|
PLATE SM RECON 3.5MM 5X61MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE SM RECON 3.5MM 6X73MM
|
Facility
|
OP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem Medicaid |
$650.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Humana KY Medicaid |
$650.67
|
| Rate for Payer: Kentucky WC Medicaid |
$657.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$663.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
PLATE SM RECON 3.5MM 6X73MM
|
Facility
|
IP
|
$1,892.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$567.61 |
| Max. Negotiated Rate |
$1,816.36 |
| Rate for Payer: Aetna Commercial |
$1,456.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,475.79
|
| Rate for Payer: Cash Price |
$946.02
|
| Rate for Payer: Cigna Commercial |
$1,570.39
|
| Rate for Payer: First Health Commercial |
$1,797.44
|
| Rate for Payer: Humana Commercial |
$1,608.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,551.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,396.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$567.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,665.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,419.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,513.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,646.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,305.51
|
| Rate for Payer: PHCS Commercial |
$1,816.36
|
| Rate for Payer: United Healthcare All Payer |
$1,665.00
|
|
|
PLATE SM RECON 3.5MM 7X85MM
|
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 RECON 3.5MM 7X85MM
|
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 RECON 3.5MM 8X97MM
|
Facility
|
IP
|
$1,962.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.64 |
| Max. Negotiated Rate |
$1,883.66 |
| Rate for Payer: Aetna Commercial |
$1,510.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.48
|
| Rate for Payer: Cash Price |
$981.08
|
| Rate for Payer: Cigna Commercial |
$1,628.58
|
| Rate for Payer: First Health Commercial |
$1,864.04
|
| Rate for Payer: Humana Commercial |
$1,667.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,608.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,726.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,569.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.88
|
| Rate for Payer: PHCS Commercial |
$1,883.66
|
| Rate for Payer: United Healthcare All Payer |
$1,726.69
|
|
|
PLATE SM RECON 3.5MM 8X97MM
|
Facility
|
OP
|
$1,962.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.64 |
| Max. Negotiated Rate |
$1,883.66 |
| Rate for Payer: Aetna Commercial |
$1,510.86
|
| Rate for Payer: Anthem Medicaid |
$674.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.48
|
| Rate for Payer: Cash Price |
$981.08
|
| Rate for Payer: Cigna Commercial |
$1,628.58
|
| Rate for Payer: First Health Commercial |
$1,864.04
|
| Rate for Payer: Humana Commercial |
$1,667.83
|
| Rate for Payer: Humana KY Medicaid |
$674.78
|
| Rate for Payer: Kentucky WC Medicaid |
$681.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,608.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,726.69
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,569.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,707.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,353.88
|
| Rate for Payer: PHCS Commercial |
$1,883.66
|
| Rate for Payer: United Healthcare All Payer |
$1,726.69
|
|
|
PLATE SM RECON 3.5MM 9X109MM
|
Facility
|
OP
|
$1,977.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.32 |
| Max. Negotiated Rate |
$1,898.62 |
| Rate for Payer: Aetna Commercial |
$1,522.85
|
| Rate for Payer: Anthem Medicaid |
$680.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.63
|
| Rate for Payer: Cash Price |
$988.86
|
| Rate for Payer: Cigna Commercial |
$1,641.52
|
| Rate for Payer: First Health Commercial |
$1,878.84
|
| Rate for Payer: Humana Commercial |
$1,681.07
|
| Rate for Payer: Humana KY Medicaid |
$680.14
|
| Rate for Payer: Kentucky WC Medicaid |
$687.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$693.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,740.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,483.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,720.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.63
|
| Rate for Payer: PHCS Commercial |
$1,898.62
|
| Rate for Payer: United Healthcare All Payer |
$1,740.40
|
|
|
PLATE SM RECON 3.5MM 9X109MM
|
Facility
|
IP
|
$1,977.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.32 |
| Max. Negotiated Rate |
$1,898.62 |
| Rate for Payer: Aetna Commercial |
$1,522.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,542.63
|
| Rate for Payer: Cash Price |
$988.86
|
| Rate for Payer: Cigna Commercial |
$1,641.52
|
| Rate for Payer: First Health Commercial |
$1,878.84
|
| Rate for Payer: Humana Commercial |
$1,681.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,621.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,459.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$593.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,740.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,483.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,582.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,720.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,364.63
|
| Rate for Payer: PHCS Commercial |
$1,898.62
|
| Rate for Payer: United Healthcare All Payer |
$1,740.40
|
|
|
PLATE SM RT 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 RT 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 UTILITY 2.7MM
|
Facility
|
IP
|
$5,527.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.34 |
| Max. Negotiated Rate |
$5,306.70 |
| Rate for Payer: Aetna Commercial |
$4,256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,311.69
