|
PLATE FUSION 1ST MTP/MPJ L
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 1ST MTP/MPJ L
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 1ST MTP/MPJ R
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 1ST MTP/MPJ R
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 1ST MTP REV L
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 1ST MTP REV L
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 1ST MTP REV R
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 1ST MTP REV R
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION 3.5MM
|
Facility
|
OP
|
$5,527.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.34 |
| Max. Negotiated Rate |
$5,306.70 |
| Rate for Payer: Aetna Commercial |
$4,256.41
|
| Rate for Payer: Anthem Medicaid |
$1,901.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,311.69
|
| Rate for Payer: Cash Price |
$2,763.91
|
| Rate for Payer: Cigna Commercial |
$4,588.08
|
| Rate for Payer: First Health Commercial |
$5,251.42
|
| Rate for Payer: Humana Commercial |
$4,698.64
|
| Rate for Payer: Humana KY Medicaid |
$1,901.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,920.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,532.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,079.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,939.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,864.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,145.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,422.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,809.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,814.19
|
| Rate for Payer: PHCS Commercial |
$5,306.70
|
| Rate for Payer: United Healthcare All Payer |
$4,864.47
|
|
|
PLATE FUSION 3.5MM
|
Facility
|
IP
|
$5,527.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,658.34 |
| Max. Negotiated Rate |
$5,306.70 |
| Rate for Payer: Aetna Commercial |
$4,256.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,311.69
|
| Rate for Payer: Cash Price |
$2,763.91
|
| Rate for Payer: Cigna Commercial |
$4,588.08
|
| Rate for Payer: First Health Commercial |
$5,251.42
|
| Rate for Payer: Humana Commercial |
$4,698.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,532.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,079.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,658.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,864.47
|
| Rate for Payer: Ohio Health Group HMO |
$4,145.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,422.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,809.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,814.19
|
| Rate for Payer: PHCS Commercial |
$5,306.70
|
| Rate for Payer: United Healthcare All Payer |
$4,864.47
|
|
|
PLATE FUSION DORSAL 1ST MTP L
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION DORSAL 1ST MTP L
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION DORSAL 1ST MTP R
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION DORSAL 1ST MTP R
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE FUSION LG 3.5MM
|
Facility
|
IP
|
$6,762.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$6,492.10 |
| Rate for Payer: Aetna Commercial |
$5,207.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,274.83
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cigna Commercial |
$5,612.96
|
| Rate for Payer: First Health Commercial |
$6,424.47
|
| Rate for Payer: Humana Commercial |
$5,748.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,545.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,990.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,951.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,071.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,410.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,883.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,666.19
|
| Rate for Payer: PHCS Commercial |
$6,492.10
|
| Rate for Payer: United Healthcare All Payer |
$5,951.09
|
|
|
PLATE FUSION LG 3.5MM
|
Facility
|
OP
|
$6,762.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,028.78 |
| Max. Negotiated Rate |
$6,492.10 |
| Rate for Payer: Aetna Commercial |
$5,207.20
|
| Rate for Payer: Anthem Medicaid |
$2,325.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,274.83
|
| Rate for Payer: Cash Price |
$3,381.30
|
| Rate for Payer: Cigna Commercial |
$5,612.96
|
| Rate for Payer: First Health Commercial |
$6,424.47
|
| Rate for Payer: Humana Commercial |
$5,748.21
|
| Rate for Payer: Humana KY Medicaid |
$2,325.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,349.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,545.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,990.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,028.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,372.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,951.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,071.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,410.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,883.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,666.19
|
| Rate for Payer: PHCS Commercial |
$6,492.10
|
| Rate for Payer: United Healthcare All Payer |
$5,951.09
|
|
|
PLATE GEMINUS HOOK
|
Facility
|
OP
|
$3,391.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.38 |
| Max. Negotiated Rate |
$3,255.60 |
| Rate for Payer: Aetna Commercial |
$2,611.26
|
| Rate for Payer: Anthem Medicaid |
$1,166.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.18
|
| Rate for Payer: Cash Price |
$1,695.62
|
| Rate for Payer: Cigna Commercial |
$2,814.74
|
| Rate for Payer: First Health Commercial |
$3,221.69
|
| Rate for Payer: Humana Commercial |
$2,882.56
|
| Rate for Payer: Humana KY Medicaid |
$1,166.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,178.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,780.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.96
|
| Rate for Payer: PHCS Commercial |
$3,255.60
|
| Rate for Payer: United Healthcare All Payer |
$2,984.30
|
|
|
PLATE GEMINUS HOOK
|
Facility
|
IP
|
$3,391.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,017.38 |
| Max. Negotiated Rate |
$3,255.60 |
| Rate for Payer: Aetna Commercial |
$2,611.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,645.18
|
| Rate for Payer: Cash Price |
$1,695.62
|
| Rate for Payer: Cigna Commercial |
$2,814.74
|
| Rate for Payer: First Health Commercial |
$3,221.69
|
| Rate for Payer: Humana Commercial |
$2,882.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,780.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,502.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,984.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,543.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,713.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,950.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.96
