|
PLATE RECON 3.5MM 6H 70MM
|
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 3.5MM 6X70MM
|
Facility
|
IP
|
$3,652.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.84 |
| Max. Negotiated Rate |
$3,506.70 |
| Rate for Payer: Aetna Commercial |
$2,812.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,849.19
|
| Rate for Payer: Cash Price |
$1,826.41
|
| Rate for Payer: Cigna Commercial |
$3,031.83
|
| Rate for Payer: First Health Commercial |
$3,470.17
|
| Rate for Payer: Humana Commercial |
$3,104.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,995.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,214.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,922.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.44
|
| Rate for Payer: PHCS Commercial |
$3,506.70
|
| Rate for Payer: United Healthcare All Payer |
$3,214.47
|
|
|
PLATE RECON 3.5MM 6X70MM
|
Facility
|
OP
|
$3,652.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.84 |
| Max. Negotiated Rate |
$3,506.70 |
| Rate for Payer: Aetna Commercial |
$2,812.66
|
| Rate for Payer: Anthem Medicaid |
$1,256.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,849.19
|
| Rate for Payer: Cash Price |
$1,826.41
|
| Rate for Payer: Cigna Commercial |
$3,031.83
|
| Rate for Payer: First Health Commercial |
$3,470.17
|
| Rate for Payer: Humana Commercial |
$3,104.89
|
| Rate for Payer: Humana KY Medicaid |
$1,256.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,268.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,995.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,695.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,095.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,281.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,214.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,739.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,922.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,177.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,520.44
|
| Rate for Payer: PHCS Commercial |
$3,506.70
|
| Rate for Payer: United Healthcare All Payer |
$3,214.47
|
|
|
PLATE RECON 3.5MM 7X82MM
|
Facility
|
OP
|
$3,575.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.78 |
| Max. Negotiated Rate |
$3,432.90 |
| Rate for Payer: Aetna Commercial |
$2,753.47
|
| Rate for Payer: Anthem Medicaid |
$1,229.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,789.23
|
| Rate for Payer: Cash Price |
$1,787.97
|
| Rate for Payer: Cigna Commercial |
$2,968.03
|
| Rate for Payer: First Health Commercial |
$3,397.14
|
| Rate for Payer: Humana Commercial |
$3,039.55
|
| Rate for Payer: Humana KY Medicaid |
$1,229.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,242.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,932.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,254.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,111.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,467.40
|
| Rate for Payer: PHCS Commercial |
$3,432.90
|
| Rate for Payer: United Healthcare All Payer |
$3,146.83
|
|
|
PLATE RECON 3.5MM 7X82MM
|
Facility
|
IP
|
$3,575.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,072.78 |
| Max. Negotiated Rate |
$3,432.90 |
| Rate for Payer: Aetna Commercial |
$2,753.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,789.23
|
| Rate for Payer: Cash Price |
$1,787.97
|
| Rate for Payer: Cigna Commercial |
$2,968.03
|
| Rate for Payer: First Health Commercial |
$3,397.14
|
| Rate for Payer: Humana Commercial |
$3,039.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,932.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,639.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,072.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,146.83
|
| Rate for Payer: Ohio Health Group HMO |
$2,681.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,860.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,111.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,467.40
|
| Rate for Payer: PHCS Commercial |
$3,432.90
|
| Rate for Payer: United Healthcare All Payer |
$3,146.83
|
|
|
PLATE RECON 3.5MM 8H 94MM
|
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 8H 94MM
|
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 3.5MM 8X94MM
|
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 8X94MM
|
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
|
|
|
PLATE RECON 3.5MM 9X106MM
|
Facility
|
OP
|
$3,698.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.68 |
| Max. Negotiated Rate |
$3,550.98 |
| Rate for Payer: Aetna Commercial |
$2,848.18
|
| Rate for Payer: Anthem Medicaid |
$1,272.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.17
|
| Rate for Payer: Cash Price |
$1,849.47
|
| Rate for Payer: Cigna Commercial |
$3,070.12
|
| Rate for Payer: First Health Commercial |
$3,513.99
|
| Rate for Payer: Humana Commercial |
$3,144.10
|
| Rate for Payer: Humana KY Medicaid |
$1,272.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,285.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,729.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,297.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.27
