|
PLATE SM FRAG 4 H 2.7MM 36MM
|
Facility
|
OP
|
$1,814.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.24 |
| Max. Negotiated Rate |
$1,741.57 |
| Rate for Payer: Aetna Commercial |
$1,396.89
|
| Rate for Payer: Anthem Medicaid |
$623.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.03
|
| Rate for Payer: Cash Price |
$907.07
|
| Rate for Payer: Cigna Commercial |
$1,505.74
|
| Rate for Payer: First Health Commercial |
$1,723.43
|
| Rate for Payer: Humana Commercial |
$1,542.02
|
| Rate for Payer: Humana KY Medicaid |
$623.88
|
| Rate for Payer: Kentucky WC Medicaid |
$630.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,487.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,596.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,360.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,451.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.76
|
| Rate for Payer: PHCS Commercial |
$1,741.57
|
| Rate for Payer: United Healthcare All Payer |
$1,596.44
|
|
|
PLATE SM FRAG 4 H 2.7MM 36MM
|
Facility
|
IP
|
$1,814.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.24 |
| Max. Negotiated Rate |
$1,741.57 |
| Rate for Payer: Aetna Commercial |
$1,396.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.03
|
| Rate for Payer: Cash Price |
$907.07
|
| Rate for Payer: Cigna Commercial |
$1,505.74
|
| Rate for Payer: First Health Commercial |
$1,723.43
|
| Rate for Payer: Humana Commercial |
$1,542.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,487.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,596.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,360.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,451.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.76
|
| Rate for Payer: PHCS Commercial |
$1,741.57
|
| Rate for Payer: United Healthcare All Payer |
$1,596.44
|
|
|
PLATE SM FRAG 5 H 2.7MM 44MM
|
Facility
|
OP
|
$1,915.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.62 |
| Max. Negotiated Rate |
$1,838.79 |
| Rate for Payer: Aetna Commercial |
$1,474.87
|
| Rate for Payer: Anthem Medicaid |
$658.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,494.02
|
| Rate for Payer: Cash Price |
$957.70
|
| Rate for Payer: Cigna Commercial |
$1,589.79
|
| Rate for Payer: First Health Commercial |
$1,819.64
|
| Rate for Payer: Humana Commercial |
$1,628.10
|
| Rate for Payer: Humana KY Medicaid |
$658.71
|
| Rate for Payer: Kentucky WC Medicaid |
$665.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$671.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.63
|
| Rate for Payer: PHCS Commercial |
$1,838.79
|
| Rate for Payer: United Healthcare All Payer |
$1,685.56
|
|
|
PLATE SM FRAG 5 H 2.7MM 44MM
|
Facility
|
IP
|
$1,915.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.62 |
| Max. Negotiated Rate |
$1,838.79 |
| Rate for Payer: Aetna Commercial |
$1,474.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,494.02
|
| Rate for Payer: Cash Price |
$957.70
|
| Rate for Payer: Cigna Commercial |
$1,589.79
|
| Rate for Payer: First Health Commercial |
$1,819.64
|
| Rate for Payer: Humana Commercial |
$1,628.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,570.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,413.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$574.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,685.56
|
| Rate for Payer: Ohio Health Group HMO |
$1,436.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,532.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,666.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,321.63
|
| Rate for Payer: PHCS Commercial |
$1,838.79
|
| Rate for Payer: United Healthcare All Payer |
$1,685.56
|
|
|
PLATE SM FRAG 6 H 2.7MM 52MM
|
Facility
|
IP
|
$1,954.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.31 |
| Max. Negotiated Rate |
$1,876.19 |
| Rate for Payer: Aetna Commercial |
$1,504.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,524.40
|
| Rate for Payer: Cash Price |
$977.18
|
| Rate for Payer: Cigna Commercial |
$1,622.12
|
| Rate for Payer: First Health Commercial |
$1,856.64
|
| Rate for Payer: Humana Commercial |
$1,661.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,602.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,442.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,700.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.51
|
| Rate for Payer: PHCS Commercial |
$1,876.19
|
| Rate for Payer: United Healthcare All Payer |
$1,719.84
|
|
|
PLATE SM FRAG 6 H 2.7MM 52MM
|
Facility
|
OP
|
$1,954.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$586.31 |
| Max. Negotiated Rate |
$1,876.19 |
| Rate for Payer: Aetna Commercial |
$1,504.86
