|
PLATE RECON 4.5MM 3X45MM
|
Facility
|
OP
|
$3,291.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.45 |
| Max. Negotiated Rate |
$3,159.84 |
| Rate for Payer: Aetna Commercial |
$2,534.45
|
| Rate for Payer: Anthem Medicaid |
$1,131.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,567.37
|
| Rate for Payer: Cash Price |
$1,645.75
|
| Rate for Payer: Cigna Commercial |
$2,731.95
|
| Rate for Payer: First Health Commercial |
$3,126.93
|
| Rate for Payer: Humana Commercial |
$2,797.78
|
| Rate for Payer: Humana KY Medicaid |
$1,131.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,143.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,699.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,429.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,154.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,896.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,633.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.14
|
| Rate for Payer: PHCS Commercial |
$3,159.84
|
| Rate for Payer: United Healthcare All Payer |
$2,896.52
|
|
|
PLATE RECON 4.5MM 3X45MM
|
Facility
|
IP
|
$3,291.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.45 |
| Max. Negotiated Rate |
$3,159.84 |
| Rate for Payer: Aetna Commercial |
$2,534.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,567.37
|
| Rate for Payer: Cash Price |
$1,645.75
|
| Rate for Payer: Cigna Commercial |
$2,731.95
|
| Rate for Payer: First Health Commercial |
$3,126.93
|
| Rate for Payer: Humana Commercial |
$2,797.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,699.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,429.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$987.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,896.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,633.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,863.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,271.14
|
| Rate for Payer: PHCS Commercial |
$3,159.84
|
| Rate for Payer: United Healthcare All Payer |
$2,896.52
|
|
|
PLATE RECON 4.5MM 4X61MM
|
Facility
|
IP
|
$3,368.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.51 |
| Max. Negotiated Rate |
$3,233.64 |
| Rate for Payer: Aetna Commercial |
$2,593.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.34
|
| Rate for Payer: Cash Price |
$1,684.19
|
| Rate for Payer: Cigna Commercial |
$2,795.76
|
| Rate for Payer: First Health Commercial |
$3,199.96
|
| Rate for Payer: Humana Commercial |
$2,863.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.18
|
| Rate for Payer: PHCS Commercial |
$3,233.64
|
| Rate for Payer: United Healthcare All Payer |
$2,964.17
|
|
|
PLATE RECON 4.5MM 4X61MM
|
Facility
|
OP
|
$3,368.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.51 |
| Max. Negotiated Rate |
$3,233.64 |
| Rate for Payer: Aetna Commercial |
$2,593.65
|
| Rate for Payer: Anthem Medicaid |
$1,158.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.34
|
| Rate for Payer: Cash Price |
$1,684.19
|
| Rate for Payer: Cigna Commercial |
$2,795.76
|
| Rate for Payer: First Health Commercial |
$3,199.96
|
| Rate for Payer: Humana Commercial |
$2,863.12
|
| Rate for Payer: Humana KY Medicaid |
$1,158.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,485.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.17
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.18
|
| Rate for Payer: PHCS Commercial |
$3,233.64
|
| Rate for Payer: United Healthcare All Payer |
$2,964.17
|
|
|
PLATE RECON 4.5MM 5X77MM
|
Facility
|
IP
|
$3,468.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.49 |
| Max. Negotiated Rate |
$3,329.58 |
| Rate for Payer: Aetna Commercial |
$2,670.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.28
|
| Rate for Payer: Cash Price |
$1,734.16
|
| Rate for Payer: Cigna Commercial |
$2,878.70
|
| Rate for Payer: First Health Commercial |
$3,294.89
|
| Rate for Payer: Humana Commercial |
$2,948.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,559.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,774.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,017.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,393.13
|
| Rate for Payer: PHCS Commercial |
$3,329.58
|
| Rate for Payer: United Healthcare All Payer |
$3,052.11
|
|
|
PLATE RECON 4.5MM 5X77MM
|
Facility
|
OP
|
$3,468.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,040.49 |
| Max. Negotiated Rate |
$3,329.58 |
| Rate for Payer: Aetna Commercial |
$2,670.60
|
| Rate for Payer: Anthem Medicaid |
$1,192.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,705.28
|
| Rate for Payer: Cash Price |
$1,734.16
|
| Rate for Payer: Cigna Commercial |
$2,878.70
|
| Rate for Payer: First Health Commercial |
$3,294.89
|
| Rate for Payer: Humana Commercial |
$2,948.06
|
| Rate for Payer: Humana KY Medicaid |