|
| Rate for Payer: PHCS Commercial |
$3,550.98
|
| Rate for Payer: United Healthcare All Payer |
$3,255.07
|
|
|
PLATE RECON 3.5MM 9X106MM
|
Facility
|
IP
|
$3,698.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,109.68 |
| Max. Negotiated Rate |
$3,550.98 |
| Rate for Payer: Aetna Commercial |
$2,848.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,885.17
|
| Rate for Payer: Cash Price |
$1,849.47
|
| Rate for Payer: Cigna Commercial |
$3,070.12
|
| Rate for Payer: First Health Commercial |
$3,513.99
|
| Rate for Payer: Humana Commercial |
$3,144.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,033.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,729.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,109.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,255.07
|
| Rate for Payer: Ohio Health Group HMO |
$2,774.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,959.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,218.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,552.27
|
| Rate for Payer: PHCS Commercial |
$3,550.98
|
| Rate for Payer: United Healthcare All Payer |
$3,255.07
|
|
|
PLATE RECON 4.5MM 10X157MM
|
Facility
|
IP
|
$4,367.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.33 |
| Max. Negotiated Rate |
$4,193.04 |
| Rate for Payer: Aetna Commercial |
$3,363.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,406.84
|
| Rate for Payer: Cash Price |
$2,183.88
|
| Rate for Payer: Cigna Commercial |
$3,625.23
|
| Rate for Payer: First Health Commercial |
$4,149.36
|
| Rate for Payer: Humana Commercial |
$3,712.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,581.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,223.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,310.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,843.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,275.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,494.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,799.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,013.75
|
| Rate for Payer: PHCS Commercial |
$4,193.04
|
| Rate for Payer: United Healthcare All Payer |
$3,843.62
|
|
|
PLATE RECON 4.5MM 10X157MM
|
Facility
|
OP
|
$4,367.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.33 |
| Max. Negotiated Rate |
$4,193.04 |
| Rate for Payer: Aetna Commercial |
$3,363.17
|
| Rate for Payer: Anthem Medicaid |
$1,502.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,406.84
|
| Rate for Payer: Cash Price |
$2,183.88
|
| Rate for Payer: Cigna Commercial |
$3,625.23
|
| Rate for Payer: First Health Commercial |
$4,149.36
|
| Rate for Payer: Humana Commercial |
$3,712.59
|
| Rate for Payer: Humana KY Medicaid |
$1,502.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,517.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,581.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,223.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,310.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,532.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,843.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,275.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,494.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,799.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,013.75
|
| Rate for Payer: PHCS Commercial |
$4,193.04
|
| Rate for Payer: United Healthcare All Payer |
$3,843.62
|
|
|
PLATE RECON 4.5MM 11X173MM
|
Facility
|
OP
|
$4,429.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,328.78 |
| Max. Negotiated Rate |
$4,252.08 |
| Rate for Payer: Aetna Commercial |
$3,410.52
|
| Rate for Payer: Anthem Medicaid |
$1,523.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,454.82
|
| Rate for Payer: Cash Price |
$2,214.62
|
| Rate for Payer: Cigna Commercial |
$3,676.28
|
| Rate for Payer: First Health Commercial |
$4,207.79
|
| Rate for Payer: Humana Commercial |
$3,764.86
|
| Rate for Payer: Humana KY Medicaid |
$1,523.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,538.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,631.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,268.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,328.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,553.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,897.74
|
| Rate for Payer: Ohio Health Group HMO |
$3,321.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,543.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,853.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.18
|
| Rate for Payer: PHCS Commercial |
$4,252.08
|
| Rate for Payer: United Healthcare All Payer |
$3,897.74
|
|
|
PLATE RECON 4.5MM 11X173MM
|
Facility
|
IP
|
$4,429.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,328.78 |
| Max. Negotiated Rate |
$4,252.08 |
| Rate for Payer: Aetna Commercial |
$3,410.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,454.82
|
| Rate for Payer: Cash Price |
$2,214.62
|
| Rate for Payer: Cigna Commercial |
$3,676.28
|
| Rate for Payer: First Health Commercial |
$4,207.79