|
| Rate for Payer: Anthem Medicaid |
$672.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,524.40
|
| Rate for Payer: Cash Price |
$977.18
|
| Rate for Payer: Cigna Commercial |
$1,622.12
|
| Rate for Payer: First Health Commercial |
$1,856.64
|
| Rate for Payer: Humana Commercial |
$1,661.21
|
| Rate for Payer: Humana KY Medicaid |
$672.10
|
| Rate for Payer: Kentucky WC Medicaid |
$678.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,602.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,442.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$586.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$685.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,719.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,465.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,563.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,700.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,348.51
|
| Rate for Payer: PHCS Commercial |
$1,876.19
|
| Rate for Payer: United Healthcare All Payer |
$1,719.84
|
|
|
PLATE SM FRAG 7 H 2.7MM 60MM
|
Facility
|
OP
|
$2,040.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.01 |
| Max. Negotiated Rate |
$1,958.45 |
| Rate for Payer: Aetna Commercial |
$1,570.84
|
| Rate for Payer: Anthem Medicaid |
$701.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.24
|
| Rate for Payer: Cash Price |
$1,020.02
|
| Rate for Payer: Cigna Commercial |
$1,693.24
|
| Rate for Payer: First Health Commercial |
$1,938.05
|
| Rate for Payer: Humana Commercial |
$1,734.04
|
| Rate for Payer: Humana KY Medicaid |
$701.57
|
| Rate for Payer: Kentucky WC Medicaid |
$708.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$715.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,774.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.63
|
| Rate for Payer: PHCS Commercial |
$1,958.45
|
| Rate for Payer: United Healthcare All Payer |
$1,795.24
|
|
|
PLATE SM FRAG 7 H 2.7MM 60MM
|
Facility
|
IP
|
$2,040.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.01 |
| Max. Negotiated Rate |
$1,958.45 |
| Rate for Payer: Aetna Commercial |
$1,570.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,591.24
|
| Rate for Payer: Cash Price |
$1,020.02
|
| Rate for Payer: Cigna Commercial |
$1,693.24
|
| Rate for Payer: First Health Commercial |
$1,938.05
|
| Rate for Payer: Humana Commercial |
$1,734.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,672.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,505.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$612.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,795.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,530.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,632.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,774.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,407.63
|
| Rate for Payer: PHCS Commercial |
$1,958.45
|
| Rate for Payer: United Healthcare All Payer |
$1,795.24
|
|
|
PLATE SM FRAG 8 H 2.7MM 68MM
|
Facility
|
OP
|
$2,110.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.05 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: Aetna Commercial |
$1,624.82
|
| Rate for Payer: Anthem Medicaid |
$725.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.92
|
| Rate for Payer: Cash Price |
$1,055.08
|
| Rate for Payer: Cigna Commercial |
$1,751.43
|
| Rate for Payer: First Health Commercial |
$2,004.65
|
| Rate for Payer: Humana Commercial |
$1,793.64
|
| Rate for Payer: Humana KY Medicaid |
$725.68
|
| Rate for Payer: Kentucky WC Medicaid |
$733.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,835.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.01
|
| Rate for Payer: PHCS Commercial |
$2,025.75
|
| Rate for Payer: United Healthcare All Payer |
$1,856.94
|
|
|
PLATE SM FRAG 8 H 2.7MM 68MM
|
Facility
|
IP
|
$2,110.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.05 |
| Max. Negotiated Rate |
$2,025.75 |
| Rate for Payer: Aetna Commercial |
$1,624.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.92
|
| Rate for Payer: Cash Price |
$1,055.08
|
| Rate for Payer: Cigna Commercial |
$1,751.43
|
| Rate for Payer: First Health Commercial |
$2,004.65
|
| Rate for Payer: Humana Commercial |
$1,793.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,730.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,557.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.94
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,688.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,835.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,456.01
|
| Rate for Payer: PHCS Commercial |
$2,025.75
|
| Rate for Payer: United Healthcare All Payer |
$1,856.94
|
|
|
