|
PLATE LCKNG COMPR 8H L110MM
|
Facility
|
IP
|
$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: Aetna Commercial |
$1,675.52
|
| 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
|
| Rate for Payer: Humana Commercial |
$1,849.60
|
| 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: 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
|
|
|
PLATE LCKNG RECON 3.5 10H*118
|
Facility
|
IP
|
$4,187.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.42 |
| Max. Negotiated Rate |
$4,020.31 |
| Rate for Payer: Aetna Commercial |
$3,224.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,266.50
|
| Rate for Payer: Cash Price |
$2,093.91
|
| Rate for Payer: Cigna Commercial |
$3,475.89
|
| Rate for Payer: First Health Commercial |
$3,978.43
|
| Rate for Payer: Humana Commercial |
$3,559.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,434.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,090.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,256.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,685.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,140.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.22
|
| Rate for Payer: PHCS Commercial |
$4,020.31
|
| Rate for Payer: United Healthcare All Payer |
$3,685.28
|
|
|
PLATE LCKNG RECON 3.5 10H*118
|
Facility
|
OP
|
$4,187.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.42 |
| Max. Negotiated Rate |
$4,020.31 |
| Rate for Payer: Aetna Commercial |
$3,224.62
|
| Rate for Payer: Anthem Medicaid |
$1,440.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,266.50
|
| Rate for Payer: Cash Price |
$2,093.91
|
| Rate for Payer: Cigna Commercial |
$3,475.89
|
| Rate for Payer: First Health Commercial |
$3,978.43
|
| Rate for Payer: Humana Commercial |
$3,559.65
|
| Rate for Payer: Humana KY Medicaid |
$1,440.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,454.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,434.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,090.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,256.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,469.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,685.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,140.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.22
|
| Rate for Payer: PHCS Commercial |
$4,020.31
|
| Rate for Payer: United Healthcare All Payer |
$3,685.28
|
|
|
PLATE LCKNG RECON 3.5 12H*142
|
Facility
|
OP
|
$4,330.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$4,157.06 |
| Rate for Payer: Aetna Commercial |
$3,334.31
|
| Rate for Payer: Anthem Medicaid |
$1,489.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,377.61
|
| Rate for Payer: Cash Price |
$2,165.14
|
| Rate for Payer: Cigna Commercial |
$3,594.12
|
| Rate for Payer: First Health Commercial |
$4,113.76
|
| Rate for Payer: Humana Commercial |
$3,680.73
|
| Rate for Payer: Humana KY Medicaid |
$1,489.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,504.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,550.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,195.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,519.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,810.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,247.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$866.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.38
|
| Rate for Payer: PHCS Commercial |
$4,157.06
|
| Rate for Payer: United Healthcare All Payer |
$3,810.64
|
|
|
PLATE LCKNG RECON 3.5 12H*142
|
Facility
|
IP
|
$4,330.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$4,157.06 |
| Rate for Payer: Aetna Commercial |
$3,334.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,377.61
|
| Rate for Payer: Cash Price |
$2,165.14
|
| Rate for Payer: Cigna Commercial |
$3,594.12
|
| Rate for Payer: First Health Commercial |
$4,113.76
|
| Rate for Payer: Humana Commercial |
$3,680.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,550.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,195.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,810.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,247.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$866.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.38
|
| Rate for Payer: PHCS Commercial |
$4,157.06
|
| Rate for Payer: United Healthcare All Payer |
$3,810.64
|
|
|