$1,192.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,204.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,844.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,559.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,040.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,216.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,052.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,601.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,774.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,017.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,393.13
|
| Rate for Payer: PHCS Commercial |
$3,329.58
|
| Rate for Payer: United Healthcare All Payer |
$3,052.11
|
|
|
PLATE RECON 4.5MM 6X93MM
|
Facility
|
OP
|
$3,568.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.47 |
| Max. Negotiated Rate |
$3,425.52 |
| Rate for Payer: Aetna Commercial |
$2,747.55
|
| Rate for Payer: Anthem Medicaid |
$1,227.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,783.24
|
| Rate for Payer: Cash Price |
$1,784.12
|
| Rate for Payer: Cigna Commercial |
$2,961.65
|
| Rate for Payer: First Health Commercial |
$3,389.84
|
| Rate for Payer: Humana Commercial |
$3,033.01
|
| Rate for Payer: Humana KY Medicaid |
$1,227.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,239.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,925.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,633.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,251.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,140.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,676.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,854.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,104.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,462.09
|
| Rate for Payer: PHCS Commercial |
$3,425.52
|
| Rate for Payer: United Healthcare All Payer |
$3,140.06
|
|
|
PLATE RECON 4.5MM 6X93MM
|
Facility
|
IP
|
$3,568.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.47 |
| Max. Negotiated Rate |
$3,425.52 |
| Rate for Payer: Aetna Commercial |
$2,747.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,783.24
|
| Rate for Payer: Cash Price |
$1,784.12
|
| Rate for Payer: Cigna Commercial |
$2,961.65
|
| Rate for Payer: First Health Commercial |
$3,389.84
|
| Rate for Payer: Humana Commercial |
$3,033.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,925.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,633.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,070.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,140.06
|
| Rate for Payer: Ohio Health Group HMO |
$2,676.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,854.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,104.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,462.09
|
| Rate for Payer: PHCS Commercial |
$3,425.52
|
| Rate for Payer: United Healthcare All Payer |
$3,140.06
|
|
|
PLATE RECON 4.5MM 7X109MM
|
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 4.5MM 7X109MM
|
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 4.5MM 8X125MM
|
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 8X125MM
|
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 9X141MM
|
Facility
|
OP
|
$4,244.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.42 |
| Max. Negotiated Rate |
$4,074.96 |
| Rate for Payer: Aetna Commercial |
$3,268.46
|
| Rate for Payer: Anthem Medicaid |
$1,459.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.91
|
| Rate for Payer: Cash Price |
$2,122.38
|
| Rate for Payer: Cigna Commercial |
$3,523.14
|
| Rate for Payer: First Health Commercial |
$4,032.51
|
| Rate for Payer: Humana Commercial |
$3,608.04
|
| Rate for Payer: Humana KY Medicaid |
$1,459.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,474.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,489.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,735.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,395.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,692.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.88
|
| Rate for Payer: PHCS Commercial |
$4,074.96
|
| Rate for Payer: United Healthcare All Payer |
$3,735.38
|
|
|
PLATE RECON 4.5MM 9X141MM
|
Facility
|
IP
|
$4,244.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,273.42 |
| Max. Negotiated Rate |
$4,074.96 |
| Rate for Payer: Aetna Commercial |
$3,268.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.91
|
| Rate for Payer: Cash Price |
$2,122.38
|
| Rate for Payer: Cigna Commercial |
$3,523.14
|
| Rate for Payer: First Health Commercial |
$4,032.51
|
| Rate for Payer: Humana Commercial |
$3,608.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,735.38
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,395.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,692.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.88
|
| Rate for Payer: PHCS Commercial |
$4,074.96
|
| Rate for Payer: United Healthcare All Payer |
$3,735.38
|
|
|
PLATE RECON 4H 3.5*70 71829514
|
Facility
|
OP
|