PLATE SM FRAG 9 H 2.7MM 76MM
|
Facility
|
IP
|
$3,030.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.04 |
| Max. Negotiated Rate |
$2,908.92 |
| Rate for Payer: Aetna Commercial |
$2,333.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,363.49
|
| Rate for Payer: Cash Price |
$1,515.06
|
| Rate for Payer: Cigna Commercial |
$2,515.00
|
| Rate for Payer: First Health Commercial |
$2,878.61
|
| Rate for Payer: Humana Commercial |
$2,575.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,484.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,236.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,666.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,272.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,424.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,636.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.78
|
| Rate for Payer: PHCS Commercial |
$2,908.92
|
| Rate for Payer: United Healthcare All Payer |
$2,666.51
|
|
|
PLATE SM FRAG 9 H 2.7MM 76MM
|
Facility
|
OP
|
$3,030.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.04 |
| Max. Negotiated Rate |
$2,908.92 |
| Rate for Payer: Aetna Commercial |
$2,333.19
|
| Rate for Payer: Anthem Medicaid |
$1,042.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,363.49
|
| Rate for Payer: Cash Price |
$1,515.06
|
| Rate for Payer: Cigna Commercial |
$2,515.00
|
| Rate for Payer: First Health Commercial |
$2,878.61
|
| Rate for Payer: Humana Commercial |
$2,575.60
|
| Rate for Payer: Humana KY Medicaid |
$1,042.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,052.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,484.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,236.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$909.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,062.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,666.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,272.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,424.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,636.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.78
|
| Rate for Payer: PHCS Commercial |
$2,908.92
|
| Rate for Payer: United Healthcare All Payer |
$2,666.51
|
|
|
PLATE SM LT JONES FX
|
Facility
|
OP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem Medicaid |
$2,952.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Humana KY Medicaid |
$2,952.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,982.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,011.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PLATE SM LT JONES FX
|
Facility
|
IP
|
$8,584.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,575.35 |
| Max. Negotiated Rate |
$8,241.12 |
| Rate for Payer: Aetna Commercial |
$6,610.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,695.91
|
| Rate for Payer: Cash Price |
$4,292.25
|
| Rate for Payer: Cigna Commercial |
$7,125.14
|
| Rate for Payer: First Health Commercial |
$8,155.27
|
| Rate for Payer: Humana Commercial |
$7,296.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,039.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,335.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,575.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,554.36
|
| Rate for Payer: Ohio Health Group HMO |
$6,438.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,867.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,468.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,923.31
|
| Rate for Payer: PHCS Commercial |
$8,241.12
|
| Rate for Payer: United Healthcare All Payer |
$7,554.36
|
|
|
PLATE SM RECON 3.5M 2X25M
|
Facility
|
IP
|
$1,782.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.89 |
| Max. Negotiated Rate |
$1,711.66 |
| Rate for Payer: Aetna Commercial |
$1,372.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.72
|
| Rate for Payer: Cash Price |
$891.49
|
| Rate for Payer: Cigna Commercial |
$1,479.87
|
| Rate for Payer: First Health Commercial |
$1,693.83
|
| Rate for Payer: Humana Commercial |
$1,515.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,551.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,230.26
|
| Rate for Payer: PHCS Commercial |
$1,711.66
|
| Rate for Payer: United Healthcare All Payer |
$1,569.02
|
|
|
PLATE SM RECON 3.5M 2X25M
|
Facility
|
OP
|
$1,782.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.89 |
| Max. Negotiated Rate |
$1,711.66 |
| Rate for Payer: Aetna Commercial |
$1,372.89
|
| Rate for Payer: Anthem Medicaid |
$613.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,390.72
|
| Rate for Payer: Cash Price |
$891.49
|
| Rate for Payer: Cigna Commercial |
$1,479.87
|
| Rate for Payer: First Health Commercial |
