PLATE LOCK 1/3 TUB 7H 89MM
|
Facility
|
OP
|
$1,859.60
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$241.75 |
Max. Negotiated Rate |
$1,785.22 |
Rate for Payer: Aetna Commercial |
$1,431.89
|
Rate for Payer: Anthem Medicaid |
$639.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$1,450.49
|
Rate for Payer: Cash Price |
$929.80
|
Rate for Payer: Cigna Commercial |
$1,543.47
|
Rate for Payer: First Health Commercial |
$1,766.62
|
Rate for Payer: Humana Commercial |
$1,580.66
|
Rate for Payer: Humana KY Medicaid |
$639.52
|
Rate for Payer: Kentucky WC Medicaid |
$646.03
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$1,524.87
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,372.38
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$557.88
|
Rate for Payer: Molina Healthcare Medicaid |
$652.35
|
Rate for Payer: Ohio Health Choice Commercial |
$1,636.45
|
Rate for Payer: Ohio Health Group HMO |
$1,394.70
|
Rate for Payer: Ohio Health Group PPO Differential |
$371.92
|
Rate for Payer: Ohio Health Group PPO No Differential |
$241.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$576.48
|
Rate for Payer: PHCS Commercial |
$1,785.22
|
Rate for Payer: United Healthcare All Payer |
$1,636.45
|
|
PLATE LOCK DIST FIB LEFT 8H
|
Facility
|
IP
|
$5,262.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$684.12 |
Max. Negotiated Rate |
$5,052.00 |
Rate for Payer: Aetna Commercial |
$4,052.12
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,104.75
|
Rate for Payer: Cash Price |
$2,631.25
|
Rate for Payer: Cigna Commercial |
$4,367.88
|
Rate for Payer: First Health Commercial |
$4,999.38
|
Rate for Payer: Humana Commercial |
$4,473.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,315.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,883.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,578.75
|
Rate for Payer: Ohio Health Choice Commercial |
$4,631.00
|
Rate for Payer: Ohio Health Group HMO |
$3,946.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,052.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$684.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,631.38
|
Rate for Payer: PHCS Commercial |
$5,052.00
|
Rate for Payer: United Healthcare All Payer |
$4,631.00
|
|
PLATE LOCK DIST FIB LEFT 8H
|
Facility
|
OP
|
$5,262.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$684.12 |
Max. Negotiated Rate |
$5,052.00 |
Rate for Payer: Aetna Commercial |
$4,052.12
|
Rate for Payer: Anthem Medicaid |
$1,809.77
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,104.75
|
Rate for Payer: Cash Price |
$2,631.25
|
Rate for Payer: Cigna Commercial |
$4,367.88
|
Rate for Payer: First Health Commercial |
$4,999.38
|
Rate for Payer: Humana Commercial |
$4,473.12
|
Rate for Payer: Humana KY Medicaid |
$1,809.77
|
Rate for Payer: Kentucky WC Medicaid |
$1,828.19
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,315.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,883.72
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,578.75
|
Rate for Payer: Molina Healthcare Medicaid |
$1,846.08
|
Rate for Payer: Ohio Health Choice Commercial |
$4,631.00
|
Rate for Payer: Ohio Health Group HMO |
$3,946.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,052.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$684.12
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,631.38
|
Rate for Payer: PHCS Commercial |
$5,052.00
|
Rate for Payer: United Healthcare All Payer |
$4,631.00
|
|
PLATE LOCK DIST FIB SS 10H R
|
Facility
|
IP
|
$5,175.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$672.75 |
Max. Negotiated Rate |
$4,968.00 |
Rate for Payer: Aetna Commercial |
$3,984.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.50
|
Rate for Payer: Cash Price |
$2,587.50
|
Rate for Payer: Cigna Commercial |
$4,295.25
|
Rate for Payer: First Health Commercial |
