|
PLATE LCK DIST FIB RT 6 HOLE
|
Facility
|
IP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
PLATE LCK DIST FIB RT 6 HOLE
|
Facility
|
OP
|
$5,140.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$668.20 |
| Max. Negotiated Rate |
$4,934.40 |
| Rate for Payer: Aetna Commercial |
$3,957.80
|
| Rate for Payer: Anthem Medicaid |
$1,767.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,009.20
|
| Rate for Payer: Cash Price |
$2,570.00
|
| Rate for Payer: Cigna Commercial |
$4,266.20
|
| Rate for Payer: First Health Commercial |
$4,883.00
|
| Rate for Payer: Humana Commercial |
$4,369.00
|
| Rate for Payer: Humana KY Medicaid |
$1,767.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,785.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,214.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,793.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,542.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,803.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,523.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,855.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,028.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$668.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,593.40
|
| Rate for Payer: PHCS Commercial |
$4,934.40
|
| Rate for Payer: United Healthcare All Payer |
$4,523.20
|
|
|
PLATE LCK LAT DST FIB 3.5 3H L
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LCK LAT DST FIB 3.5 3H L
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LCK LAT DST FIB 3.5 3H R
|
Facility
|
OP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem Medicaid |
$1,614.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Humana KY Medicaid |
$1,614.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,631.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,647.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LCK LAT DST FIB 3.5 3H R
|
Facility
|
IP
|
$4,695.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.42 |
| Max. Negotiated Rate |
$4,507.68 |
| Rate for Payer: Aetna Commercial |
$3,615.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,662.49
|
| Rate for Payer: Cash Price |
$2,347.75
|
| Rate for Payer: Cigna Commercial |
$3,897.26
|
| Rate for Payer: First Health Commercial |
$4,460.72
|
| Rate for Payer: Humana Commercial |
$3,991.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,850.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,465.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,408.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,132.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,521.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$939.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$610.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,455.60
|
| Rate for Payer: PHCS Commercial |
$4,507.68
|
| Rate for Payer: United Healthcare All Payer |
$4,132.04
|
|
|
PLATE LCK LAT DST FIB 3.5 4H L
|
Facility
|
IP
|
$4,190.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.80 |
| Max. Negotiated Rate |
$4,023.17 |
| Rate for Payer: Aetna Commercial |
$3,226.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.82
|
| Rate for Payer: Cash Price |
$2,095.40
|
| Rate for Payer: Cigna Commercial |
$3,478.36
|
| Rate for Payer: First Health Commercial |
$3,981.26
|
| Rate for Payer: Humana Commercial |
$3,562.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.15
|
| Rate for Payer: PHCS Commercial |
$4,023.17
|
| Rate for Payer: United Healthcare All Payer |
$3,687.90
|
|
|
PLATE LCK LAT DST FIB 3.5 4H L
|
Facility
|
OP
|
$4,190.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.80 |
| Max. Negotiated Rate |
$4,023.17 |
| Rate for Payer: Kentucky WC Medicaid |
$1,455.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,470.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.15
|
| Rate for Payer: PHCS Commercial |
$4,023.17
|
| Rate for Payer: United Healthcare All Payer |
$3,687.90
|
| Rate for Payer: Aetna Commercial |
$3,226.92
|
| Rate for Payer: Anthem Medicaid |
$1,441.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.82
|
| Rate for Payer: Cash Price |
$2,095.40
|
| Rate for Payer: Cigna Commercial |
$3,478.36
|
| Rate for Payer: First Health Commercial |
$3,981.26
|
| Rate for Payer: Humana Commercial |
$3,562.18
|
| Rate for Payer: Humana KY Medicaid |
$1,441.22
|
|
|
PLATE LCK LAT DST FIB 3.5 4H R
|
Facility
|
OP
|
$4,178.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.17 |
| Max. Negotiated Rate |
$4,011.07 |
| Rate for Payer: Aetna Commercial |
$3,217.21
|
| Rate for Payer: Anthem Medicaid |
$1,436.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,259.00
|
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Cigna Commercial |