$1,693.83
|
| Rate for Payer: Humana Commercial |
$1,515.53
|
| Rate for Payer: Humana KY Medicaid |
$613.17
|
| Rate for Payer: Kentucky WC Medicaid |
$619.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,462.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,315.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$534.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$625.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,569.02
|
| Rate for Payer: Ohio Health Group HMO |
$1,337.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,551.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,230.26
|
| Rate for Payer: PHCS Commercial |
$1,711.66
|
| Rate for Payer: United Healthcare All Payer |
$1,569.02
|
|
|
PLATE SM RECON 3.5M 3X37M
|
Facility
|
OP
|
$1,806.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.90 |
| Max. Negotiated Rate |
$1,734.10 |
| Rate for Payer: Aetna Commercial |
$1,390.89
|
| Rate for Payer: Anthem Medicaid |
$621.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.95
|
| Rate for Payer: Cash Price |
$903.18
|
| Rate for Payer: Cigna Commercial |
$1,499.27
|
| Rate for Payer: First Health Commercial |
$1,716.03
|
| Rate for Payer: Humana Commercial |
$1,535.40
|
| Rate for Payer: Humana KY Medicaid |
$621.20
|
| Rate for Payer: Kentucky WC Medicaid |
$627.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,333.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$633.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,445.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.38
|
| Rate for Payer: PHCS Commercial |
$1,734.10
|
| Rate for Payer: United Healthcare All Payer |
$1,589.59
|
|
|
PLATE SM RECON 3.5M 3X37M
|
Facility
|
IP
|
$1,806.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$541.90 |
| Max. Negotiated Rate |
$1,734.10 |
| Rate for Payer: Aetna Commercial |
$1,390.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,408.95
|
| Rate for Payer: Cash Price |
$903.18
|
| Rate for Payer: Cigna Commercial |
$1,499.27
|
| Rate for Payer: First Health Commercial |
$1,716.03
|
| Rate for Payer: Humana Commercial |
$1,535.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,481.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,333.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$541.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,589.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,354.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,445.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,571.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,246.38
|
| Rate for Payer: PHCS Commercial |
$1,734.10
|
| Rate for Payer: United Healthcare All Payer |
$1,589.59
|
|
|
PLATE SM RECON 3.5M 4*49M
|
Facility
|
OP
|
$1,814.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.24 |
| Max. Negotiated Rate |
$1,741.57 |
| Rate for Payer: Aetna Commercial |
$1,396.89
|
| Rate for Payer: Anthem Medicaid |
$623.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.03
|
| Rate for Payer: Cash Price |
$907.07
|
| Rate for Payer: Cigna Commercial |
$1,505.74
|
| Rate for Payer: First Health Commercial |
$1,723.43
|
| Rate for Payer: Humana Commercial |
$1,542.02
|
| Rate for Payer: Humana KY Medicaid |
$623.88
|
| Rate for Payer: Kentucky WC Medicaid |
$630.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,487.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$636.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,596.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,360.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,451.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.76
|
| Rate for Payer: PHCS Commercial |
$1,741.57
|
| Rate for Payer: United Healthcare All Payer |
$1,596.44
|
|
|
PLATE SM RECON 3.5M 4*49M
|
Facility
|
IP
|
$1,814.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.24 |
| Max. Negotiated Rate |
$1,741.57 |
| Rate for Payer: Aetna Commercial |
$1,396.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,415.03
|
| Rate for Payer: Cash Price |
$907.07
|
| Rate for Payer: Cigna Commercial |
$1,505.74
|
| Rate for Payer: First Health Commercial |
$1,723.43
|
| Rate for Payer: Humana Commercial |
$1,542.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,487.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,338.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$544.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,596.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,360.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,451.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,578.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.76
|
| Rate for Payer: PHCS Commercial |
