|
PLATE LOCK LAT HOOK SS 5H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE LOCK LAT HOOK SS 7H
|
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: 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
|
| 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
|
|
|
PLATE LOCK LAT HOOK SS 7H
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE LOCK MEDIAL HOOK SS 3H
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE LOCK MEDIAL HOOK SS 3H
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE LOCK MEDIAL HOOK SS 5H
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE LOCK MEDIAL HOOK SS 5H
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE LOCK MEDIAL HOOK SS 7H
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE LOCK MEDIAL HOOK SS 7H
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE LOCK STERNAL 11H JLT
|
Facility
|
IP
|
$5,220.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.71 |
| Max. Negotiated Rate |
$5,012.02 |
| Rate for Payer: Aetna Commercial |
$4,020.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,072.26
|
| Rate for Payer: Cash Price |
$2,610.43
|
| Rate for Payer: Cigna Commercial |
$4,333.31
|
| Rate for Payer: First Health Commercial |
$4,959.81
|
| Rate for Payer: Humana Commercial |
$4,437.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,281.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,852.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,566.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,594.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,915.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.46
|
| Rate for Payer: PHCS Commercial |
$5,012.02
|
| Rate for Payer: United Healthcare All Payer |
$4,594.35
|
|
|
PLATE LOCK STERNAL 11H JLT
|
Facility
|
OP
|
$5,220.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$678.71 |
| Max. Negotiated Rate |
$5,012.02 |
| Rate for Payer: Aetna Commercial |
$4,020.05
|
| Rate for Payer: Anthem Medicaid |
$1,795.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,072.26
|
| Rate for Payer: Cash Price |
$2,610.43
|
| Rate for Payer: Cigna Commercial |
$4,333.31
|
| Rate for Payer: First Health Commercial |
$4,959.81
|
| Rate for Payer: Humana Commercial |
$4,437.72
|
| Rate for Payer: Humana KY Medicaid |
$1,795.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,813.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,281.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,852.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,566.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,831.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,594.35
|
| Rate for Payer: Ohio Health Group HMO |
$3,915.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,044.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$678.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,618.46
|
| Rate for Payer: PHCS Commercial |
$5,012.02
|
| Rate for Payer: United Healthcare All Payer |
$4,594.35
|
|
|
PLATE LOCK STERNAL 14H Y SHP
|
Facility
|
IP
|
$4,732.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.24 |
| Max. Negotiated Rate |
$4,543.30 |
| Rate for Payer: Aetna Commercial |
$3,644.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,691.43
|
| Rate for Payer: Cash Price |
$2,366.30
|
| Rate for Payer: Cigna Commercial |
$3,928.06
|
| Rate for Payer: First Health Commercial |
$4,495.97
|
| Rate for Payer: Humana Commercial |
$4,022.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,880.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,492.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,164.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,549.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.11
|
| Rate for Payer: PHCS Commercial |
$4,543.30
|
| Rate for Payer: United Healthcare All Payer |
$4,164.69
|
|
|
PLATE LOCK STERNAL 14H Y SHP
|
Facility
|
OP
|
$4,732.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.24 |
| Max. Negotiated Rate |
$4,543.30 |
| Rate for Payer: Aetna Commercial |
$3,644.10
|
| Rate for Payer: Anthem Medicaid |
$1,627.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,691.43
|
| Rate for Payer: Cash Price |
$2,366.30
|
| Rate for Payer: Cigna Commercial |
$3,928.06
|
| Rate for Payer: First Health Commercial |
$4,495.97
|
| Rate for Payer: Humana Commercial |
$4,022.71
|
| Rate for Payer: Humana KY Medicaid |
$1,627.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,880.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,492.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,164.69
|
| Rate for Payer: Ohio Health Group HMO |
$3,549.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.11
|
| Rate for Payer: PHCS Commercial |
$4,543.30
|
| Rate for Payer: United Healthcare All Payer |
$4,164.69
|
|
|
PLATE LOCK STERNAL 18H LADDER
|
Facility
|
IP
|
$6,475.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.80 |
| Max. Negotiated Rate |
$6,216.36 |
| Rate for Payer: Aetna Commercial |
$4,986.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,050.79
|
| Rate for Payer: Cash Price |
$3,237.68
|
| Rate for Payer: Cigna Commercial |
$5,374.56
|
| Rate for Payer: First Health Commercial |
$6,151.60
|
| Rate for Payer: Humana Commercial |