$3,467.91
|
| Rate for Payer: First Health Commercial |
$3,969.29
|
| Rate for Payer: Humana Commercial |
$3,551.47
|
| Rate for Payer: Humana KY Medicaid |
$1,436.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,451.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,426.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,083.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,465.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,676.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,133.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$835.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.24
|
| Rate for Payer: PHCS Commercial |
$4,011.07
|
| Rate for Payer: United Healthcare All Payer |
$3,676.82
|
|
|
PLATE LCK LAT DST FIB 3.5 4H R
|
Facility
|
IP
|
$4,178.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$543.17 |
| Max. Negotiated Rate |
$4,011.07 |
| Rate for Payer: Aetna Commercial |
$3,217.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,259.00
|
| Rate for Payer: Cash Price |
$2,089.10
|
| Rate for Payer: Cigna Commercial |
$3,467.91
|
| Rate for Payer: First Health Commercial |
$3,969.29
|
| Rate for Payer: Humana Commercial |
$3,551.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,426.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,083.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,253.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,676.82
|
| Rate for Payer: Ohio Health Group HMO |
$3,133.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$835.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$543.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,295.24
|
| Rate for Payer: PHCS Commercial |
$4,011.07
|
| Rate for Payer: United Healthcare All Payer |
$3,676.82
|
|
|
PLATE LCK LAT DST FIB 3.5 5H L
|
Facility
|
IP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE LCK LAT DST FIB 3.5 5H L
|
Facility
|
OP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem Medicaid |
$1,480.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Humana KY Medicaid |
$1,480.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,509.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE LCK LAT DST FIB 3.5 5H R
|
Facility
|
OP
|
$4,291.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.91 |
| Max. Negotiated Rate |
$4,119.94 |
| Rate for Payer: Aetna Commercial |
$3,304.53
|
| Rate for Payer: Anthem Medicaid |
$1,475.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,347.45
|
| Rate for Payer: Cash Price |
$2,145.80
|
| Rate for Payer: Cigna Commercial |
$3,562.03
|
| Rate for Payer: First Health Commercial |
$4,077.02
|
| Rate for Payer: Humana Commercial |
$3,647.86
|
| Rate for Payer: Humana KY Medicaid |
$1,475.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,490.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,519.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,167.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,505.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,776.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,218.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$858.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,330.40
|
| Rate for Payer: PHCS Commercial |
$4,119.94
|
| Rate for Payer: United Healthcare All Payer |
$3,776.61
|
|
|
PLATE LCK LAT DST FIB 3.5 5H R
|
Facility
|
IP
|
$4,291.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$557.91 |
| Max. Negotiated Rate |
$4,119.94 |
| Rate for Payer: Aetna Commercial |
$3,304.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,347.45
|
| Rate for Payer: Cash Price |
$2,145.80
|
| Rate for Payer: Cigna Commercial |
$3,562.03
|
| Rate for Payer: First Health Commercial |
$4,077.02
|
| Rate for Payer: Humana Commercial |
$3,647.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,519.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,167.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,287.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,776.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,218.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$858.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$557.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,330.40
|
| Rate for Payer: PHCS Commercial |
$4,119.94
|
| Rate for Payer: United Healthcare All Payer |
$3,776.61
|
|
|
PLATE LCK LAT DST FIB 3.5 7H L
|
Facility
|
IP
|
$4,417.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.29 |
| Max. Negotiated Rate |
$4,240.90 |
| Rate for Payer: Aetna Commercial |
$3,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,445.73
|
| Rate for Payer: Cash Price |
$2,208.80
|
| Rate for Payer: Cigna Commercial |
$3,666.61
|