|
| Rate for Payer: Cash Price |
$2,763.91
|
| Rate for Payer: Cigna Commercial |
$4,588.08
|
| Rate for Payer: First Health Commercial |
$5,251.42
|
| Rate for Payer: Humana Commercial |
$4,698.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,532.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,079.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,864.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,145.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,422.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,809.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,814.19
|
| Rate for Payer: PHCS Commercial |
$5,306.70
|
| Rate for Payer: United Healthcare All Payer |
$4,864.47
|
|
|
PLATE SM UTILITY 2.7MM
|
Facility
|
OP
|
$5,527.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.34 |
| Max. Negotiated Rate |
$5,306.70 |
| Rate for Payer: Aetna Commercial |
$4,256.41
|
| Rate for Payer: Anthem Medicaid |
$1,901.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,311.69
|
| Rate for Payer: Cash Price |
$2,763.91
|
| Rate for Payer: Cigna Commercial |
$4,588.08
|
| Rate for Payer: First Health Commercial |
$5,251.42
|
| Rate for Payer: Humana Commercial |
$4,698.64
|
| Rate for Payer: Humana KY Medicaid |
$1,901.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,920.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,532.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,079.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,939.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,864.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,145.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,422.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,809.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,814.19
|
| Rate for Payer: PHCS Commercial |
$5,306.70
|
| Rate for Payer: United Healthcare All Payer |
$4,864.47
|
|
|
PLATE SPIDER 16MM
|
Facility
|
OP
|
$1,702.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.84 |
| Max. Negotiated Rate |
$1,634.69 |
| Rate for Payer: Aetna Commercial |
$1,311.16
|
| Rate for Payer: Anthem Medicaid |
$585.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.18
|
| Rate for Payer: Cash Price |
$851.40
|
| Rate for Payer: Cigna Commercial |
$1,413.32
|
| Rate for Payer: First Health Commercial |
$1,617.66
|
| Rate for Payer: Humana Commercial |
$1,447.38
|
| Rate for Payer: Humana KY Medicaid |
$585.59
|
| Rate for Payer: Kentucky WC Medicaid |
$591.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,362.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,481.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.93
|
| Rate for Payer: PHCS Commercial |
$1,634.69
|
| Rate for Payer: United Healthcare All Payer |
$1,498.46
|
|
|
PLATE SPIDER 16MM
|
Facility
|
IP
|
$1,702.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.84 |
| Max. Negotiated Rate |
$1,634.69 |
| Rate for Payer: Aetna Commercial |
$1,311.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.18
|
| Rate for Payer: Cash Price |
$851.40
|
| Rate for Payer: Cigna Commercial |
$1,413.32
|
| Rate for Payer: First Health Commercial |
$1,617.66
|
| Rate for Payer: Humana Commercial |
$1,447.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,362.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,481.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.93
|
| Rate for Payer: PHCS Commercial |
$1,634.69
|
| Rate for Payer: United Healthcare All Payer |
$1,498.46
|
|
|
PLATE SPIDER 20MM
|
Facility
|
OP
|
$1,702.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.84 |
| Max. Negotiated Rate |
$1,634.69 |
| Rate for Payer: Aetna Commercial |
$1,311.16
|
| Rate for Payer: Anthem Medicaid |
$585.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.18
|
| Rate for Payer: Cash Price |
$851.40
|
| Rate for Payer: Cigna Commercial |
$1,413.32
|
| Rate for Payer: First Health Commercial |
$1,617.66
|
| Rate for Payer: Humana Commercial |
$1,447.38
|
| Rate for Payer: Humana KY Medicaid |
$585.59
|
| Rate for Payer: Kentucky WC Medicaid |
$591.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$597.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,362.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,481.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.93
|
| Rate for Payer: PHCS Commercial |
$1,634.69
|
| Rate for Payer: United Healthcare All Payer |
$1,498.46
|
|
|
PLATE SPIDER 20MM
|
Facility
|
IP
|
$1,702.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.84 |
| Max. Negotiated Rate |
$1,634.69 |
| Rate for Payer: Aetna Commercial |
$1,311.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,328.18
|
| Rate for Payer: Cash Price |
$851.40
|
| Rate for Payer: Cigna Commercial |
$1,413.32
|
| Rate for Payer: First Health Commercial |
$1,617.66
|
| Rate for Payer: Humana Commercial |
$1,447.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,396.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,256.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,498.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,277.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,362.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,481.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,174.93
|
| Rate for Payer: PHCS Commercial |
$1,634.69
|
| Rate for Payer: United Healthcare All Payer |
$1,498.46
|
|
|
PLATE SPIDER LRG FRAG 20MM
|
Facility
|
IP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
PLATE SPIDER LRG FRAG 20MM
|
Facility
|
OP
|
$1,908.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$1,831.68 |
| Rate for Payer: Aetna Commercial |
$1,469.16
|
| Rate for Payer: Anthem Medicaid |
$656.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,488.24
|