|
| Rate for Payer: Humana Commercial |
$3,764.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,631.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,268.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,328.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,897.74
|
| Rate for Payer: Ohio Health Group HMO |
$3,321.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,543.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,853.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.18
|
| Rate for Payer: PHCS Commercial |
$4,252.08
|
| Rate for Payer: United Healthcare All Payer |
$3,897.74
|
|
|
PLATE RECON 4.5MM 12X189MM
|
Facility
|
OP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem Medicaid |
$1,409.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Humana KY Medicaid |
$1,409.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,423.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,437.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE RECON 4.5MM 12X189MM
|
Facility
|
IP
|
$4,098.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,229.61 |
| Max. Negotiated Rate |
$3,934.74 |
| Rate for Payer: Aetna Commercial |
$3,155.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,196.98
|
| Rate for Payer: Cash Price |
$2,049.34
|
| Rate for Payer: Cigna Commercial |
$3,401.91
|
| Rate for Payer: First Health Commercial |
$3,893.76
|
| Rate for Payer: Humana Commercial |
$3,483.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,360.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,024.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,229.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,606.85
|
| Rate for Payer: Ohio Health Group HMO |
$3,074.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,565.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,828.10
|
| Rate for Payer: PHCS Commercial |
$3,934.74
|
| Rate for Payer: United Healthcare All Payer |
$3,606.85
|
|
|
PLATE RECON 4.5MM 13X205MM
|
Facility
|
OP
|
$4,744.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.33 |
| Max. Negotiated Rate |
$4,554.66 |
| Rate for Payer: Aetna Commercial |
$3,653.22
|
| Rate for Payer: Anthem Medicaid |
$1,631.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,700.66
|
| Rate for Payer: Cash Price |
$2,372.22
|
| Rate for Payer: Cigna Commercial |
$3,937.89
|
| Rate for Payer: First Health Commercial |
$4,507.22
|
| Rate for Payer: Humana Commercial |
$4,032.77
|
| Rate for Payer: Humana KY Medicaid |
$1,631.61
|
| Rate for Payer: Kentucky WC Medicaid |
$1,648.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,890.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,501.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,664.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,175.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,558.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,795.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,273.66
|
| Rate for Payer: PHCS Commercial |
$4,554.66
|
| Rate for Payer: United Healthcare All Payer |
$4,175.11
|
|
|
PLATE RECON 4.5MM 13X205MM
|
Facility
|
IP
|
$4,744.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.33 |
| Max. Negotiated Rate |
$4,554.66 |
| Rate for Payer: Aetna Commercial |
$3,653.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,700.66
|
| Rate for Payer: Cash Price |
$2,372.22
|
| Rate for Payer: Cigna Commercial |
$3,937.89
|
| Rate for Payer: First Health Commercial |
$4,507.22
|
| Rate for Payer: Humana Commercial |
$4,032.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,890.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,501.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,423.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,175.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,558.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,795.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,127.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,273.66
|
| Rate for Payer: PHCS Commercial |
$4,554.66
|
| Rate for Payer: United Healthcare All Payer |
$4,175.11
|
|
|
PLATE RECON 4.5MM 14X221MM
|
Facility
|
IP
|
$4,298.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.57 |
| Max. Negotiated Rate |
$4,126.62 |
| Rate for Payer: Aetna Commercial |
$3,309.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,352.88
|
| Rate for Payer: Cash Price |
$2,149.28
|
| Rate for Payer: Cigna Commercial |
$3,567.80
|
| Rate for Payer: First Health Commercial |
$4,083.63
|
| Rate for Payer: Humana Commercial |
$3,653.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,524.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,782.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,223.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,438.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,739.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.01
|
| Rate for Payer: PHCS Commercial |
$4,126.62
|
| Rate for Payer: United Healthcare All Payer |
$3,782.73
|
|
|
PLATE RECON 4.5MM 14X221MM
|
Facility
|
OP
|
$4,298.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.57 |