$4,916.25
|
Rate for Payer: Humana Commercial |
$4,398.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,819.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.50
|
Rate for Payer: Ohio Health Choice Commercial |
$4,554.00
|
Rate for Payer: Ohio Health Group HMO |
$3,881.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,035.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$672.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
Rate for Payer: PHCS Commercial |
$4,968.00
|
Rate for Payer: United Healthcare All Payer |
$4,554.00
|
|
PLATE LOCK DIST FIB SS 10H R
|
Facility
|
OP
|
$5,175.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$672.75 |
Max. Negotiated Rate |
$4,968.00 |
Rate for Payer: Aetna Commercial |
$3,984.75
|
Rate for Payer: Anthem Medicaid |
$1,779.68
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,036.50
|
Rate for Payer: Cash Price |
$2,587.50
|
Rate for Payer: Cigna Commercial |
$4,295.25
|
Rate for Payer: First Health Commercial |
$4,916.25
|
Rate for Payer: Humana Commercial |
$4,398.75
|
Rate for Payer: Humana KY Medicaid |
$1,779.68
|
Rate for Payer: Kentucky WC Medicaid |
$1,797.80
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,243.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,819.15
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,552.50
|
Rate for Payer: Molina Healthcare Medicaid |
$1,815.39
|
Rate for Payer: Ohio Health Choice Commercial |
$4,554.00
|
Rate for Payer: Ohio Health Group HMO |
$3,881.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,035.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$672.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,604.25
|
Rate for Payer: PHCS Commercial |
$4,968.00
|
Rate for Payer: United Healthcare All Payer |
$4,554.00
|
|
PLATE LOCK DIST FIB SS LEFT 4H
|
Facility
|
OP
|
$4,125.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$536.25 |
Max. Negotiated Rate |
$3,960.00 |
Rate for Payer: Aetna Commercial |
$3,176.25
|
Rate for Payer: Aetna Commercial |
$3,434.29
|
Rate for Payer: Anthem Medicaid |
$1,418.59
|
Rate for Payer: Anthem Medicaid |
$1,533.84
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,478.89
|
Rate for Payer: Cash Price |
$2,062.50
|
Rate for Payer: Cash Price |
$2,230.06
|
Rate for Payer: Cigna Commercial |
$3,701.90
|
Rate for Payer: Cigna Commercial |
$3,423.75
|
Rate for Payer: First Health Commercial |
$4,237.11
|
Rate for Payer: First Health Commercial |
$3,918.75
|
Rate for Payer: Humana Commercial |
$3,506.25
|
Rate for Payer: Humana Commercial |
$3,791.10
|
Rate for Payer: Humana KY Medicaid |
$1,418.59
|
Rate for Payer: Humana KY Medicaid |
$1,533.84
|
Rate for Payer: Kentucky WC Medicaid |
$1,549.45
|
Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,657.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,291.57
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.04
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
Rate for Payer: Molina Healthcare Medicaid |
$1,564.61
|
Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
Rate for Payer: Ohio Health Choice Commercial |
$3,924.91
|
Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
Rate for Payer: Ohio Health Group HMO |
$3,345.09
|
Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$892.02
|
Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$579.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.64
|
Rate for Payer: PHCS Commercial |
$4,281.72
|
Rate for Payer: PHCS Commercial |
$3,960.00
|
Rate for Payer: United Healthcare All Payer |
$3,924.91
|
Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
PLATE LOCK DIST FIB SS LEFT 4H
|
Facility
|
IP
|
$4,125.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$536.25 |
Max. Negotiated Rate |
$3,960.00 |
Rate for Payer: Aetna Commercial |
$3,176.25
|
Rate for Payer: Aetna Commercial |
$3,434.29