| Rate for Payer: Cash Price |
$954.00
|
| Rate for Payer: Cigna Commercial |
$1,583.64
|
| Rate for Payer: First Health Commercial |
$1,812.60
|
| Rate for Payer: Humana Commercial |
$1,621.80
|
| Rate for Payer: Humana KY Medicaid |
$656.16
|
| Rate for Payer: Kentucky WC Medicaid |
$662.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,564.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,408.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,679.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,431.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,659.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,316.52
|
| Rate for Payer: PHCS Commercial |
$1,831.68
|
| Rate for Payer: United Healthcare All Payer |
$1,679.04
|
|
|
PLATE SPIDER OFFSET
|
Facility
|
IP
|
$1,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$1,161.60 |
| Rate for Payer: Aetna Commercial |
$931.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$943.80
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cigna Commercial |
$1,004.30
|
| Rate for Payer: First Health Commercial |
$1,149.50
|
| Rate for Payer: Humana Commercial |
$1,028.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$992.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$363.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,064.80
|
| Rate for Payer: Ohio Health Group HMO |
$907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.90
|
| Rate for Payer: PHCS Commercial |
$1,161.60
|
| Rate for Payer: United Healthcare All Payer |
$1,064.80
|
|
|
PLATE SPIDER OFFSET
|
Facility
|
OP
|
$1,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$363.00 |
| Max. Negotiated Rate |
$1,161.60 |
| Rate for Payer: Aetna Commercial |
$931.70
|
| Rate for Payer: Anthem Medicaid |
$416.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$943.80
|
| Rate for Payer: Cash Price |
$605.00
|
| Rate for Payer: Cigna Commercial |
$1,004.30
|
| Rate for Payer: First Health Commercial |
$1,149.50
|
| Rate for Payer: Humana Commercial |
$1,028.50
|
| Rate for Payer: Humana KY Medicaid |
$416.12
|
| Rate for Payer: Kentucky WC Medicaid |
$420.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$992.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$892.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$363.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$424.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,064.80
|
| Rate for Payer: Ohio Health Group HMO |
$907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$968.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,052.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$834.90
|
| Rate for Payer: PHCS Commercial |
$1,161.60
|
| Rate for Payer: United Healthcare All Payer |
$1,064.80
|
|
|
PLATE SPIDER OFFST LG FRAG 25M
|
Facility
|
IP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
PLATE SPIDER OFFST LG FRAG 25M
|
Facility
|
OP
|
$1,877.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.28 |
| Max. Negotiated Rate |
$1,802.50 |
| Rate for Payer: Aetna Commercial |
$1,445.75
|
| Rate for Payer: Anthem Medicaid |
$645.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,464.53
|
| Rate for Payer: Cash Price |
$938.80
|
| Rate for Payer: Cigna Commercial |
$1,558.41
|
| Rate for Payer: First Health Commercial |
$1,783.72
|
| Rate for Payer: Humana Commercial |
$1,595.96
|
| Rate for Payer: Humana KY Medicaid |
$645.71
|
| Rate for Payer: Kentucky WC Medicaid |
$652.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,539.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,385.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$563.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$658.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,652.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,408.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,502.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,633.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.54
|
| Rate for Payer: PHCS Commercial |
$1,802.50
|
| Rate for Payer: United Healthcare All Payer |
$1,652.29
|
|
|
PLATE SPOON 5 HOLE 100MM
|
Facility
|
OP
|
$3,399.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.74 |
| Max. Negotiated Rate |
$3,263.16 |
| Rate for Payer: Aetna Commercial |
$2,617.32
|
| Rate for Payer: Anthem Medicaid |
$1,168.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.31
|
| Rate for Payer: Cash Price |
$1,699.56
|
| Rate for Payer: Cigna Commercial |
$2,821.27
|
| Rate for Payer: First Health Commercial |
$3,229.16
|
| Rate for Payer: Humana Commercial |
$2,889.25
|
| Rate for Payer: Humana KY Medicaid |
$1,168.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,180.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,787.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,991.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.39
|
| Rate for Payer: PHCS Commercial |
$3,263.16
|
| Rate for Payer: United Healthcare All Payer |
$2,991.23
|
|
|
PLATE SPOON 5 HOLE 100MM
|
Facility
|
IP
|
$3,399.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.74 |
| Max. Negotiated Rate |
$3,263.16 |
| Rate for Payer: Aetna Commercial |
$2,617.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.31
|
| Rate for Payer: Cash Price |
$1,699.56
|
| Rate for Payer: Cigna Commercial |
$2,821.27
|
| Rate for Payer: First Health Commercial |
$3,229.16
|
| Rate for Payer: Humana Commercial |
$2,889.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,787.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,991.23
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,957.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.39
|
| Rate for Payer: PHCS Commercial |
$3,263.16
|
| Rate for Payer: United Healthcare All Payer |
$2,991.23
|
|