$3,196.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.88 |
| Max. Negotiated Rate |
$3,068.40 |
| Rate for Payer: Aetna Commercial |
$2,461.11
|
| Rate for Payer: Anthem Medicaid |
$1,099.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,493.07
|
| Rate for Payer: Cash Price |
$1,598.12
|
| Rate for Payer: Cigna Commercial |
$2,652.89
|
| Rate for Payer: First Health Commercial |
$3,036.44
|
| Rate for Payer: Humana Commercial |
$2,716.81
|
| Rate for Payer: Humana KY Medicaid |
$1,099.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,620.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,358.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,812.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,397.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,557.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,780.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.41
|
| Rate for Payer: PHCS Commercial |
$3,068.40
|
| Rate for Payer: United Healthcare All Payer |
$2,812.70
|
|
|
PLATE RECON 4H 3.5*70 71829514
|
Facility
|
IP
|
$3,196.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.88 |
| Max. Negotiated Rate |
$3,068.40 |
| Rate for Payer: Aetna Commercial |
$2,461.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,493.07
|
| Rate for Payer: Cash Price |
$1,598.12
|
| Rate for Payer: Cigna Commercial |
$2,652.89
|
| Rate for Payer: First Health Commercial |
$3,036.44
|
| Rate for Payer: Humana Commercial |
$2,716.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,620.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,358.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,812.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,397.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,557.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,780.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.41
|
| Rate for Payer: PHCS Commercial |
$3,068.40
|
| Rate for Payer: United Healthcare All Payer |
$2,812.70
|
|
|
PLATE RECON 6H 3.5*70 71829516
|
Facility
|
IP
|
$3,398.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.62 |
| Max. Negotiated Rate |
$3,262.80 |
| Rate for Payer: Aetna Commercial |
$2,617.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.03
|
| Rate for Payer: Cash Price |
$1,699.38
|
| Rate for Payer: Cigna Commercial |
$2,820.96
|
| Rate for Payer: First Health Commercial |
$3,228.81
|
| Rate for Payer: Humana Commercial |
$2,888.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,990.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.14
|
| Rate for Payer: PHCS Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Payer |
$2,990.90
|
|
|
PLATE RECON 6H 3.5*70 71829516
|
Facility
|
OP
|
$3,398.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.62 |
| Max. Negotiated Rate |
$3,262.80 |
| Rate for Payer: Aetna Commercial |
$2,617.04
|
| Rate for Payer: Anthem Medicaid |
$1,168.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.03
|
| Rate for Payer: Cash Price |
$1,699.38
|
| Rate for Payer: Cigna Commercial |
$2,820.96
|
| Rate for Payer: First Health Commercial |
$3,228.81
|
| Rate for Payer: Humana Commercial |
$2,888.94
|
| Rate for Payer: Humana KY Medicaid |
$1,168.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,180.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,990.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.14
|
| Rate for Payer: PHCS Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Payer |
$2,990.90
|
|
|
PLATE RECON 6 HOLE - STERILE
|
Facility
|
IP
|
$4,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,437.00 |
| Max. Negotiated Rate |
$4,598.40 |
| Rate for Payer: Aetna Commercial |
$3,688.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,736.20
|
| Rate for Payer: Cash Price |
$2,395.00
|
| Rate for Payer: Cigna Commercial |
$3,975.70
|
| Rate for Payer: First Health Commercial |
$4,550.50
|
| Rate for Payer: Humana Commercial |
$4,071.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,927.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,535.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,215.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,167.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,305.10
|
| Rate for Payer: PHCS Commercial |
$4,598.40
|
| Rate for Payer: United Healthcare All Payer |
$4,215.20
|
|
|
PLATE RECON 6 HOLE - STERILE
|
Facility
|
OP
|
$4,790.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,437.00 |
| Max. Negotiated Rate |
$4,598.40 |
| Rate for Payer: Aetna Commercial |
$3,688.30
|
| Rate for Payer: Anthem Medicaid |
$1,647.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,736.20
|
| Rate for Payer: Cash Price |
$2,395.00
|
| Rate for Payer: Cigna Commercial |
$3,975.70
|
| Rate for Payer: First Health Commercial |
$4,550.50
|
| Rate for Payer: Humana Commercial |
$4,071.50
|
| Rate for Payer: Humana KY Medicaid |
