|
PLATE HOCKEY STICK LEFT
|
Facility
|
IP
|
$3,856.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
PLATE HOCKEY STICK RIGHT
|
Facility
|
OP
|
$3,856.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem Medicaid |
$1,326.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Humana KY Medicaid |
$1,326.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
PLATE HOCKEY STICK RIGHT
|
Facility
|
IP
|
$3,856.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,156.88 |
| Max. Negotiated Rate |
$3,702.00 |
| Rate for Payer: Aetna Commercial |
$2,969.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,007.88
|
| Rate for Payer: Cash Price |
$1,928.12
|
| Rate for Payer: Cigna Commercial |
$3,200.69
|
| Rate for Payer: First Health Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial |
$3,277.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,845.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,156.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,085.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,354.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,660.81
|
| Rate for Payer: PHCS Commercial |
$3,702.00
|
| Rate for Payer: United Healthcare All Payer |
$3,393.50
|
|
|
PLATE HOOK 2H
|
Facility
|
IP
|
$3,803.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.12 |
| Max. Negotiated Rate |
$3,651.60 |
| Rate for Payer: Aetna Commercial |
$2,928.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.93
|
| Rate for Payer: Cash Price |
$1,901.88
|
| Rate for Payer: Cigna Commercial |
$3,157.11
|
| Rate for Payer: First Health Commercial |
$3,613.56
|
| Rate for Payer: Humana Commercial |
$3,233.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.59
|
| Rate for Payer: PHCS Commercial |
$3,651.60
|
| Rate for Payer: United Healthcare All Payer |
$3,347.30
|
|
|
PLATE HOOK 2H
|
Facility
|
OP
|
$3,803.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.12 |
| Max. Negotiated Rate |
$3,651.60 |
| Rate for Payer: Aetna Commercial |
$2,928.89
|
| Rate for Payer: Anthem Medicaid |
$1,308.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.93
|
| Rate for Payer: Cash Price |
$1,901.88
|
| Rate for Payer: Cigna Commercial |
$3,157.11
|
| Rate for Payer: First Health Commercial |
$3,613.56
|
| Rate for Payer: Humana Commercial |
$3,233.19
|
| Rate for Payer: Humana KY Medicaid |
$1,308.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.59
|
| Rate for Payer: PHCS Commercial |
$3,651.60
|
| Rate for Payer: United Healthcare All Payer |
$3,347.30
|
|
|
PLATE HOOK 3H
|
Facility
|
IP
|
$3,901.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.38 |
| Max. Negotiated Rate |
$3,745.20 |
| Rate for Payer: Aetna Commercial |
$3,003.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.97
|
| Rate for Payer: Cash Price |
$1,950.62
|
| Rate for Payer: Cigna Commercial |
$3,238.04
|
| Rate for Payer: First Health Commercial |
$3,706.19
|
| Rate for Payer: Humana Commercial |
$3,316.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.86
|
| Rate for Payer: PHCS Commercial |
$3,745.20
|
| Rate for Payer: United Healthcare All Payer |
$3,433.10
|
|
|
PLATE HOOK 3H
|
Facility
|
OP
|
$3,901.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.38 |
| Max. Negotiated Rate |
$3,745.20 |
| Rate for Payer: Aetna Commercial |
$3,003.96
|
| Rate for Payer: Anthem Medicaid |
$1,341.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.97
|
| Rate for Payer: Cash Price |
$1,950.62
|
| Rate for Payer: Cigna Commercial |
$3,238.04
|
| Rate for Payer: First Health Commercial |
$3,706.19
|
| Rate for Payer: Humana Commercial |
$3,316.06
|
| Rate for Payer: Humana KY Medicaid |
$1,341.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.86
|
| Rate for Payer: PHCS Commercial |
$3,745.20
|
| Rate for Payer: United Healthcare All Payer |
$3,433.10
|
|
|
PLATE HOOK LOCKING PEG 2H
|
Facility
|
OP
|
$3,803.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.12 |
| Max. Negotiated Rate |
$3,651.60 |
| Rate for Payer: Aetna Commercial |
$2,928.89
|
| Rate for Payer: Anthem Medicaid |
$1,308.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.93
|
| Rate for Payer: Cash Price |
$1,901.88
|
| Rate for Payer: Cigna Commercial |
$3,157.11
|
| Rate for Payer: First Health Commercial |
$3,613.56
|
| Rate for Payer: Humana Commercial |
$3,233.19
|
| Rate for Payer: Humana KY Medicaid |
$1,308.11
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.59
|
| Rate for Payer: PHCS Commercial |
$3,651.60
|
| Rate for Payer: United Healthcare All Payer |
$3,347.30
|
|
|
PLATE HOOK LOCKING PEG 2H
|
Facility
|
IP
|
$3,803.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.12 |
| Max. Negotiated Rate |
$3,651.60 |
| Rate for Payer: Aetna Commercial |
$2,928.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.93
|
| Rate for Payer: Cash Price |