$5,504.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,309.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,778.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,942.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,698.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,856.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,007.36
|
| Rate for Payer: PHCS Commercial |
$6,216.36
|
| Rate for Payer: United Healthcare All Payer |
$5,698.33
|
|
|
PLATE LOCK STERNAL 18H LADDER
|
Facility
|
OP
|
$6,475.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$841.80 |
| Max. Negotiated Rate |
$6,216.36 |
| Rate for Payer: Aetna Commercial |
$4,986.03
|
| Rate for Payer: Anthem Medicaid |
$2,226.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,050.79
|
| Rate for Payer: Cash Price |
$3,237.68
|
| Rate for Payer: Cigna Commercial |
$5,374.56
|
| Rate for Payer: First Health Commercial |
$6,151.60
|
| Rate for Payer: Humana Commercial |
$5,504.06
|
| Rate for Payer: Humana KY Medicaid |
$2,226.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,249.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,309.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,778.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,942.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,271.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,698.33
|
| Rate for Payer: Ohio Health Group HMO |
$4,856.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,295.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$841.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,007.36
|
| Rate for Payer: PHCS Commercial |
$6,216.36
|
| Rate for Payer: United Healthcare All Payer |
$5,698.33
|
|
|
PLATE LOCK STERNAL 26H LADDER
|
Facility
|
OP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem Medicaid |
$2,237.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Humana KY Medicaid |
$2,237.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,260.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,282.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
PLATE LOCK STERNAL 26H LADDER
|
Facility
|
IP
|
$6,505.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.71 |
| Max. Negotiated Rate |
$6,245.26 |
| Rate for Payer: Aetna Commercial |
$5,009.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,074.27
|
| Rate for Payer: Cash Price |
$3,252.74
|
| Rate for Payer: Cigna Commercial |
$5,399.55
|
| Rate for Payer: First Health Commercial |
$6,180.21
|
| Rate for Payer: Humana Commercial |
$5,529.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,334.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,801.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,951.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,724.82
|
| Rate for Payer: Ohio Health Group HMO |
$4,879.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,016.70
|
| Rate for Payer: PHCS Commercial |
$6,245.26
|
| Rate for Payer: United Healthcare All Payer |
$5,724.82
|
|
|
PLATE LOCK STERNAL 34H LADDER
|
Facility
|
IP
|
$7,731.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.05 |
| Max. Negotiated Rate |
$7,421.90 |
| Rate for Payer: Aetna Commercial |
$5,952.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,030.30
|
| Rate for Payer: Cash Price |
$3,865.57
|
| Rate for Payer: Cigna Commercial |
$6,416.85
|
| Rate for Payer: First Health Commercial |
$7,344.59
|
| Rate for Payer: Humana Commercial |
$6,571.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,339.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,705.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,803.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,798.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,396.66
|
| Rate for Payer: PHCS Commercial |
$7,421.90
|
| Rate for Payer: United Healthcare All Payer |
$6,803.41
|
|
|
PLATE LOCK STERNAL 34H LADDER
|
Facility
|
OP
|
$7,731.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,005.05 |
| Max. Negotiated Rate |
$7,421.90 |
| Rate for Payer: Aetna Commercial |
$5,952.99
|
| Rate for Payer: Anthem Medicaid |
$2,658.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,030.30
|
| Rate for Payer: Cash Price |
$3,865.57
|
| Rate for Payer: Cigna Commercial |
$6,416.85
|
| Rate for Payer: First Health Commercial |
$7,344.59
|
| Rate for Payer: Humana Commercial |
$6,571.48
|
| Rate for Payer: Humana KY Medicaid |
$2,658.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,685.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,339.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,705.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,712.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,803.41
|
| Rate for Payer: Ohio Health Group HMO |
$5,798.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,546.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,005.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,396.66
|
| Rate for Payer: PHCS Commercial |
$7,421.90
|
| Rate for Payer: United Healthcare All Payer |
$6,803.41
|
|
|
PLATE LOCK STERNAL 4H ANGLE
|
Facility
|
OP
|
$4,107.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.98 |
| Max. Negotiated Rate |
$3,943.20 |
| Rate for Payer: Anthem Medicaid |