| Rate for Payer: First Health Commercial |
$4,196.72
|
| Rate for Payer: Humana Commercial |
$3,754.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.46
|
| Rate for Payer: PHCS Commercial |
$4,240.90
|
| Rate for Payer: United Healthcare All Payer |
$3,887.49
|
|
|
PLATE LCK LAT DST FIB 3.5 7H L
|
Facility
|
OP
|
$4,417.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.29 |
| Max. Negotiated Rate |
$4,240.90 |
| Rate for Payer: Aetna Commercial |
$3,401.55
|
| Rate for Payer: Anthem Medicaid |
$1,519.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,445.73
|
| Rate for Payer: Cash Price |
$2,208.80
|
| Rate for Payer: Cigna Commercial |
$3,666.61
|
| Rate for Payer: First Health Commercial |
$4,196.72
|
| Rate for Payer: Humana Commercial |
$3,754.96
|
| Rate for Payer: Humana KY Medicaid |
$1,519.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,534.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,549.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.46
|
| Rate for Payer: PHCS Commercial |
$4,240.90
|
| Rate for Payer: United Healthcare All Payer |
$3,887.49
|
|
|
PLATE LCK LAT DST FIB 3.5 7H R
|
Facility
|
OP
|
$3,877.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.11 |
| Max. Negotiated Rate |
$3,722.69 |
| Rate for Payer: Aetna Commercial |
$2,985.91
|
| Rate for Payer: Anthem Medicaid |
$1,333.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,024.68
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$3,218.57
|
| Rate for Payer: First Health Commercial |
$3,683.91
|
| Rate for Payer: Humana Commercial |
$3,296.13
|
| Rate for Payer: Humana KY Medicaid |
$1,333.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,347.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,179.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,861.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,163.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,360.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,412.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,908.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.12
|
| Rate for Payer: PHCS Commercial |
$3,722.69
|
| Rate for Payer: United Healthcare All Payer |
$3,412.46
|
|
|
PLATE LCK LAT DST FIB 3.5 7H R
|
Facility
|
IP
|
$3,877.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.11 |
| Max. Negotiated Rate |
$3,722.69 |
| Rate for Payer: Humana Commercial |
$3,296.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,179.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,861.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,163.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,412.46
|
| Rate for Payer: Ohio Health Group HMO |
$2,908.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$775.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,202.12
|
| Rate for Payer: PHCS Commercial |
$3,722.69
|
| Rate for Payer: United Healthcare All Payer |
$3,412.46
|
| Rate for Payer: Aetna Commercial |
$2,985.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,024.68
|
| Rate for Payer: Cash Price |
$1,938.90
|
| Rate for Payer: Cigna Commercial |
$3,218.57
|
| Rate for Payer: First Health Commercial |
$3,683.91
|
|
|
PLATE LCK LAT DST FIB 3.5 9H L
|
Facility
|
IP
|
$4,751.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.70 |
| Max. Negotiated Rate |
$4,561.44 |
| Rate for Payer: Aetna Commercial |
$3,658.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,706.17
|
| Rate for Payer: Cash Price |
$2,375.75
|
| Rate for Payer: Cigna Commercial |
$3,943.74
|
| Rate for Payer: First Health Commercial |
$4,513.92
|
| Rate for Payer: Humana Commercial |
$4,038.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,896.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,506.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,181.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,563.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.96
|
| Rate for Payer: PHCS Commercial |
$4,561.44
|
| Rate for Payer: United Healthcare All Payer |
$4,181.32
|
|
|
PLATE LCK LAT DST FIB 3.5 9H L
|
Facility
|
OP
|
$4,751.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.70 |
| Max. Negotiated Rate |
$4,561.44 |
| Rate for Payer: Aetna Commercial |
$3,658.66
|
| Rate for Payer: Anthem Medicaid |
$1,634.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,706.17
|
| Rate for Payer: Cash Price |
$2,375.75
|
| Rate for Payer: Cigna Commercial |
$3,943.74
|
| Rate for Payer: First Health Commercial |
$4,513.92
|
| Rate for Payer: Humana Commercial |
$4,038.78
|
| Rate for Payer: Humana KY Medicaid |
$1,634.04
|
| Rate for Payer: Kentucky WC Medicaid |
