|
PLATE LOCKING RECON 3.5MM 10H
|
Facility
|
OP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.99 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem Medicaid |
$1,452.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Humana KY Medicaid |
$1,452.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,467.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,481.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.13
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLATE LOCKING RECON 3.5MM 10H
|
Facility
|
IP
|
$4,223.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$548.99 |
| Max. Negotiated Rate |
$4,054.08 |
| Rate for Payer: Aetna Commercial |
$3,251.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,293.94
|
| Rate for Payer: Cash Price |
$2,111.50
|
| Rate for Payer: Cigna Commercial |
$3,505.09
|
| Rate for Payer: First Health Commercial |
$4,011.85
|
| Rate for Payer: Humana Commercial |
$3,589.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,462.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,116.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,266.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,716.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,167.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$844.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$548.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,309.13
|
| Rate for Payer: PHCS Commercial |
$4,054.08
|
| Rate for Payer: United Healthcare All Payer |
$3,716.24
|
|
|
PLATE LOCKING RECON 3.5MM 12H
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.10 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.70
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
PLATE LOCKING RECON 3.5MM 12H
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$568.10 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$3,364.90
|
| Rate for Payer: Anthem Medicaid |
$1,502.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,408.60
|
| Rate for Payer: Cash Price |
$2,185.00
|
| Rate for Payer: Cigna Commercial |
$3,627.10
|
| Rate for Payer: First Health Commercial |
$4,151.50
|
| Rate for Payer: Humana Commercial |
$3,714.50
|
| Rate for Payer: Humana KY Medicaid |
$1,502.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,518.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,583.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,225.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,311.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,533.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,845.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,277.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$874.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$568.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,354.70
|
| Rate for Payer: PHCS Commercial |
$4,195.20
|
| Rate for Payer: United Healthcare All Payer |
$3,845.60
|
|
|
PLATE LOCKING RECON 3.5MM 4H
|
Facility
|
IP
|
$3,708.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.10 |
| Max. Negotiated Rate |
$3,560.16 |
| Rate for Payer: Aetna Commercial |
$2,855.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,892.63
|
| Rate for Payer: Cash Price |
$1,854.25
|
| Rate for Payer: Cigna Commercial |
$3,078.06
|
| Rate for Payer: First Health Commercial |
$3,523.08
|
| Rate for Payer: Humana Commercial |
$3,152.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,040.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,736.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,112.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,263.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,781.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,149.64
|
| Rate for Payer: PHCS Commercial |
$3,560.16
|
| Rate for Payer: United Healthcare All Payer |
$3,263.48
|
|
|
PLATE LOCKING RECON 3.5MM 4H
|
Facility
|
OP
|
$3,708.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$482.10 |
| Max. Negotiated Rate |
$3,560.16 |
| Rate for Payer: Aetna Commercial |
$2,855.54
|
| Rate for Payer: Anthem Medicaid |
$1,275.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,892.63
|
| Rate for Payer: Cash Price |
$1,854.25
|
| Rate for Payer: Cigna Commercial |
$3,078.06
|
| Rate for Payer: First Health Commercial |
$3,523.08
|
| Rate for Payer: Humana Commercial |
$3,152.22
|
| Rate for Payer: Humana KY Medicaid |
$1,275.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,288.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,040.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,736.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,112.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,300.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,263.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,781.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$741.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$482.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,149.64
|
| Rate for Payer: PHCS Commercial |
$3,560.16
|
| Rate for Payer: United Healthcare All Payer |
$3,263.48
|
|
|
PLATE LOCKING RECON 3.5MM 6H
|
Facility
|
OP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem Medicaid |
$1,363.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Humana KY Medicaid |
$1,363.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,377.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,390.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE LOCKING RECON 3.5MM 6H
|
Facility
|
IP
|
$3,964.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,805.44 |
| Rate for Payer: Aetna Commercial |
$3,052.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,091.92
|
| Rate for Payer: Cash Price |
$1,982.00
|
| Rate for Payer: Cigna Commercial |
$3,290.12
|
| Rate for Payer: First Health Commercial |
$3,765.80
|
| Rate for Payer: Humana Commercial |
$3,369.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,250.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,925.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,189.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,488.32
|
| Rate for Payer: Ohio Health Group HMO |
$2,973.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$792.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$515.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,228.84
|
| Rate for Payer: PHCS Commercial |
$3,805.44
|
| Rate for Payer: United Healthcare All Payer |
$3,488.32
|
|
|
PLATE LOCKING RECON 3.5MM 8H
|
Facility
|
OP
|
$4,149.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.44 |
| Max. Negotiated Rate |
$3,983.52 |
| Rate for Payer: Kentucky WC Medicaid |
$1,441.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,062.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,651.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.34
|
| Rate for Payer: PHCS Commercial |
$3,983.52
|
| Rate for Payer: United Healthcare All Payer |
$3,651.56
|
| Rate for Payer: Aetna Commercial |
$3,195.12
|
| Rate for Payer: Anthem Medicaid |
$1,427.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.61
|
| Rate for Payer: Cash Price |
$2,074.75
|
| Rate for Payer: Cigna Commercial |
$3,444.08
|
| Rate for Payer: First Health Commercial |
$3,942.02
|
| Rate for Payer: Humana Commercial |
$3,527.08
|
| Rate for Payer: Humana KY Medicaid |
$1,427.01
|
|
|
PLATE LOCKING RECON 3.5MM 8H
|
Facility
|
IP
|
$4,149.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.44 |
| Max. Negotiated Rate |
$3,983.52 |
| Rate for Payer: Aetna Commercial |
$3,195.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,236.61
|