$1,647.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,664.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,927.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,535.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,437.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,680.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,215.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,592.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,832.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,167.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,305.10
|
| Rate for Payer: PHCS Commercial |
$4,598.40
|
| Rate for Payer: United Healthcare All Payer |
$4,215.20
|
|
|
PLATE RECON 7 HOLE - STERILE
|
Facility
|
OP
|
$4,067.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.10 |
| Max. Negotiated Rate |
$3,904.32 |
| Rate for Payer: Aetna Commercial |
$3,131.59
|
| Rate for Payer: Anthem Medicaid |
$1,398.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,172.26
|
| Rate for Payer: Cash Price |
$2,033.50
|
| Rate for Payer: Cigna Commercial |
$3,375.61
|
| Rate for Payer: First Health Commercial |
$3,863.65
|
| Rate for Payer: Humana Commercial |
$3,456.95
|
| Rate for Payer: Humana KY Medicaid |
$1,398.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,001.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,426.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,050.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,806.23
|
| Rate for Payer: PHCS Commercial |
$3,904.32
|
| Rate for Payer: United Healthcare All Payer |
$3,578.96
|
|
|
PLATE RECON 7 HOLE - STERILE
|
Facility
|
IP
|
$4,067.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.10 |
| Max. Negotiated Rate |
$3,904.32 |
| Rate for Payer: Aetna Commercial |
$3,131.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,172.26
|
| Rate for Payer: Cash Price |
$2,033.50
|
| Rate for Payer: Cigna Commercial |
$3,375.61
|
| Rate for Payer: First Health Commercial |
$3,863.65
|
| Rate for Payer: Humana Commercial |
$3,456.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,001.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,220.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,050.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,538.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,806.23
|
| Rate for Payer: PHCS Commercial |
$3,904.32
|
| Rate for Payer: United Healthcare All Payer |
$3,578.96
|
|
|
PLATE RECON 8H 3.5*94 71829518
|
Facility
|
IP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.00 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.70
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
PLATE RECON 8H 3.5*94 71829518
|
Facility
|
OP
|
$3,530.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,059.00 |
| Max. Negotiated Rate |
$3,388.80 |
| Rate for Payer: Aetna Commercial |
$2,718.10
|
| Rate for Payer: Anthem Medicaid |
$1,213.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,753.40
|
| Rate for Payer: Cash Price |
$1,765.00
|
| Rate for Payer: Cigna Commercial |
$2,929.90
|
| Rate for Payer: First Health Commercial |
$3,353.50
|
| Rate for Payer: Humana Commercial |
$3,000.50
|
| Rate for Payer: Humana KY Medicaid |
$1,213.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,226.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,894.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,605.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,059.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,238.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,106.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,647.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,824.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,071.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.70
|
| Rate for Payer: PHCS Commercial |
$3,388.80
|
| Rate for Payer: United Healthcare All Payer |
$3,106.40
|
|
|
PLATE RECON 8 HOLE - STERILE
|
Facility
|
OP
|
$4,154.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.20 |
| Max. Negotiated Rate |
$3,987.84 |
| Rate for Payer: Aetna Commercial |
$3,198.58
|
| Rate for Payer: Anthem Medicaid |
$1,428.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,240.12
|
| Rate for Payer: Cash Price |
$2,077.00
|
| Rate for Payer: Cigna Commercial |
$3,447.82
|
| Rate for Payer: First Health Commercial |
$3,946.30
|
| Rate for Payer: Humana Commercial |
$3,530.90
|
| Rate for Payer: Humana KY Medicaid |
$1,428.56
|
| Rate for Payer: Kentucky WC Medicaid |
$1,443.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,406.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,065.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,457.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,655.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,613.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,866.26
|
| Rate for Payer: PHCS Commercial |
$3,987.84
|
| Rate for Payer: United Healthcare All Payer |
$3,655.52
|
|