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,478.89
|
Rate for Payer: Cash Price |
$2,062.50
|
Rate for Payer: Cash Price |
$2,230.06
|
Rate for Payer: Cigna Commercial |
$3,423.75
|
Rate for Payer: Cigna Commercial |
$3,701.90
|
Rate for Payer: First Health Commercial |
$4,237.11
|
Rate for Payer: First Health Commercial |
$3,918.75
|
Rate for Payer: Humana Commercial |
$3,791.10
|
Rate for Payer: Humana Commercial |
$3,506.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,657.30
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,291.57
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.04
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
Rate for Payer: Ohio Health Choice Commercial |
$3,924.91
|
Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
Rate for Payer: Ohio Health Group HMO |
$3,345.09
|
Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
Rate for Payer: Ohio Health Group PPO Differential |
$892.02
|
Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
Rate for Payer: Ohio Health Group PPO No Differential |
$579.82
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.64
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
Rate for Payer: PHCS Commercial |
$3,960.00
|
Rate for Payer: PHCS Commercial |
$4,281.72
|
Rate for Payer: United Healthcare All Payer |
$3,630.00
|
Rate for Payer: United Healthcare All Payer |
$3,924.91
|
|
PLATE LOCK DIST FIB SS LEFT 5H
|
Facility
|
IP
|
$4,737.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$615.88 |
Max. Negotiated Rate |
$4,548.00 |
Rate for Payer: Aetna Commercial |
$3,647.88
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
Rate for Payer: Cash Price |
$2,368.75
|
Rate for Payer: Cigna Commercial |
$3,932.12
|
Rate for Payer: First Health Commercial |
$4,500.62
|
Rate for Payer: Humana Commercial |
$4,026.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
Rate for Payer: PHCS Commercial |
$4,548.00
|
Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
PLATE LOCK DIST FIB SS LEFT 5H
|
Facility
|
OP
|
$4,737.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$615.88 |
Max. Negotiated Rate |
$4,548.00 |
Rate for Payer: Aetna Commercial |
$3,647.88
|
Rate for Payer: Anthem Medicaid |
$1,629.23
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
Rate for Payer: Cash Price |
$2,368.75
|
Rate for Payer: Cigna Commercial |
$3,932.12
|
Rate for Payer: First Health Commercial |
$4,500.62
|
Rate for Payer: Humana Commercial |
$4,026.88
|
Rate for Payer: Humana KY Medicaid |
$1,629.23
|
Rate for Payer: Kentucky WC Medicaid |
$1,645.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
Rate for Payer: Molina Healthcare Medicaid |
$1,661.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
Rate for Payer: PHCS Commercial |
$4,548.00
|
Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
PLATE LOCK DIST FIB SS LEFT 6H
|
Facility
|
IP
|
$4,737.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$615.88 |
Max. Negotiated Rate |
$4,548.00 |
Rate for Payer: Aetna Commercial |
$3,647.88
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
Rate for Payer: Cash Price |
$2,368.75
|
Rate for Payer: Cigna Commercial |
$3,932.12
|
Rate for Payer: First Health Commercial |
$4,500.62
|
Rate for Payer: Humana Commercial |
$4,026.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
Rate for Payer: PHCS Commercial |
$4,548.00
|
Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
PLATE LOCK DIST FIB SS LEFT 6H
|
Facility
|
OP
|
$4,737.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$615.88 |
Max. Negotiated Rate |
$4,548.00 |
Rate for Payer: Aetna Commercial |
$3,647.88
|
Rate for Payer: Anthem Medicaid |
$1,629.23
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
Rate for Payer: Cash Price |
$2,368.75
|
Rate for Payer: Cigna Commercial |
$3,932.12
|
Rate for Payer: First Health Commercial |
$4,500.62
|
