|
PLATE FRACTURE 6H WITH BAR
|
Facility
|
IP
|
$3,847.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.15 |
| Max. Negotiated Rate |
$3,693.42 |
| Rate for Payer: Aetna Commercial |
$2,962.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,000.90
|
| Rate for Payer: Cash Price |
$1,923.65
|
| Rate for Payer: Cigna Commercial |
$3,193.27
|
| Rate for Payer: First Health Commercial |
$3,654.94
|
| Rate for Payer: Humana Commercial |
$3,270.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,154.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,839.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,385.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,885.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,192.67
|
| Rate for Payer: PHCS Commercial |
$3,693.42
|
| Rate for Payer: United Healthcare All Payer |
$3,385.63
|
|
|
PLATE FRACTURE 6H WITH BAR
|
Facility
|
OP
|
$3,847.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$500.15 |
| Max. Negotiated Rate |
$3,693.42 |
| Rate for Payer: Aetna Commercial |
$2,962.43
|
| Rate for Payer: Anthem Medicaid |
$1,323.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,000.90
|
| Rate for Payer: Cash Price |
$1,923.65
|
| Rate for Payer: Cigna Commercial |
$3,193.27
|
| Rate for Payer: First Health Commercial |
$3,654.94
|
| Rate for Payer: Humana Commercial |
$3,270.21
|
| Rate for Payer: Humana KY Medicaid |
$1,323.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,336.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,154.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,839.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,154.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,349.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,385.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,885.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$769.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$500.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,192.67
|
| Rate for Payer: PHCS Commercial |
$3,693.42
|
| Rate for Payer: United Healthcare All Payer |
$3,385.63
|
|
|
PLATE FRAGMENT 2.7*60
|
Facility
|
OP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem Medicaid |
$1,124.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Humana KY Medicaid |
$1,124.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
PLATE FRAGMENT 2.7*60
|
Facility
|
IP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
PLATE FULL RECON MAND 5528932
|
Facility
|
IP
|
$7,533.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.31 |
| Max. Negotiated Rate |
$7,231.81 |
| Rate for Payer: Aetna Commercial |
$5,800.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,875.85
|
| Rate for Payer: Cash Price |
$3,766.57
|
| Rate for Payer: Cigna Commercial |
$6,252.51
|
| Rate for Payer: First Health Commercial |
$7,156.48
|
| Rate for Payer: Humana Commercial |
$6,403.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,177.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,559.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,259.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,629.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,649.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,335.27
|
| Rate for Payer: PHCS Commercial |
$7,231.81
|
| Rate for Payer: United Healthcare All Payer |
$6,629.16
|
|
|
PLATE FULL RECON MAND 5528932
|
Facility
|
OP
|
$7,533.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.31 |
| Max. Negotiated Rate |
$7,231.81 |
| Rate for Payer: Aetna Commercial |
$5,800.52
|
| Rate for Payer: Anthem Medicaid |
$2,590.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,875.85
|
| Rate for Payer: Cash Price |
$3,766.57
|
| Rate for Payer: Cigna Commercial |
$6,252.51
|
| Rate for Payer: First Health Commercial |
$7,156.48
|
| Rate for Payer: Humana Commercial |
$6,403.17
|
| Rate for Payer: Humana KY Medicaid |
$2,590.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,617.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,177.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,559.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,259.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,642.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,629.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,649.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,506.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,335.27
|
| Rate for Payer: PHCS Commercial |
$7,231.81
|
| Rate for Payer: United Healthcare All Payer |
$6,629.16
|
|
|
PLATE FUSION 1ST MTP/MPJ L
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 1ST MTP/MPJ L
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 1ST MTP/MPJ R
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 1ST MTP/MPJ R
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 1ST MTP REV L
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 1ST MTP REV L
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 1ST MTP REV R
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 1ST MTP REV R
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION 3.5MM
|
Facility
|
IP
|
$5,492.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.04 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$4,229.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,284.24
|
| Rate for Payer: Cash Price |
$2,746.31
|
| Rate for Payer: Cigna Commercial |
$4,558.87
|
| Rate for Payer: First Health Commercial |
$5,217.99
|
| Rate for Payer: Humana Commercial |
$4,668.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.71
|
| Rate for Payer: PHCS Commercial |
$5,272.92
|
| Rate for Payer: United Healthcare All Payer |
$4,833.51
|
|
|
PLATE FUSION 3.5MM
|
Facility
|
OP
|
$5,492.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.04 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$4,229.32
|
| Rate for Payer: Anthem Medicaid |
$1,888.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,284.24
|
| Rate for Payer: Cash Price |
$2,746.31
|
| Rate for Payer: Cigna Commercial |
$4,558.87
|
| Rate for Payer: First Health Commercial |
$5,217.99
|
| Rate for Payer: Humana Commercial |
$4,668.73
|
| Rate for Payer: Humana KY Medicaid |