$1,412.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,203.85
|
| Rate for Payer: Cash Price |
$2,053.75
|
| Rate for Payer: Cigna Commercial |
$3,409.22
|
| Rate for Payer: First Health Commercial |
$3,902.12
|
| Rate for Payer: Humana Commercial |
$3,491.38
|
| Rate for Payer: Humana KY Medicaid |
$1,412.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,426.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,368.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,031.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,232.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,440.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,614.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,080.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$821.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,273.32
|
| Rate for Payer: PHCS Commercial |
$3,943.20
|
| Rate for Payer: United Healthcare All Payer |
$3,614.60
|
| Rate for Payer: Aetna Commercial |
$3,162.78
|
|
|
PLATE LOCK STERNAL 4H ANGLE
|
Facility
|
IP
|
$4,107.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.98 |
| Max. Negotiated Rate |
$3,943.20 |
| Rate for Payer: Aetna Commercial |
$3,162.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,203.85
|
| Rate for Payer: Cash Price |
$2,053.75
|
| Rate for Payer: Cigna Commercial |
$3,409.22
|
| Rate for Payer: First Health Commercial |
$3,902.12
|
| Rate for Payer: Humana Commercial |
$3,491.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,368.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,031.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,232.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,614.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,080.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$821.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,273.32
|
| Rate for Payer: PHCS Commercial |
$3,943.20
|
| Rate for Payer: United Healthcare All Payer |
$3,614.60
|
|
|
PLATE LOCK STERNAL 6H FOOTBALL
|
Facility
|
OP
|
$4,093.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.11 |
| Max. Negotiated Rate |
$3,929.42 |
| Rate for Payer: Aetna Commercial |
$3,151.73
|
| Rate for Payer: Anthem Medicaid |
$1,407.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,192.66
|
| Rate for Payer: Cash Price |
$2,046.58
|
| Rate for Payer: Cigna Commercial |
$3,397.31
|
| Rate for Payer: First Health Commercial |
$3,888.49
|
| Rate for Payer: Humana Commercial |
$3,479.18
|
| Rate for Payer: Humana KY Medicaid |
$1,407.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,421.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,356.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,020.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,435.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,601.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,069.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$532.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,268.88
|
| Rate for Payer: PHCS Commercial |
$3,929.42
|
| Rate for Payer: United Healthcare All Payer |
$3,601.97
|
|
|
PLATE LOCK STERNAL 6H FOOTBALL
|
Facility
|
IP
|
$4,093.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$532.11 |
| Max. Negotiated Rate |
$3,929.42 |
| Rate for Payer: Aetna Commercial |
$3,151.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,192.66
|
| Rate for Payer: Cash Price |
$2,046.58
|
| Rate for Payer: Cigna Commercial |
$3,397.31
|
| Rate for Payer: First Health Commercial |
$3,888.49
|
| Rate for Payer: Humana Commercial |
$3,479.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,356.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,020.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,227.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,601.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,069.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$818.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$532.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,268.88
|
| Rate for Payer: PHCS Commercial |
$3,929.42
|
| Rate for Payer: United Healthcare All Payer |
$3,601.97
|
|
|
PLATE LOCK STERNAL 8H LADDER
|
Facility
|
IP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
|
PLATE LOCK STERNAL 8H LADDER
|
Facility
|
OP
|
$4,779.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.38 |
| Max. Negotiated Rate |
$4,588.66 |
| Rate for Payer: Aetna Commercial |
$3,680.48
|
| Rate for Payer: Anthem Medicaid |
$1,643.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,728.28
|
| Rate for Payer: Cash Price |
$2,389.93
|
| Rate for Payer: Cigna Commercial |
$3,967.28
|
| Rate for Payer: First Health Commercial |
$4,540.86
|
| Rate for Payer: Humana Commercial |
$4,062.87
|
| Rate for Payer: Humana KY Medicaid |
$1,643.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,919.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,527.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,206.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$955.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$621.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,481.75
|
| Rate for Payer: PHCS Commercial |
$4,588.66
|
| Rate for Payer: United Healthcare All Payer |
$4,206.27
|
|