Rate for Payer: Humana Commercial |
$4,026.88
|
Rate for Payer: Humana KY Medicaid |
$1,629.23
|
Rate for Payer: Kentucky WC Medicaid |
$1,645.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
Rate for Payer: Molina Healthcare Medicaid |
$1,661.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
Rate for Payer: PHCS Commercial |
$4,548.00
|
Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
PLATE LOCK DIST FIB SS LEFT 8H
|
Facility
|
IP
|
$4,982.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$647.72 |
Max. Negotiated Rate |
$4,783.20 |
Rate for Payer: Aetna Commercial |
$3,836.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
Rate for Payer: Cash Price |
$2,491.25
|
Rate for Payer: Cigna Commercial |
$4,135.48
|
Rate for Payer: First Health Commercial |
$4,733.38
|
Rate for Payer: Humana Commercial |
$4,235.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
Rate for Payer: PHCS Commercial |
$4,783.20
|
Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
PLATE LOCK DIST FIB SS LEFT 8H
|
Facility
|
OP
|
$4,982.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$647.72 |
Max. Negotiated Rate |
$4,783.20 |
Rate for Payer: Aetna Commercial |
$3,836.52
|
Rate for Payer: Anthem Medicaid |
$1,713.48
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
Rate for Payer: Cash Price |
$2,491.25
|
Rate for Payer: Cigna Commercial |
$4,135.48
|
Rate for Payer: First Health Commercial |
$4,733.38
|
Rate for Payer: Humana Commercial |
$4,235.12
|
Rate for Payer: Humana KY Medicaid |
$1,713.48
|
Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
Rate for Payer: PHCS Commercial |
$4,783.20
|
Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
PLATE LOCK DIST FIB SS RGHT 4H
|
Facility
|
IP
|
$4,125.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$536.25 |
Max. Negotiated Rate |
$3,960.00 |
Rate for Payer: Aetna Commercial |
$3,176.25
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
Rate for Payer: Cash Price |
$2,062.50
|
Rate for Payer: Cigna Commercial |
$3,423.75
|
Rate for Payer: First Health Commercial |
$3,918.75
|
Rate for Payer: Humana Commercial |
$3,506.25
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
Rate for Payer: PHCS Commercial |
$3,960.00
|
Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
PLATE LOCK DIST FIB SS RGHT 4H
|
Facility
|
OP
|
$4,125.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$536.25 |
Max. Negotiated Rate |
$3,960.00 |
Rate for Payer: Aetna Commercial |
$3,176.25
|
Rate for Payer: Anthem Medicaid |
$1,418.59
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,217.50
|
Rate for Payer: Cash Price |
$2,062.50
|
Rate for Payer: Cigna Commercial |
$3,423.75
|
Rate for Payer: First Health Commercial |
$3,918.75
|
Rate for Payer: Humana Commercial |
$3,506.25
|
Rate for Payer: Humana KY Medicaid |
$1,418.59
|
Rate for Payer: Kentucky WC Medicaid |
$1,433.02
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,382.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,044.25
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,237.50
|
Rate for Payer: Molina Healthcare Medicaid |
$1,447.05
|
Rate for Payer: Ohio Health Choice Commercial |
$3,630.00
|
Rate for Payer: Ohio Health Group HMO |
$3,093.75
|
Rate for Payer: Ohio Health Group PPO Differential |
$825.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$536.25
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.75
|
Rate for Payer: PHCS Commercial |
$3,960.00
|
Rate for Payer: United Healthcare All Payer |
$3,630.00
|
|
PLATE LOCK DIST FIB SS RGHT 5H
|
Facility
|
OP
|
$4,475.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$581.75 |
Max. Negotiated Rate |
$4,296.00 |
Rate for Payer: Aetna Commercial |
$3,445.75
|
Rate for Payer: Anthem Medicaid |
$1,538.95
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
Rate for Payer: Cash Price |
$2,237.50
|
Rate for Payer: Cigna Commercial |