$1,650.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,896.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,506.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,425.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,666.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,181.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,563.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$950.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$617.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,472.96
|
| Rate for Payer: PHCS Commercial |
$4,561.44
|
| Rate for Payer: United Healthcare All Payer |
$4,181.32
|
|
|
PLATE LCKNG COMPR 6H L 84MM
|
Facility
|
IP
|
$1,565.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.10 |
| Rate for Payer: Aetna Commercial |
$1,205.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.27
|
| Rate for Payer: Cash Price |
$782.87
|
| Rate for Payer: Cigna Commercial |
$1,299.56
|
| Rate for Payer: First Health Commercial |
$1,487.44
|
| Rate for Payer: Humana Commercial |
$1,330.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.38
|
| Rate for Payer: PHCS Commercial |
$1,503.10
|
| Rate for Payer: United Healthcare All Payer |
$1,377.84
|
|
|
PLATE LCKNG COMPR 6H L 84MM
|
Facility
|
OP
|
$1,565.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.54 |
| Max. Negotiated Rate |
$1,503.10 |
| Rate for Payer: Aetna Commercial |
$1,205.61
|
| Rate for Payer: Anthem Medicaid |
$538.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,221.27
|
| Rate for Payer: Cash Price |
$782.87
|
| Rate for Payer: Cigna Commercial |
$1,299.56
|
| Rate for Payer: First Health Commercial |
$1,487.44
|
| Rate for Payer: Humana Commercial |
$1,330.87
|
| Rate for Payer: Humana KY Medicaid |
$538.45
|
| Rate for Payer: Kentucky WC Medicaid |
$543.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,283.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,155.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$469.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$549.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,377.84
|
| Rate for Payer: Ohio Health Group HMO |
$1,174.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$313.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$485.38
|
| Rate for Payer: PHCS Commercial |
$1,503.10
|
| Rate for Payer: United Healthcare All Payer |
$1,377.84
|
|
|
PLATE LCKNG COMPR 7H L97MM
|
Facility
|
IP
|
$2,092.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.52
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
PLATE LCKNG COMPR 7H L97MM
|
Facility
|
OP
|
$2,092.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.96 |
| Max. Negotiated Rate |
$2,008.32 |
| Rate for Payer: Aetna Commercial |
$1,610.84
|
| Rate for Payer: Anthem Medicaid |
$719.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,631.76
|
| Rate for Payer: Cash Price |
$1,046.00
|
| Rate for Payer: Cigna Commercial |
$1,736.36
|
| Rate for Payer: First Health Commercial |
$1,987.40
|
| Rate for Payer: Humana Commercial |
$1,778.20
|
| Rate for Payer: Humana KY Medicaid |
$719.44
|
| Rate for Payer: Kentucky WC Medicaid |
$726.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,715.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,543.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$627.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$733.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,840.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,569.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$418.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$648.52
|
| Rate for Payer: PHCS Commercial |
$2,008.32
|
| Rate for Payer: United Healthcare All Payer |
$1,840.96
|
|
|
PLATE LCKNG COMPR 8H L110MM
|
Facility
|
OP
|
$2,176.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$2,088.96 |
| Rate for Payer: Humana Commercial |
$1,849.60
|
| Rate for Payer: Humana KY Medicaid |
$748.33
|
| Rate for Payer: Kentucky WC Medicaid |
$755.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,784.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,605.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$763.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,914.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$435.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$282.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$674.56
|
| Rate for Payer: PHCS Commercial |
$2,088.96
|
| Rate for Payer: United Healthcare All Payer |
$1,914.88
|
| Rate for Payer: Aetna Commercial |
$1,675.52
|
| Rate for Payer: Anthem Medicaid |
$748.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.28
|
| Rate for Payer: Cash Price |
$1,088.00
|
| Rate for Payer: Cigna Commercial |
$1,806.08
|
| Rate for Payer: First Health Commercial |
$2,067.20
|
|