$1,888.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,503.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,053.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,647.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,926.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,833.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,119.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,702.71
|
| Rate for Payer: PHCS Commercial |
$5,272.92
|
| Rate for Payer: United Healthcare All Payer |
$4,833.51
|
|
|
PLATE FUSION DORSAL 1ST MTP L
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION DORSAL 1ST MTP L
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION DORSAL 1ST MTP R
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION DORSAL 1ST MTP R
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE FUSION LG 3.5MM
|
Facility
|
IP
|
$6,562.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$853.14 |
| Max. Negotiated Rate |
$6,300.10 |
| Rate for Payer: Aetna Commercial |
$5,053.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.83
|
| Rate for Payer: Cash Price |
$3,281.30
|
| Rate for Payer: Cigna Commercial |
$5,446.96
|
| Rate for Payer: First Health Commercial |
$6,234.47
|
| Rate for Payer: Humana Commercial |
$5,578.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.09
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.41
|
| Rate for Payer: PHCS Commercial |
$6,300.10
|
| Rate for Payer: United Healthcare All Payer |
$5,775.09
|
|
|
PLATE FUSION LG 3.5MM
|
Facility
|
OP
|
$6,562.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$853.14 |
| Max. Negotiated Rate |
$6,300.10 |
| Rate for Payer: Aetna Commercial |
$5,053.20
|
| Rate for Payer: Anthem Medicaid |
$2,256.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,118.83
|
| Rate for Payer: Cash Price |
$3,281.30
|
| Rate for Payer: Cigna Commercial |
$5,446.96
|
| Rate for Payer: First Health Commercial |
$6,234.47
|
| Rate for Payer: Humana Commercial |
$5,578.21
|
| Rate for Payer: Humana KY Medicaid |
$2,256.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,279.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,381.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,843.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,968.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,302.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,775.09
|
| Rate for Payer: Ohio Health Group HMO |
$4,921.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,312.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$853.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.41
|
| Rate for Payer: PHCS Commercial |
$6,300.10
|
| Rate for Payer: United Healthcare All Payer |
$5,775.09
|
|
|
PLATE GEMINUS HOOK
|
Facility
|
OP
|
$3,498.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.80 |
| Max. Negotiated Rate |
$3,358.56 |
| Rate for Payer: Aetna Commercial |
$2,693.84
|
| Rate for Payer: Anthem Medicaid |
$1,203.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,728.83
|
| Rate for Payer: Cash Price |
$1,749.25
|
| Rate for Payer: Cigna Commercial |
$2,903.76
|
| Rate for Payer: First Health Commercial |
$3,323.58
|
| Rate for Payer: Humana Commercial |
$2,973.72
|
| Rate for Payer: Humana KY Medicaid |
$1,203.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,215.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,868.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,581.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,049.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,227.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,078.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,623.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$454.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.54
|
| Rate for Payer: PHCS Commercial |
$3,358.56
|
| Rate for Payer: United Healthcare All Payer |
$3,078.68
|
|
|
PLATE GEMINUS HOOK
|
Facility
|
IP
|
$3,498.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.80 |
| Max. Negotiated Rate |
$3,358.56 |
| Rate for Payer: Aetna Commercial |
$2,693.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,728.83
|
| Rate for Payer: Cash Price |
$1,749.25
|
| Rate for Payer: Cigna Commercial |
$2,903.76
|
| Rate for Payer: First Health Commercial |
$3,323.58
|
| Rate for Payer: Humana Commercial |
$2,973.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,868.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,581.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,049.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,078.68
|
| Rate for Payer: Ohio Health Group HMO |
$2,623.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$699.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$454.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,084.54
|
| Rate for Payer: PHCS Commercial |
$3,358.56
|
| Rate for Payer: United Healthcare All Payer |
$3,078.68
|
|
|
PLATE GEMINUS VOL DSRD N 4H L
|
Facility
|
OP
|
$8,970.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,166.14 |
| Max. Negotiated Rate |
$8,611.52 |
| Rate for Payer: Aetna Commercial |
$6,907.15
|
| Rate for Payer: Anthem Medicaid |
$3,084.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,996.86
|
| Rate for Payer: Cash Price |
$4,485.16
|
| Rate for Payer: Cigna Commercial |
$7,445.37
|
| Rate for Payer: First Health Commercial |
$8,521.81
|
| Rate for Payer: Humana Commercial |
$7,624.78
|
| Rate for Payer: Humana KY Medicaid |
$3,084.90
|
| Rate for Payer: Kentucky WC Medicaid |
$3,116.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,355.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,620.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,691.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,146.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,893.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,727.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,794.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,166.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,780.80
|
| Rate for Payer: PHCS Commercial |
$8,611.52
|
| Rate for Payer: United Healthcare All Payer |
$7,893.89
|
|