$1,901.88
|
| Rate for Payer: Cigna Commercial |
$3,157.11
|
| Rate for Payer: First Health Commercial |
$3,613.56
|
| Rate for Payer: Humana Commercial |
$3,233.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,119.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,807.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,347.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,043.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,309.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,624.59
|
| Rate for Payer: PHCS Commercial |
$3,651.60
|
| Rate for Payer: United Healthcare All Payer |
$3,347.30
|
|
|
PLATE HOOK LOCKING PEG 3H
|
Facility
|
IP
|
$3,901.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.38 |
| Max. Negotiated Rate |
$3,745.20 |
| Rate for Payer: Aetna Commercial |
$3,003.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.97
|
| Rate for Payer: Cash Price |
$1,950.62
|
| Rate for Payer: Cigna Commercial |
$3,238.04
|
| Rate for Payer: First Health Commercial |
$3,706.19
|
| Rate for Payer: Humana Commercial |
$3,316.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.86
|
| Rate for Payer: PHCS Commercial |
$3,745.20
|
| Rate for Payer: United Healthcare All Payer |
$3,433.10
|
|
|
PLATE HOOK LOCKING PEG 3H
|
Facility
|
OP
|
$3,901.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,170.38 |
| Max. Negotiated Rate |
$3,745.20 |
| Rate for Payer: Aetna Commercial |
$3,003.96
|
| Rate for Payer: Anthem Medicaid |
$1,341.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,042.97
|
| Rate for Payer: Cash Price |
$1,950.62
|
| Rate for Payer: Cigna Commercial |
$3,238.04
|
| Rate for Payer: First Health Commercial |
$3,706.19
|
| Rate for Payer: Humana Commercial |
$3,316.06
|
| Rate for Payer: Humana KY Medicaid |
$1,341.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,355.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,199.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,879.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,170.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,368.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,433.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,925.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,121.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,394.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,691.86
|
| Rate for Payer: PHCS Commercial |
$3,745.20
|
| Rate for Payer: United Healthcare All Payer |
$3,433.10
|
|
|
PLATE HTO ST WDGE 15MM L
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE HTO ST WDGE 15MM L
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE HUB CAP WRIST FUSION
|
Facility
|
IP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
PLATE HUB CAP WRIST FUSION
|
Facility
|
OP
|
$5,045.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,513.50 |
| Max. Negotiated Rate |
$4,843.20 |
| Rate for Payer: Aetna Commercial |
$3,884.65
|
| Rate for Payer: Anthem Medicaid |
$1,734.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,935.10
|
| Rate for Payer: Cash Price |
$2,522.50
|
| Rate for Payer: Cigna Commercial |
$4,187.35
|
| Rate for Payer: First Health Commercial |
$4,792.75
|
| Rate for Payer: Humana Commercial |
$4,288.25
|
| Rate for Payer: Humana KY Medicaid |
$1,734.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,752.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,136.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,723.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,513.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,769.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,439.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,783.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,036.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,389.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,481.05
|
| Rate for Payer: PHCS Commercial |
$4,843.20
|
| Rate for Payer: United Healthcare All Payer |
$4,439.60
|
|
|
PLATE HUB CAP WRST FUSION POST
|
Facility
|
OP
|
$1,695.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$1,627.39 |
| Rate for Payer: Aetna Commercial |
$1,305.30
|
| Rate for Payer: Anthem Medicaid |
$582.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,322.26
|
| Rate for Payer: Cash Price |
$847.60
|
| Rate for Payer: Cigna Commercial |
$1,407.02
|
| Rate for Payer: First Health Commercial |
$1,610.44
|
| Rate for Payer: Humana Commercial |
$1,440.92
|
| Rate for Payer: Humana KY Medicaid |
$582.98
|
| Rate for Payer: Kentucky WC Medicaid |
$588.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,390.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,251.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$594.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,271.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,356.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.69
