Rate |
$4,480.86 |
| Rate for Payer: Aetna Commercial |
$3,594.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.70
|
| Rate for Payer: Cash Price |
$2,333.78
|
| Rate for Payer: Cigna Commercial |
$3,874.07
|
| Rate for Payer: First Health Commercial |
$4,434.18
|
| Rate for Payer: Humana Commercial |
$3,967.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,827.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,107.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,734.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,060.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,220.62
|
| Rate for Payer: PHCS Commercial |
$4,480.86
|
| Rate for Payer: United Healthcare All Payer |
$4,107.45
|
|
|
PLATE RECON 3.5MM 16X190MM
|
Facility
|
IP
|
$4,267.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.34 |
| Max. Negotiated Rate |
$4,097.10 |
| Rate for Payer: Aetna Commercial |
$3,286.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,328.89
|
| Rate for Payer: Cash Price |
$2,133.91
|
| Rate for Payer: Cigna Commercial |
$3,542.28
|
| Rate for Payer: First Health Commercial |
$4,054.42
|
| Rate for Payer: Humana Commercial |
$3,627.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,499.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,149.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,755.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,200.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,414.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,712.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,944.79
|
| Rate for Payer: PHCS Commercial |
$4,097.10
|
| Rate for Payer: United Healthcare All Payer |
$3,755.67
|
|
|
PLATE RECON 3.5MM 16X190MM
|
Facility
|
OP
|
$4,267.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,280.34 |
| Max. Negotiated Rate |
$4,097.10 |
| Rate for Payer: Aetna Commercial |
$3,286.21
|
| Rate for Payer: Anthem Medicaid |
$1,467.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,328.89
|
| Rate for Payer: Cash Price |
$2,133.91
|
| Rate for Payer: Cigna Commercial |
$3,542.28
|
| Rate for Payer: First Health Commercial |
$4,054.42
|
| Rate for Payer: Humana Commercial |
$3,627.64
|
| Rate for Payer: Humana KY Medicaid |
$1,467.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,482.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,499.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,149.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,280.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,497.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,755.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,200.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,414.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,712.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,944.79
|
| Rate for Payer: PHCS Commercial |
$4,097.10
|
| Rate for Payer: United Healthcare All Payer |
$3,755.67
|
|
|
PLATE RECON 3.5MM 18X214MM
|
Facility
|
IP
|
$4,390.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,317.24 |
| Max. Negotiated Rate |
$4,215.18 |
| Rate for Payer: Aetna Commercial |
$3,380.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,424.83
|
| Rate for Payer: Cash Price |
$2,195.41
|
| Rate for Payer: Cigna Commercial |
$3,644.37
|
| Rate for Payer: First Health Commercial |
$4,171.27
|
| Rate for Payer: Humana Commercial |
$3,732.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,600.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,240.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,317.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,863.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,293.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,512.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,820.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.66
|
| Rate for Payer: PHCS Commercial |
$4,215.18
|
| Rate for Payer: United Healthcare All Payer |
$3,863.91
|
|
|
PLATE RECON 3.5MM 18X214MM
|
Facility
|
OP
|
$4,390.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,317.24 |
| Max. Negotiated Rate |
$4,215.18 |
| Rate for Payer: Aetna Commercial |
$3,380.92
|
| Rate for Payer: Anthem Medicaid |
$1,510.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,424.83
|
| Rate for Payer: Cash Price |
$2,195.41
|
| Rate for Payer: Cigna Commercial |
$3,644.37
|
| Rate for Payer: First Health Commercial |
$4,171.27
|
| Rate for Payer: Humana Commercial |
$3,732.19
|
| Rate for Payer: Humana KY Medicaid |
$1,510.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,525.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,600.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,240.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,317.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,540.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,863.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,293.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,512.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,820.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,029.66
|
| Rate for Payer: PHCS Commercial |
$4,215.18
|
| Rate for Payer: United Healthcare All Payer |
$3,863.91
|
|
|
PLATE RECON 3.5MM 20X238MM
|
Facility
|
IP
|
$4,905.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.76 |
| Max. Negotiated Rate |
$4,709.64 |
| Rate for Payer: Aetna Commercial |
$3,777.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.59
|
| Rate for Payer: Cash Price |
$2,452.94
|
| Rate for Payer: Cigna Commercial |
$4,071.88
|
| Rate for Payer: First Health Commercial |
$4,660.59
|
| Rate for Payer: Humana Commercial |
$4,170.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,022.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,924.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.06
|
| Rate for Payer: PHCS Commercial |
$4,709.64
|
| Rate for Payer: United Healthcare All Payer |
$4,317.17
|
|
|
PLATE RECON 3.5MM 20X238MM
|
Facility
|
OP
|
$4,905.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.76 |
| Max. Negotiated Rate |
$4,709.64 |
| Rate for Payer: Aetna Commercial |
$3,777.53
|
| Rate for Payer: Anthem Medicaid |
$1,687.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.59
|
| Rate for Payer: Cash Price |
$2,452.94
|
| Rate for Payer: Cigna Commercial |
$4,071.88
|
| Rate for Payer: First Health Commercial |
$4,660.59
|
| Rate for Payer: Humana Commercial |
$4,170.00
|
| Rate for Payer: Humana KY Medicaid |
$1,687.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,022.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,720.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,924.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.06