$1,741.57
|
| Rate for Payer: United Healthcare All Payer |
$1,596.44
|
|
|
PLATE SM RECON 3.5MM 10X121MM
|
Facility
|
IP
|
$1,993.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.99 |
| Max. Negotiated Rate |
$1,913.58 |
| Rate for Payer: Aetna Commercial |
$1,534.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.78
|
| Rate for Payer: Cash Price |
$996.66
|
| Rate for Payer: Cigna Commercial |
$1,654.45
|
| Rate for Payer: First Health Commercial |
$1,893.64
|
| Rate for Payer: Humana Commercial |
$1,694.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.11
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,734.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.38
|
| Rate for Payer: PHCS Commercial |
$1,913.58
|
| Rate for Payer: United Healthcare All Payer |
$1,754.11
|
|
|
PLATE SM RECON 3.5MM 10X121MM
|
Facility
|
OP
|
$1,993.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$597.99 |
| Max. Negotiated Rate |
$1,913.58 |
| Rate for Payer: Aetna Commercial |
$1,534.85
|
| Rate for Payer: Anthem Medicaid |
$685.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,554.78
|
| Rate for Payer: Cash Price |
$996.66
|
| Rate for Payer: Cigna Commercial |
$1,654.45
|
| Rate for Payer: First Health Commercial |
$1,893.64
|
| Rate for Payer: Humana Commercial |
$1,694.31
|
| Rate for Payer: Humana KY Medicaid |
$685.50
|
| Rate for Payer: Kentucky WC Medicaid |
$692.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.11
|
| Rate for Payer: Ohio Health Group HMO |
$1,494.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,594.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,734.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,375.38
|
| Rate for Payer: PHCS Commercial |
$1,913.58
|
| Rate for Payer: United Healthcare All Payer |
$1,754.11
|
|
|
PLATE SM RECON 3.5MM 12X145MM
|
Facility
|
OP
|
$2,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,995.84 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem Medicaid |
$714.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,621.62
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cigna Commercial |
$1,725.57
|
| Rate for Payer: First Health Commercial |
$1,975.05
|
| Rate for Payer: Humana Commercial |
$1,767.15
|
| Rate for Payer: Humana KY Medicaid |
$714.97
|
| Rate for Payer: Kentucky WC Medicaid |
$722.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,704.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,829.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,559.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,808.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.51
|
| Rate for Payer: PHCS Commercial |
$1,995.84
|
| Rate for Payer: United Healthcare All Payer |
$1,829.52
|
|
|
PLATE SM RECON 3.5MM 12X145MM
|
Facility
|
IP
|
$2,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,995.84 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,621.62
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cigna Commercial |
$1,725.57
|
| Rate for Payer: First Health Commercial |
$1,975.05
|
| Rate for Payer: Humana Commercial |
$1,767.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,704.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,829.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,559.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,808.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.51
|
| Rate for Payer: PHCS Commercial |
$1,995.84
|
| Rate for Payer: United Healthcare All Payer |
$1,829.52
|
|
|
PLATE SM RECON 3.5MM 5X61MM
|
Facility
|
OP
|
$1,860.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$558.26 |
| Max. Negotiated Rate |
$1,786.44 |
| Rate for Payer: Aetna Commercial |
$1,432.88
|
| Rate for Payer: Anthem Medicaid |
$639.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,451.49
|
| Rate for Payer: Cash Price |
$930.44
|
| Rate for Payer: Cigna Commercial |
$1,544.53
|
| Rate for Payer: First Health Commercial |
$1,767.84
|
| Rate for Payer: Humana Commercial |
$1,581.75
|
| Rate for Payer: Humana KY Medicaid |
$639.96
|
| Rate for Payer: Kentucky WC Medicaid |
$646.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,525.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,373.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$558.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$652.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,637.57
|
| Rate for Payer: Ohio Health Group HMO |
$1,395.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,618.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,284.01
|
| Rate for Payer: PHCS Commercial |
$1,786.44
|
| Rate for Payer: United Healthcare All Payer |
$1,637.57
|
|