PLATE LCKNG RECON 3.5 14H*166
|
Facility
|
IP
|
$4,498.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.82 |
| Max. Negotiated Rate |
$4,318.68 |
| Rate for Payer: Aetna Commercial |
$3,463.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.92
|
| Rate for Payer: Cash Price |
$2,249.31
|
| Rate for Payer: Cigna Commercial |
$3,733.85
|
| Rate for Payer: First Health Commercial |
$4,273.69
|
| Rate for Payer: Humana Commercial |
$3,823.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.57
|
| Rate for Payer: PHCS Commercial |
$4,318.68
|
| Rate for Payer: United Healthcare All Payer |
$3,958.79
|
|
|
PLATE LCKNG RECON 3.5 14H*166
|
Facility
|
OP
|
$4,498.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.82 |
| Max. Negotiated Rate |
$4,318.68 |
| Rate for Payer: Aetna Commercial |
$3,463.94
|
| Rate for Payer: Anthem Medicaid |
$1,547.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.92
|
| Rate for Payer: Cash Price |
$2,249.31
|
| Rate for Payer: Cigna Commercial |
$3,733.85
|
| Rate for Payer: First Health Commercial |
$4,273.69
|
| Rate for Payer: Humana Commercial |
$3,823.83
|
| Rate for Payer: Humana KY Medicaid |
$1,547.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,562.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.57
|
| Rate for Payer: PHCS Commercial |
$4,318.68
|
| Rate for Payer: United Healthcare All Payer |
$3,958.79
|
|
|
PLATE LCKNG RECON 3.5 4H*46
|
Facility
|
IP
|
$3,682.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.76 |
| Max. Negotiated Rate |
$3,535.47 |
| Rate for Payer: Aetna Commercial |
$2,835.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.57
|
| Rate for Payer: Cash Price |
$1,841.39
|
| Rate for Payer: Cigna Commercial |
$3,056.71
|
| Rate for Payer: First Health Commercial |
$3,498.64
|
| Rate for Payer: Humana Commercial |
$3,130.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,019.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,717.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,240.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,762.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.66
|
| Rate for Payer: PHCS Commercial |
$3,535.47
|
| Rate for Payer: United Healthcare All Payer |
$3,240.85
|
|
|
PLATE LCKNG RECON 3.5 4H*46
|
Facility
|
OP
|
$3,682.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.76 |
| Max. Negotiated Rate |
$3,535.47 |
| Rate for Payer: Aetna Commercial |
$2,835.74
|
| Rate for Payer: Anthem Medicaid |
$1,266.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.57
|
| Rate for Payer: Cash Price |
$1,841.39
|
| Rate for Payer: Cigna Commercial |
$3,056.71
|
| Rate for Payer: First Health Commercial |
$3,498.64
|
| Rate for Payer: Humana Commercial |
$3,130.36
|
| Rate for Payer: Humana KY Medicaid |
$1,266.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,019.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,717.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,291.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,240.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,762.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.66
|
| Rate for Payer: PHCS Commercial |
$3,535.47
|
| Rate for Payer: United Healthcare All Payer |
$3,240.85
|
|
|
PLATE LCKNG RECON 3.5 6H*70
|
Facility
|
IP
|
$3,928.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.75 |
| Max. Negotiated Rate |
$3,771.67 |
| Rate for Payer: Aetna Commercial |
$3,025.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.48
|
| Rate for Payer: Cash Price |
$1,964.41
|
| Rate for Payer: Cigna Commercial |
$3,260.92
|
| Rate for Payer: First Health Commercial |
$3,732.38
|
| Rate for Payer: Humana Commercial |
$3,339.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.93
|
| Rate for Payer: PHCS Commercial |
$3,771.67
|
| Rate for Payer: United Healthcare All Payer |
$3,457.36
|
|
|
PLATE LCKNG RECON 3.5 6H*70
|
Facility
|
OP
|
$3,928.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.75 |
| Max. Negotiated Rate |
$3,771.67 |
| Rate for Payer: Aetna Commercial |
$3,025.19
|
| Rate for Payer: Anthem Medicaid |
$1,351.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.48
|
| Rate for Payer: Cash Price |
$1,964.41
|
| Rate for Payer: Cigna Commercial |
$3,260.92
|
| Rate for Payer: First Health Commercial |
$3,732.38
|
| Rate for Payer: Humana Commercial |
$3,339.50
|
| Rate for Payer: Humana KY Medicaid |