$3,714.25
|
Rate for Payer: First Health Commercial |
$4,251.25
|
Rate for Payer: Humana Commercial |
$3,803.75
|
Rate for Payer: Humana KY Medicaid |
$1,538.95
|
Rate for Payer: Kentucky WC Medicaid |
$1,554.62
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
Rate for Payer: Molina Healthcare Medicaid |
$1,569.83
|
Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
Rate for Payer: PHCS Commercial |
$4,296.00
|
Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
PLATE LOCK DIST FIB SS RGHT 5H
|
Facility
|
IP
|
$4,475.00
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$581.75 |
Max. Negotiated Rate |
$4,296.00 |
Rate for Payer: Aetna Commercial |
$3,445.75
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,490.50
|
Rate for Payer: Cash Price |
$2,237.50
|
Rate for Payer: Cigna Commercial |
$3,714.25
|
Rate for Payer: First Health Commercial |
$4,251.25
|
Rate for Payer: Humana Commercial |
$3,803.75
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,669.50
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,302.55
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,342.50
|
Rate for Payer: Ohio Health Choice Commercial |
$3,938.00
|
Rate for Payer: Ohio Health Group HMO |
$3,356.25
|
Rate for Payer: Ohio Health Group PPO Differential |
$895.00
|
Rate for Payer: Ohio Health Group PPO No Differential |
$581.75
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,387.25
|
Rate for Payer: PHCS Commercial |
$4,296.00
|
Rate for Payer: United Healthcare All Payer |
$3,938.00
|
|
PLATE LOCK DIST FIB SS RGHT 6H
|
Facility
|
IP
|
$4,737.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$615.88 |
Max. Negotiated Rate |
$4,548.00 |
Rate for Payer: Aetna Commercial |
$3,647.88
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
Rate for Payer: Cash Price |
$2,368.75
|
Rate for Payer: Cigna Commercial |
$3,932.12
|
Rate for Payer: First Health Commercial |
$4,500.62
|
Rate for Payer: Humana Commercial |
$4,026.88
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
Rate for Payer: PHCS Commercial |
$4,548.00
|
Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
PLATE LOCK DIST FIB SS RGHT 6H
|
Facility
|
OP
|
$4,737.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$615.88 |
Max. Negotiated Rate |
$4,548.00 |
Rate for Payer: Aetna Commercial |
$3,647.88
|
Rate for Payer: Anthem Medicaid |
$1,629.23
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,695.25
|
Rate for Payer: Cash Price |
$2,368.75
|
Rate for Payer: Cigna Commercial |
$3,932.12
|
Rate for Payer: First Health Commercial |
$4,500.62
|
Rate for Payer: Humana Commercial |
$4,026.88
|
Rate for Payer: Humana KY Medicaid |
$1,629.23
|
Rate for Payer: Kentucky WC Medicaid |
$1,645.81
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$3,884.75
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,496.28
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,421.25
|
Rate for Payer: Molina Healthcare Medicaid |
$1,661.92
|
Rate for Payer: Ohio Health Choice Commercial |
$4,169.00
|
Rate for Payer: Ohio Health Group HMO |
$3,553.12
|
Rate for Payer: Ohio Health Group PPO Differential |
$947.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$615.88
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,468.62
|
Rate for Payer: PHCS Commercial |
$4,548.00
|
Rate for Payer: United Healthcare All Payer |
$4,169.00
|
|
PLATE LOCK DIST FIB SS RGHT 8H
|
Facility
|
IP
|
$4,982.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$647.72 |
Max. Negotiated Rate |
$4,783.20 |
Rate for Payer: Aetna Commercial |
$3,836.52
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
Rate for Payer: Cash Price |
$2,491.25
|
Rate for Payer: Cigna Commercial |
$4,135.48
|
Rate for Payer: First Health Commercial |
$4,733.38
|
Rate for Payer: Humana Commercial |
$4,235.12
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