| Rate for Payer: Cash Price |
$2,074.75
|
| Rate for Payer: Cigna Commercial |
$3,444.08
|
| Rate for Payer: First Health Commercial |
$3,942.02
|
| Rate for Payer: Humana Commercial |
$3,527.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,402.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,062.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,244.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,651.56
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$829.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.34
|
| Rate for Payer: PHCS Commercial |
$3,983.52
|
| Rate for Payer: United Healthcare All Payer |
$3,651.56
|
|
|
PLATE LOCKING SS STR 10H
|
Facility
|
OP
|
$4,282.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.72 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Aetna Commercial |
$3,297.52
|
| Rate for Payer: Anthem Medicaid |
$1,472.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.35
|
| Rate for Payer: Cash Price |
$2,141.25
|
| Rate for Payer: Cigna Commercial |
$3,554.48
|
| Rate for Payer: First Health Commercial |
$4,068.38
|
| Rate for Payer: Humana Commercial |
$3,640.12
|
| Rate for Payer: Humana KY Medicaid |
$1,472.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,502.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.58
|
| Rate for Payer: PHCS Commercial |
$4,111.20
|
| Rate for Payer: United Healthcare All Payer |
$3,768.60
|
|
|
PLATE LOCKING SS STR 10H
|
Facility
|
IP
|
$4,282.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$556.72 |
| Max. Negotiated Rate |
$4,111.20 |
| Rate for Payer: Aetna Commercial |
$3,297.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.35
|
| Rate for Payer: Cash Price |
$2,141.25
|
| Rate for Payer: Cigna Commercial |
$3,554.48
|
| Rate for Payer: First Health Commercial |
$4,068.38
|
| Rate for Payer: Humana Commercial |
$3,640.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$856.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$556.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,327.58
|
| Rate for Payer: PHCS Commercial |
$4,111.20
|
| Rate for Payer: United Healthcare All Payer |
$3,768.60
|
|
|
PLATE LOCKING SS STR 12H
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE LOCKING SS STR 12H
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE LOCKING SS STR 4H
|
Facility
|
OP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem Medicaid |
$1,298.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Humana KY Medicaid |
$1,298.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,311.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,324.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
PLATE LOCKING SS STR 4H
|
Facility
|
IP
|
$3,775.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.75 |
| Max. Negotiated Rate |
$3,624.00 |
| Rate for Payer: Aetna Commercial |
$2,906.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,944.50
|
| Rate for Payer: Cash Price |
$1,887.50
|
| Rate for Payer: Cigna Commercial |
$3,133.25
|
| Rate for Payer: First Health Commercial |
$3,586.25
|
| Rate for Payer: Humana Commercial |
$3,208.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,095.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,785.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,132.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,322.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,831.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$755.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$490.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,170.25
|
| Rate for Payer: PHCS Commercial |
$3,624.00
|
| Rate for Payer: United Healthcare All Payer |
$3,322.00
|
|
|
PLATE LOCKING SS STR 6H
|
Facility
|
OP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem Medicaid |
$1,328.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Humana KY Medicaid |
$1,328.31
|
| Rate for Payer: Kentucky WC Medicaid |
$1,341.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,354.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
PLATE LOCKING SS STR 6H
|
Facility
|
IP
|
$3,862.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$2,974.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,012.75
|
| Rate for Payer: Cash Price |
$1,931.25
|
| Rate for Payer: Cigna Commercial |
$3,205.88
|
| Rate for Payer: First Health Commercial |
$3,669.38
|
| Rate for Payer: Humana Commercial |
$3,283.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,167.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,850.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,158.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,399.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,896.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$772.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$502.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,197.38
|
| Rate for Payer: PHCS Commercial |
$3,708.00
|
| Rate for Payer: United Healthcare All Payer |
$3,399.00
|
|
|
PLATE LOCKING SS STR 7H
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
|
|
PLATE LOCKING SS STR 7H
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE LOCKING SS STR 8H
|
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 LOCKING SS STR 8H
|
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 LAT HOOK SS 3H
|
Facility
|
OP
|
$4,772.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.42 |
| Max. Negotiated Rate |
$4,581.60 |
| Rate for Payer: Aetna Commercial |
$3,674.82
|
| Rate for Payer: Anthem Medicaid |
$1,641.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,722.55
|
| Rate for Payer: Cash Price |
$2,386.25
|
| Rate for Payer: Cigna Commercial |
$3,961.18
|
| Rate for Payer: First Health Commercial |
$4,533.88
|
| Rate for Payer: Humana Commercial |
$4,056.62
|
| Rate for Payer: Humana KY Medicaid |
$1,641.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,657.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,913.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,522.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,431.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,674.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,199.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,579.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$954.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.48
|
| Rate for Payer: PHCS Commercial |
$4,581.60
|
| Rate for Payer: United Healthcare All Payer |
$4,199.80
|
|
|
PLATE LOCK LAT HOOK SS 3H
|
Facility
|
IP
|
$4,772.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$620.42 |
| Max. Negotiated Rate |
$4,581.60 |
| Rate for Payer: Aetna Commercial |
$3,674.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,722.55
|
| Rate for Payer: Cash Price |
$2,386.25
|
| Rate for Payer: Cigna Commercial |
$3,961.18
|
| Rate for Payer: First Health Commercial |
$4,533.88
|
| Rate for Payer: Humana Commercial |
$4,056.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,913.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,522.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,431.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,199.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,579.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$954.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$620.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,479.48
|
| Rate for Payer: PHCS Commercial |
$4,581.60
|
| Rate for Payer: United Healthcare All Payer |
$4,199.80
|
|
|
PLATE LOCK LAT HOOK SS 5H
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