| Max. Negotiated Rate |
$4,126.62 |
| Rate for Payer: Aetna Commercial |
$3,309.89
|
| Rate for Payer: Anthem Medicaid |
$1,478.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,352.88
|
| Rate for Payer: Cash Price |
$2,149.28
|
| Rate for Payer: Cigna Commercial |
$3,567.80
|
| Rate for Payer: First Health Commercial |
$4,083.63
|
| Rate for Payer: Humana Commercial |
$3,653.78
|
| Rate for Payer: Humana KY Medicaid |
$1,478.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,524.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,507.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,782.73
|
| Rate for Payer: Ohio Health Group HMO |
$3,223.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,438.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,739.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.01
|
| Rate for Payer: PHCS Commercial |
$4,126.62
|
| Rate for Payer: United Healthcare All Payer |
$3,782.73
|
|
|
PLATE RECON 4.5MM 15X237MM
|
Facility
|
OP
|
$4,913.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.07 |
| Max. Negotiated Rate |
$4,717.02 |
| Rate for Payer: Aetna Commercial |
$3,783.44
|
| Rate for Payer: Anthem Medicaid |
$1,689.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.58
|
| Rate for Payer: Cash Price |
$2,456.78
|
| Rate for Payer: Cigna Commercial |
$4,078.25
|
| Rate for Payer: First Health Commercial |
$4,667.88
|
| Rate for Payer: Humana Commercial |
$4,176.53
|
| Rate for Payer: Humana KY Medicaid |
$1,689.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,029.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,626.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,685.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,930.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,274.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.36
|
| Rate for Payer: PHCS Commercial |
$4,717.02
|
| Rate for Payer: United Healthcare All Payer |
$4,323.93
|
|
|
PLATE RECON 4.5MM 15X237MM
|
Facility
|
IP
|
$4,913.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.07 |
| Max. Negotiated Rate |
$4,717.02 |
| Rate for Payer: Aetna Commercial |
$3,783.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,832.58
|
| Rate for Payer: Cash Price |
$2,456.78
|
| Rate for Payer: Cigna Commercial |
$4,078.25
|
| Rate for Payer: First Health Commercial |
$4,667.88
|
| Rate for Payer: Humana Commercial |
$4,176.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,029.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,626.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,474.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.93
|
| Rate for Payer: Ohio Health Group HMO |
$3,685.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,930.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,274.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,390.36
|
| Rate for Payer: PHCS Commercial |
$4,717.02
|
| Rate for Payer: United Healthcare All Payer |
$4,323.93
|
|
|
PLATE RECON 4.5MM 16X253MM
|
Facility
|
OP
|
$5,021.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.36 |
| Max. Negotiated Rate |
$4,820.34 |
| Rate for Payer: Aetna Commercial |
$3,866.32
|
| Rate for Payer: Anthem Medicaid |
$1,726.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,916.53
|
| Rate for Payer: Cash Price |
$2,510.59
|
| Rate for Payer: Cigna Commercial |
$4,167.59
|
| Rate for Payer: First Health Commercial |
$4,770.13
|
| Rate for Payer: Humana Commercial |
$4,268.01
|
| Rate for Payer: Humana KY Medicaid |
$1,726.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,744.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,705.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,761.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,418.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,765.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,016.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,368.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,464.62
|
| Rate for Payer: PHCS Commercial |
$4,820.34
|
| Rate for Payer: United Healthcare All Payer |
$4,418.65
|
|
|
PLATE RECON 4.5MM 16X253MM
|
Facility
|
IP
|
$5,021.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,506.36 |
| Max. Negotiated Rate |
$4,820.34 |
| Rate for Payer: Aetna Commercial |
$3,866.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,916.53
|
| Rate for Payer: Cash Price |
$2,510.59
|
| Rate for Payer: Cigna Commercial |
$4,167.59
|
| Rate for Payer: First Health Commercial |
$4,770.13
|
| Rate for Payer: Humana Commercial |
$4,268.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,705.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,506.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,418.65
|
| Rate for Payer: Ohio Health Group HMO |
$3,765.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,016.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,368.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,464.62
|
| Rate for Payer: PHCS Commercial |
$4,820.34
|
| Rate for Payer: United Healthcare All Payer |
$4,418.65
|
|