Rate for Payer: PHCS Commercial |
$4,783.20
|
Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
PLATE LOCK DIST FIB SS RGHT 8H
|
Facility
|
OP
|
$4,982.50
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$647.72 |
Max. Negotiated Rate |
$4,783.20 |
Rate for Payer: Aetna Commercial |
$3,836.52
|
Rate for Payer: Anthem Medicaid |
$1,713.48
|
Rate for Payer: Anthem POS/PPO/Traditional |
$3,886.35
|
Rate for Payer: Cash Price |
$2,491.25
|
Rate for Payer: Cigna Commercial |
$4,135.48
|
Rate for Payer: First Health Commercial |
$4,733.38
|
Rate for Payer: Humana Commercial |
$4,235.12
|
Rate for Payer: Humana KY Medicaid |
$1,713.48
|
Rate for Payer: Kentucky WC Medicaid |
$1,730.92
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,085.65
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,677.08
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.75
|
Rate for Payer: Molina Healthcare Medicaid |
$1,747.86
|
Rate for Payer: Ohio Health Choice Commercial |
$4,384.60
|
Rate for Payer: Ohio Health Group HMO |
$3,736.88
|
Rate for Payer: Ohio Health Group PPO Differential |
$996.50
|
Rate for Payer: Ohio Health Group PPO No Differential |
$647.72
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.58
|
Rate for Payer: PHCS Commercial |
$4,783.20
|
Rate for Payer: United Healthcare All Payer |
$4,384.60
|
|
PLATE LOCK DIST FIB SS RT 8H
|
Facility
|
OP
|
$5,415.62
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$704.03 |
Max. Negotiated Rate |
$5,199.00 |
Rate for Payer: Aetna Commercial |
$4,170.03
|
Rate for Payer: Anthem Medicaid |
$1,862.43
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,224.18
|
Rate for Payer: Cash Price |
$2,707.81
|
Rate for Payer: Cigna Commercial |
$4,494.96
|
Rate for Payer: First Health Commercial |
$5,144.84
|
Rate for Payer: Humana Commercial |
$4,603.28
|
Rate for Payer: Humana KY Medicaid |
$1,862.43
|
Rate for Payer: Kentucky WC Medicaid |
$1,881.39
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,440.81
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,996.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,624.69
|
Rate for Payer: Molina Healthcare Medicaid |
$1,899.80
|
Rate for Payer: Ohio Health Choice Commercial |
$4,765.75
|
Rate for Payer: Ohio Health Group HMO |
$4,061.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,083.12
|
Rate for Payer: Ohio Health Group PPO No Differential |
$704.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,678.84
|
Rate for Payer: PHCS Commercial |
$5,199.00
|
Rate for Payer: United Healthcare All Payer |
$4,765.75
|
|
PLATE LOCK DIST FIB SS RT 8H
|
Facility
|
IP
|
$5,415.62
|
|
Service Code
|
HCPCS C1713
|
Hospital Charge Code |
27000005
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$704.03 |
Max. Negotiated Rate |
$5,199.00 |
Rate for Payer: Aetna Commercial |
$4,170.03
|
Rate for Payer: Anthem POS/PPO/Traditional |
$4,224.18
|
Rate for Payer: Cash Price |
$2,707.81
|
Rate for Payer: Cigna Commercial |
$4,494.96
|
Rate for Payer: First Health Commercial |
$5,144.84
|
Rate for Payer: Humana Commercial |
$4,603.28
|
Rate for Payer: Medical Mutual Of Ohio HMO |
$4,440.81
|
Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,996.73
|
Rate for Payer: Molina Healthcare Benefit Exchange |
$1,624.69
|
Rate for Payer: Ohio Health Choice Commercial |
$4,765.75
|
Rate for Payer: Ohio Health Group HMO |
$4,061.72
|
Rate for Payer: Ohio Health Group PPO Differential |
$1,083.12
|
Rate for Payer: Ohio Health Group PPO No Differential |
$704.03
|
Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,678.84
|
Rate for Payer: PHCS Commercial |
$5,199.00
|
Rate for Payer: United Healthcare All Payer |
$4,765.75
|
|
PLATE LOCKING 4 HOLE 80MM LFT
|
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 LOCKING 4 HOLE 80MM LFT
|
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
|
|