|
| Rate for Payer: PHCS Commercial |
$1,627.39
|
| Rate for Payer: United Healthcare All Payer |
$1,491.78
|
|
|
PLATE HUB CAP WRST FUSION POST
|
Facility
|
IP
|
$1,695.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$508.56 |
| Max. Negotiated Rate |
$1,627.39 |
| Rate for Payer: Aetna Commercial |
$1,305.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,322.26
|
| Rate for Payer: Cash Price |
$847.60
|
| Rate for Payer: Cigna Commercial |
$1,407.02
|
| Rate for Payer: First Health Commercial |
$1,610.44
|
| Rate for Payer: Humana Commercial |
$1,440.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,390.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,251.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$508.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,491.78
|
| Rate for Payer: Ohio Health Group HMO |
$1,271.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,356.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,474.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,169.69
|
| Rate for Payer: PHCS Commercial |
$1,627.39
|
| Rate for Payer: United Healthcare All Payer |
$1,491.78
|
|
|
PLATE HUM LK PRX 11H L 3.5*191
|
Facility
|
OP
|
$8,530.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.09 |
| Max. Negotiated Rate |
$8,189.09 |
| Rate for Payer: Aetna Commercial |
$6,568.33
|
| Rate for Payer: Anthem Medicaid |
$2,933.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.63
|
| Rate for Payer: Cash Price |
$4,265.15
|
| Rate for Payer: Cigna Commercial |
$7,080.15
|
| Rate for Payer: First Health Commercial |
$8,103.78
|
| Rate for Payer: Humana Commercial |
$7,250.76
|
| Rate for Payer: Humana KY Medicaid |
$2,933.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,963.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,994.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,992.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,824.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,421.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,885.91
|
| Rate for Payer: PHCS Commercial |
$8,189.09
|
| Rate for Payer: United Healthcare All Payer |
$7,506.66
|
|
|
PLATE HUM LK PRX 11H L 3.5*191
|
Facility
|
IP
|
$8,530.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,559.09 |
| Max. Negotiated Rate |
$8,189.09 |
| Rate for Payer: Aetna Commercial |
$6,568.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,653.63
|
| Rate for Payer: Cash Price |
$4,265.15
|
| Rate for Payer: Cigna Commercial |
$7,080.15
|
| Rate for Payer: First Health Commercial |
$8,103.78
|
| Rate for Payer: Humana Commercial |
$7,250.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,994.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,295.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,559.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,506.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,397.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,824.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,421.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,885.91
|
| Rate for Payer: PHCS Commercial |
$8,189.09
|
| Rate for Payer: United Healthcare All Payer |
$7,506.66
|
|
|
PLATE HUM LK PRX 11H L 4.5*195
|
Facility
|
OP
|
$9,293.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.00 |
| Max. Negotiated Rate |
$8,921.60 |
| Rate for Payer: Aetna Commercial |
$7,155.86
|
| Rate for Payer: Anthem Medicaid |
$3,195.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.80
|
| Rate for Payer: Cash Price |
$4,646.66
|
| Rate for Payer: Cigna Commercial |
$7,713.46
|
| Rate for Payer: First Health Commercial |
$8,828.66
|
| Rate for Payer: Humana Commercial |
$7,899.33
|
| Rate for Payer: Humana KY Medicaid |
$3,195.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,228.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,620.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,858.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,260.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,178.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,085.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,412.40
|
| Rate for Payer: PHCS Commercial |
$8,921.60
|
| Rate for Payer: United Healthcare All Payer |
$8,178.13
|
|
|
PLATE HUM LK PRX 11H L 4.5*195
|
Facility
|
IP
|
$9,293.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.00 |
| Max. Negotiated Rate |
$8,921.60 |
| Rate for Payer: Aetna Commercial |
$7,155.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.80
|
| Rate for Payer: Cash Price |
$4,646.66
|
| Rate for Payer: Cigna Commercial |
$7,713.46
|
| Rate for Payer: First Health Commercial |
$8,828.66
|
| Rate for Payer: Humana Commercial |