|
| Rate for Payer: PHCS Commercial |
$3,255.60
|
| Rate for Payer: United Healthcare All Payer |
$2,984.30
|
|
|
PLATE GEMINUS VOL DSRD N 4H L
|
Facility
|
IP
|
$9,170.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.10 |
| Max. Negotiated Rate |
$8,803.52 |
| Rate for Payer: Aetna Commercial |
$7,061.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,152.86
|
| Rate for Payer: Cash Price |
$4,585.16
|
| Rate for Payer: Cigna Commercial |
$7,611.37
|
| Rate for Payer: First Health Commercial |
$8,711.81
|
| Rate for Payer: Humana Commercial |
$7,794.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,519.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,767.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,069.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,336.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,978.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,327.53
|
| Rate for Payer: PHCS Commercial |
$8,803.52
|
| Rate for Payer: United Healthcare All Payer |
$8,069.89
|
|
|
PLATE GEMINUS VOL DSRD N 4H L
|
Facility
|
OP
|
$9,170.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,751.10 |
| Max. Negotiated Rate |
$8,803.52 |
| Rate for Payer: Aetna Commercial |
$7,061.15
|
| Rate for Payer: Anthem Medicaid |
$3,153.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,152.86
|
| Rate for Payer: Cash Price |
$4,585.16
|
| Rate for Payer: Cigna Commercial |
$7,611.37
|
| Rate for Payer: First Health Commercial |
$8,711.81
|
| Rate for Payer: Humana Commercial |
$7,794.78
|
| Rate for Payer: Humana KY Medicaid |
$3,153.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,185.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,519.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,767.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,751.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,216.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,069.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,877.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,336.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,978.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,327.53
|
| Rate for Payer: PHCS Commercial |
$8,803.52
|
| Rate for Payer: United Healthcare All Payer |
$8,069.89
|
|
|
PLATE GEMI VOL DIS RAD N 3H L
|
Facility
|
OP
|
$4,797.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.25 |
| Max. Negotiated Rate |
$4,605.60 |
| Rate for Payer: Aetna Commercial |
$3,694.07
|
| Rate for Payer: Anthem Medicaid |
$1,649.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,742.05
|
| Rate for Payer: Cash Price |
$2,398.75
|
| Rate for Payer: Cigna Commercial |
$3,981.93
|
| Rate for Payer: First Health Commercial |
$4,557.62
|
| Rate for Payer: Humana Commercial |
$4,077.88
|
| Rate for Payer: Humana KY Medicaid |
$1,649.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,598.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,838.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,173.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.28
|
| Rate for Payer: PHCS Commercial |
$4,605.60
|
| Rate for Payer: United Healthcare All Payer |
$4,221.80
|
|
|
PLATE GEMI VOL DIS RAD N 3H L
|
Facility
|
IP
|
$4,797.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.25 |
| Max. Negotiated Rate |
$4,605.60 |
| Rate for Payer: Aetna Commercial |
$3,694.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,742.05
|
| Rate for Payer: Cash Price |
$2,398.75
|
| Rate for Payer: Cigna Commercial |
$3,981.93
|
| Rate for Payer: First Health Commercial |
$4,557.62
|
| Rate for Payer: Humana Commercial |
$4,077.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,598.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,838.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,173.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.28
|
| Rate for Payer: PHCS Commercial |
$4,605.60
|
| Rate for Payer: United Healthcare All Payer |
$4,221.80
|
|
|
PLATE GEMI VOL DIS RAD N 3H R
|
Facility
|
IP
|
$4,797.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.25 |
| Max. Negotiated Rate |
$4,605.60 |
| Rate for Payer: Aetna Commercial |
$3,694.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,742.05
|
| Rate for Payer: Cash Price |
$2,398.75
|
| Rate for Payer: Cigna Commercial |
$3,981.93
|
| Rate for Payer: First Health Commercial |
$4,557.62
|
| Rate for Payer: Humana Commercial |
$4,077.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,598.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,838.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,173.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.28
|
| Rate for Payer: PHCS Commercial |
$4,605.60
|
| Rate for Payer: United Healthcare All Payer |
$4,221.80
|
|
|
PLATE GEMI VOL DIS RAD N 3H R
|
Facility
|
OP
|
$4,797.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.25 |
| Max. Negotiated Rate |
$4,605.60 |
| Rate for Payer: Aetna Commercial |
$3,694.07
|
| Rate for Payer: Anthem Medicaid |
$1,649.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,742.05
|
| Rate for Payer: Cash Price |
$2,398.75
|
| Rate for Payer: Cigna Commercial |
$3,981.93
|
| Rate for Payer: First Health Commercial |
$4,557.62
|
| Rate for Payer: Humana Commercial |
$4,077.88
|
| Rate for Payer: Humana KY Medicaid |
$1,649.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,666.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,682.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,598.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,838.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,173.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.28
|
| Rate for Payer: PHCS Commercial |
$4,605.60
|
| Rate for Payer: United Healthcare All Payer |
$4,221.80
|
|
|
PLATE GEMI VOL DIS RAD N 4H R
|
Facility
|
IP
|
$4,797.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,439.25 |
| Max. Negotiated Rate |
$4,605.60 |
| Rate for Payer: Aetna Commercial |
$3,694.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,742.05
|
| Rate for Payer: Cash Price |
$2,398.75
|
| Rate for Payer: Cigna Commercial |
$3,981.93
|
| Rate for Payer: First Health Commercial |
$4,557.62
|
| Rate for Payer: Humana Commercial |
$4,077.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,933.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,540.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,439.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,221.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,598.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,838.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,173.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,310.28
|
| Rate for Payer: PHCS Commercial |
$4,605.60
|
| Rate for Payer: United Healthcare All Payer |
$4,221.80
|
|