$1,351.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,364.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,378.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.93
|
| Rate for Payer: PHCS Commercial |
$3,771.67
|
| Rate for Payer: United Healthcare All Payer |
$3,457.36
|
|
|
PLATE LCKNG RECON 3.5 8H*94
|
Facility
|
OP
|
$4,103.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.47 |
| Max. Negotiated Rate |
$3,939.50 |
| Rate for Payer: Aetna Commercial |
$3,159.81
|
| Rate for Payer: Anthem Medicaid |
$1,411.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.85
|
| Rate for Payer: Cash Price |
$2,051.82
|
| Rate for Payer: Cigna Commercial |
$3,406.03
|
| Rate for Payer: First Health Commercial |
$3,898.47
|
| Rate for Payer: Humana Commercial |
$3,488.10
|
| Rate for Payer: Humana KY Medicaid |
$1,411.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,077.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.13
|
| Rate for Payer: PHCS Commercial |
$3,939.50
|
| Rate for Payer: United Healthcare All Payer |
$3,611.21
|
|
|
PLATE LCKNG RECON 3.5 8H*94
|
Facility
|
IP
|
$4,103.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.47 |
| Max. Negotiated Rate |
$3,939.50 |
| Rate for Payer: Aetna Commercial |
$3,159.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.85
|
| Rate for Payer: Cash Price |
$2,051.82
|
| Rate for Payer: Cigna Commercial |
$3,406.03
|
| Rate for Payer: First Health Commercial |
$3,898.47
|
| Rate for Payer: Humana Commercial |
$3,488.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,077.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.13
|
| Rate for Payer: PHCS Commercial |
$3,939.50
|
| Rate for Payer: United Healthcare All Payer |
$3,611.21
|
|
|
PLATE LCK RECON 2.7M 10H*81M
|
Facility
|
OP
|
$4,220.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.63 |
| Max. Negotiated Rate |
$4,051.39 |
| Rate for Payer: Aetna Commercial |
$3,249.55
|
| Rate for Payer: Anthem Medicaid |
$1,451.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,291.76
|
| Rate for Payer: Cash Price |
$2,110.10
|
| Rate for Payer: Cigna Commercial |
$3,502.77
|
| Rate for Payer: First Health Commercial |
$4,009.19
|
| Rate for Payer: Humana Commercial |
$3,587.17
|
| Rate for Payer: Humana KY Medicaid |
$1,451.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,466.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,460.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,114.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,480.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,713.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,165.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.26
|
| Rate for Payer: PHCS Commercial |
$4,051.39
|
| Rate for Payer: United Healthcare All Payer |
$3,713.78
|
|
|
PLATE LCK RECON 2.7M 10H*81M
|
Facility
|
IP
|
$4,220.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.63 |
| Max. Negotiated Rate |
$4,051.39 |
| Rate for Payer: Aetna Commercial |
$3,249.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,291.76
|
| Rate for Payer: Cash Price |
$2,110.10
|
| Rate for Payer: Cigna Commercial |
$3,502.77
|
| Rate for Payer: First Health Commercial |
$4,009.19
|
| Rate for Payer: Humana Commercial |
$3,587.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,460.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,114.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,713.78
|
| Rate for Payer: Ohio Health Group HMO |
$3,165.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,308.26
|
| Rate for Payer: PHCS Commercial |
$4,051.39
|
| Rate for Payer: United Healthcare All Payer |
$3,713.78
|
|
|
PLATE LCK RECON 2.7M 12H*97M
|
Facility
|
OP
|
$4,388.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.51 |
| Max. Negotiated Rate |
$4,213.01 |
| Rate for Payer: Aetna Commercial |
$3,379.18
|
| Rate for Payer: Anthem Medicaid |
$1,509.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,423.07
|
| Rate for Payer: Cash Price |
$2,194.28
|
| Rate for Payer: Cigna Commercial |
$3,642.50
|
| Rate for Payer: First Health Commercial |
$4,169.12
|
| Rate for Payer: Humana Commercial |
$3,730.27
|
| Rate for Payer: Humana KY Medicaid |
$1,509.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,524.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,598.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,238.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,539.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,291.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.45