$7,899.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,620.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,858.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,178.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,085.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,412.40
|
| Rate for Payer: PHCS Commercial |
$8,921.60
|
| Rate for Payer: United Healthcare All Payer |
$8,178.13
|
|
|
PLATE HUM LK PRX 11H R 4.5*195
|
Facility
|
OP
|
$9,293.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.00 |
| Max. Negotiated Rate |
$8,921.60 |
| Rate for Payer: Aetna Commercial |
$7,155.86
|
| Rate for Payer: Anthem Medicaid |
$3,195.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.80
|
| Rate for Payer: Cash Price |
$4,646.66
|
| Rate for Payer: Cigna Commercial |
$7,713.46
|
| Rate for Payer: First Health Commercial |
$8,828.66
|
| Rate for Payer: Humana Commercial |
$7,899.33
|
| Rate for Payer: Humana KY Medicaid |
$3,195.98
|
| Rate for Payer: Kentucky WC Medicaid |
$3,228.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,620.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,858.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,260.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,178.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,085.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,412.40
|
| Rate for Payer: PHCS Commercial |
$8,921.60
|
| Rate for Payer: United Healthcare All Payer |
$8,178.13
|
|
|
PLATE HUM LK PRX 11H R 4.5*195
|
Facility
|
IP
|
$9,293.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,788.00 |
| Max. Negotiated Rate |
$8,921.60 |
| Rate for Payer: Aetna Commercial |
$7,155.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,248.80
|
| Rate for Payer: Cash Price |
$4,646.66
|
| Rate for Payer: Cigna Commercial |
$7,713.46
|
| Rate for Payer: First Health Commercial |
$8,828.66
|
| Rate for Payer: Humana Commercial |
$7,899.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,620.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,858.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,788.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,178.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,970.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,434.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,085.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,412.40
|
| Rate for Payer: PHCS Commercial |
$8,921.60
|
| Rate for Payer: United Healthcare All Payer |
$8,178.13
|
|
|
PLATE HUM LK PRX 13H L 3.5*216
|
Facility
|
OP
|
$8,678.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,603.66 |
| Max. Negotiated Rate |
$8,331.70 |
| Rate for Payer: Aetna Commercial |
$6,682.71
|
| Rate for Payer: Anthem Medicaid |
$2,984.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,769.50
|
| Rate for Payer: Cash Price |
$4,339.43
|
| Rate for Payer: Cigna Commercial |
$7,203.45
|
| Rate for Payer: First Health Commercial |
$8,244.91
|
| Rate for Payer: Humana Commercial |
$7,377.02
|
| Rate for Payer: Humana KY Medicaid |
$2,984.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,015.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,116.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,404.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,603.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,044.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,637.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,509.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,943.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,550.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,988.41
|
| Rate for Payer: PHCS Commercial |
$8,331.70
|
| Rate for Payer: United Healthcare All Payer |
$7,637.39
|
|
|
PLATE HUM LK PRX 13H L 3.5*216
|
Facility
|
IP
|
$8,678.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,603.66 |
| Max. Negotiated Rate |
$8,331.70 |
| Rate for Payer: Aetna Commercial |
$6,682.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,769.50
|
| Rate for Payer: Cash Price |
$4,339.43
|
| Rate for Payer: Cigna Commercial |
$7,203.45
|
| Rate for Payer: First Health Commercial |
$8,244.91
|
| Rate for Payer: Humana Commercial |
$7,377.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,116.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,404.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,603.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,637.39
|
| Rate for Payer: Ohio Health Group HMO |
$6,509.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,943.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,550.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,988.41
|
| Rate for Payer: PHCS Commercial |
$8,331.70
|
| Rate for Payer: United Healthcare All Payer |
$7,637.39
|
|