|
| Rate for Payer: PHCS Commercial |
$4,709.64
|
| Rate for Payer: United Healthcare All Payer |
$4,317.17
|
|
|
PLATE RECON 3.5MM 22X263MM
|
Facility
|
IP
|
$5,690.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,707.00 |
| Max. Negotiated Rate |
$5,462.40 |
| Rate for Payer: Aetna Commercial |
$4,381.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,438.20
|
| Rate for Payer: Cash Price |
$2,845.00
|
| Rate for Payer: Cigna Commercial |
$4,722.70
|
| Rate for Payer: First Health Commercial |
$5,405.50
|
| Rate for Payer: Humana Commercial |
$4,836.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,665.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,199.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,707.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,007.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,950.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,926.10
|
| Rate for Payer: PHCS Commercial |
$5,462.40
|
| Rate for Payer: United Healthcare All Payer |
$5,007.20
|
|
|
PLATE RECON 3.5MM 22X263MM
|
Facility
|
OP
|
$5,690.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,707.00 |
| Max. Negotiated Rate |
$5,462.40 |
| Rate for Payer: Aetna Commercial |
$4,381.30
|
| Rate for Payer: Anthem Medicaid |
$1,956.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,438.20
|
| Rate for Payer: Cash Price |
$2,845.00
|
| Rate for Payer: Cigna Commercial |
$4,722.70
|
| Rate for Payer: First Health Commercial |
$5,405.50
|
| Rate for Payer: Humana Commercial |
$4,836.50
|
| Rate for Payer: Humana KY Medicaid |
$1,956.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,976.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,665.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,199.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,707.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,996.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,007.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,267.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,552.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,950.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,926.10
|
| Rate for Payer: PHCS Commercial |
$5,462.40
|
| Rate for Payer: United Healthcare All Payer |
$5,007.20
|
|
|
PLATE RECON 3.5MM 4H 46MM
|
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 3.5MM 4H 46MM
|
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 3.5MM 4X46MM
|
Facility
|
OP
|
$3,414.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.35 |
| Max. Negotiated Rate |
$3,277.92 |
| Rate for Payer: Aetna Commercial |
$2,629.16
|
| Rate for Payer: Anthem Medicaid |
$1,174.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,663.31
|
| Rate for Payer: Cash Price |
$1,707.25
|
| Rate for Payer: Cigna Commercial |
$2,834.03
|
| Rate for Payer: First Health Commercial |
$3,243.78
|
| Rate for Payer: Humana Commercial |
$2,902.32
|
| Rate for Payer: Humana KY Medicaid |
$1,174.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,186.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,799.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,519.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,197.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,004.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,560.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,731.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,970.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.01
|
| Rate for Payer: PHCS Commercial |
$3,277.92
|
| Rate for Payer: United Healthcare All Payer |
$3,004.76
|
|
|
PLATE RECON 3.5MM 4X46MM
|
Facility
|
IP
|
$3,414.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,024.35 |
| Max. Negotiated Rate |
$3,277.92 |
| Rate for Payer: Aetna Commercial |
$2,629.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,663.31
|
| Rate for Payer: Cash Price |
$1,707.25
|
| Rate for Payer: Cigna Commercial |
$2,834.03
|
| Rate for Payer: First Health Commercial |
$3,243.78
|
| Rate for Payer: Humana Commercial |
$2,902.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,799.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,519.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,024.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,004.76
|
| Rate for Payer: Ohio Health Group HMO |
$2,560.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,731.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,970.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,356.01
|
| Rate for Payer: PHCS Commercial |
$3,277.92
|
| Rate for Payer: United Healthcare All Payer |
$3,004.76
|
|
|
PLATE RECON 3.5MM 5X58MM
|
Facility
|
OP
|
$3,314.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.37 |
| Max. Negotiated Rate |
$3,181.98 |
| Rate for Payer: Aetna Commercial |
$2,552.21
|
| Rate for Payer: Anthem Medicaid |
$1,139.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,585.36
|
| Rate for Payer: Cash Price |
$1,657.28
|
| Rate for Payer: Cigna Commercial |
$2,751.08
|
| Rate for Payer: First Health Commercial |
$3,148.83
|
| Rate for Payer: Humana Commercial |
$2,817.38
|
| Rate for Payer: Humana KY Medicaid |
$1,139.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,151.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,446.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,162.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,883.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,287.05
|
| Rate for Payer: PHCS Commercial |
$3,181.98
|
| Rate for Payer: United Healthcare All Payer |
$2,916.81
|
|
|
PLATE RECON 3.5MM 5X58MM
|
Facility
|
IP
|
$3,314.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.37 |
| Max. Negotiated Rate |
$3,181.98 |
| Rate for Payer: Aetna Commercial |
$2,552.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,585.36
|
| Rate for Payer: Cash Price |
$1,657.28
|
| Rate for Payer: Cigna Commercial |
$2,751.08
|
| Rate for Payer: First Health Commercial |
$3,148.83
|
| Rate for Payer: Humana Commercial |
$2,817.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,717.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,446.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,916.81
|
| Rate for Payer: Ohio Health Group HMO |
$2,485.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,651.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,883.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,287.05
|
| Rate for Payer: PHCS Commercial |
$3,181.98
|
| Rate for Payer: United Healthcare All Payer |
$2,916.81
|
|
|
PLATE RECON 3.5MM 6H 70MM
|
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
|
|