|
| Rate for Payer: PHCS Commercial |
$4,213.01
|
| Rate for Payer: United Healthcare All Payer |
$3,861.92
|
|
|
PLATE LCK RECON 2.7M 12H*97M
|
Facility
|
IP
|
$4,388.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$570.51 |
| Max. Negotiated Rate |
$4,213.01 |
| Rate for Payer: Aetna Commercial |
$3,379.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,423.07
|
| Rate for Payer: Cash Price |
$2,194.28
|
| Rate for Payer: Cigna Commercial |
$3,642.50
|
| Rate for Payer: First Health Commercial |
$4,169.12
|
| Rate for Payer: Humana Commercial |
$3,730.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,598.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,238.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,316.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,861.92
|
| Rate for Payer: Ohio Health Group HMO |
$3,291.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$877.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$570.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.45
|
| Rate for Payer: PHCS Commercial |
$4,213.01
|
| Rate for Payer: United Healthcare All Payer |
$3,861.92
|
|
|
PLATE LCK RECON 2.7M 14H*113M
|
Facility
|
OP
|
$4,602.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.29 |
| Max. Negotiated Rate |
$4,418.14 |
| Rate for Payer: Anthem Medicaid |
$1,582.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,589.74
|
| Rate for Payer: Cash Price |
$2,301.11
|
| Rate for Payer: Cigna Commercial |
$3,819.85
|
| Rate for Payer: First Health Commercial |
$4,372.12
|
| Rate for Payer: Humana Commercial |
$3,911.90
|
| Rate for Payer: Humana KY Medicaid |
$1,582.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,598.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,773.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,396.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,614.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,049.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,451.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.69
|
| Rate for Payer: PHCS Commercial |
$4,418.14
|
| Rate for Payer: United Healthcare All Payer |
$4,049.96
|
| Rate for Payer: Aetna Commercial |
$3,543.72
|
|
|
PLATE LCK RECON 2.7M 14H*113M
|
Facility
|
IP
|
$4,602.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.29 |
| Max. Negotiated Rate |
$4,418.14 |
| Rate for Payer: Aetna Commercial |
$3,543.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,589.74
|
| Rate for Payer: Cash Price |
$2,301.11
|
| Rate for Payer: Cigna Commercial |
$3,819.85
|
| Rate for Payer: First Health Commercial |
$4,372.12
|
| Rate for Payer: Humana Commercial |
$3,911.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,773.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,396.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,380.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,049.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,451.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$920.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$598.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,426.69
|
| Rate for Payer: PHCS Commercial |
$4,418.14
|
| Rate for Payer: United Healthcare All Payer |
$4,049.96
|
|
|
PLATE LCK RECON 2.7MM 4H*32MM
|
Facility
|
OP
|
$3,721.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.81 |
| Max. Negotiated Rate |
$3,572.76 |
| Rate for Payer: Aetna Commercial |
$2,865.65
|
| Rate for Payer: Anthem Medicaid |
$1,279.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.86
|
| Rate for Payer: Cash Price |
$1,860.81
|
| Rate for Payer: Cigna Commercial |
$3,088.94
|
| Rate for Payer: First Health Commercial |
$3,535.54
|
| Rate for Payer: Humana Commercial |
$3,163.38
|
| Rate for Payer: Humana KY Medicaid |
$1,279.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.70
|
| Rate for Payer: PHCS Commercial |
$3,572.76
|
| Rate for Payer: United Healthcare All Payer |
$3,275.03
|
|
|
PLATE LCK RECON 2.7MM 4H*32MM
|
Facility
|
IP
|
$3,721.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$483.81 |
| Max. Negotiated Rate |
$3,572.76 |
| Rate for Payer: Aetna Commercial |
$2,865.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.86
|
| Rate for Payer: Cash Price |
$1,860.81
|
| Rate for Payer: Cigna Commercial |
$3,088.94
|
| Rate for Payer: First Health Commercial |
$3,535.54
|
| Rate for Payer: Humana Commercial |
$3,163.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,275.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,791.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$744.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$483.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,153.70
|
| Rate for Payer: PHCS Commercial |
$3,572.76
|
| Rate for Payer: United Healthcare All Payer |
$3,275.03
|
|
|
PLATE LCK RECON 2.7MM 6H*48MM
|
Facility
|
IP
|
$3,980.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.48 |
| Max. Negotiated Rate |
$3,821.40 |
| Rate for Payer: Aetna Commercial |
$3,065.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,104.88
|
| Rate for Payer: Cash Price |
$1,990.31
|
| Rate for Payer: Cigna Commercial |
$3,303.91
|
| Rate for Payer: First Health Commercial |
$3,781.59
|
| Rate for Payer: Humana Commercial |
$3,383.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,937.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,502.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,985.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.99
|
| Rate for Payer: PHCS Commercial |
$3,821.40
|
| Rate for Payer: United Healthcare All Payer |
$3,502.95
|
|
|
PLATE LCK RECON 2.7MM 6H*48MM
|
Facility
|
OP
|
$3,980.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$517.48 |
| Max. Negotiated Rate |
$3,821.40 |
| Rate for Payer: Aetna Commercial |
$3,065.08
|
| Rate for Payer: Anthem Medicaid |
$1,368.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,104.88
|
| Rate for Payer: Cash Price |
$1,990.31
|
| Rate for Payer: Cigna Commercial |
$3,303.91
|
| Rate for Payer: First Health Commercial |
$3,781.59
|
| Rate for Payer: Humana Commercial |
$3,383.53
|
| Rate for Payer: Humana KY Medicaid |
$1,368.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,382.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,264.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,937.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,194.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,396.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,502.95
|
| Rate for Payer: Ohio Health Group HMO |
$2,985.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$796.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$517.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,233.99
|
| Rate for Payer: PHCS Commercial |
$3,821.40
|
| Rate for Payer: United Healthcare All Payer |
$3,502.95
|
|
|
PLATE LCK RECON 2.7MM 8H*65MM
|
Facility
|
IP
|
$4,148.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.37 |
| Max. Negotiated Rate |
$3,983.02 |
| Rate for Payer: Aetna Commercial |
$3,194.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.20
|
| Rate for Payer: Cash Price |
$2,074.49
|
| Rate for Payer: Cigna Commercial |
$3,443.65
|
| Rate for Payer: First Health Commercial |
$3,941.53
|
| Rate for Payer: Humana Commercial |
$3,526.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,061.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,651.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,111.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.18
|
| Rate for Payer: PHCS Commercial |
$3,983.02
|
| Rate for Payer: United Healthcare All Payer |
$3,651.10
|
|
|
PLATE LCK RECON 2.7MM 8H*65MM
|
Facility
|
OP
|
$4,148.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.37 |
| Max. Negotiated Rate |
$3,983.02 |
| Rate for Payer: Aetna Commercial |
$3,194.71
|
| Rate for Payer: Anthem Medicaid |
$1,426.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.20
|
| Rate for Payer: Cash Price |
$2,074.49
|
| Rate for Payer: Cigna Commercial |
$3,443.65
|
| Rate for Payer: First Health Commercial |
$3,941.53
|
| Rate for Payer: Humana Commercial |
$3,526.63
|
| Rate for Payer: Humana KY Medicaid |
$1,426.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,441.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,061.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,651.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,111.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.18
|
| Rate for Payer: PHCS Commercial |
$3,983.02
|
| Rate for Payer: United Healthcare All Payer |
$3,651.10
|
|
