|
PLATE LCK 1/3 TUB 4H L50MM
|
Facility
|
OP
|
$2,129.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.98 |
| Max. Negotiated Rate |
$2,044.72 |
| Rate for Payer: Aetna Commercial |
$1,640.04
|
| Rate for Payer: Anthem Medicaid |
$732.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.34
|
| Rate for Payer: Cash Price |
$1,064.96
|
| Rate for Payer: Cigna Commercial |
$1,767.83
|
| Rate for Payer: First Health Commercial |
$2,023.42
|
| Rate for Payer: Humana Commercial |
$1,810.43
|
| Rate for Payer: Humana KY Medicaid |
$732.48
|
| Rate for Payer: Kentucky WC Medicaid |
$739.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$747.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,874.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,597.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,853.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,469.64
|
| Rate for Payer: PHCS Commercial |
$2,044.72
|
| Rate for Payer: United Healthcare All Payer |
$1,874.33
|
|
|
PLATE LCK 1/3 TUB 6H L76MM
|
Facility
|
OP
|
$1,920.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.05 |
| Max. Negotiated Rate |
$1,843.35 |
| Rate for Payer: Aetna Commercial |
$1,478.52
|
| Rate for Payer: Anthem Medicaid |
$660.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.72
|
| Rate for Payer: Cash Price |
$960.08
|
| Rate for Payer: Cigna Commercial |
$1,593.73
|
| Rate for Payer: First Health Commercial |
$1,824.15
|
| Rate for Payer: Humana Commercial |
$1,632.14
|
| Rate for Payer: Humana KY Medicaid |
$660.34
|
| Rate for Payer: Kentucky WC Medicaid |
$667.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$673.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.91
|
| Rate for Payer: PHCS Commercial |
$1,843.35
|
| Rate for Payer: United Healthcare All Payer |
$1,689.74
|
|
|
PLATE LCK 1/3 TUB 6H L76MM
|
Facility
|
IP
|
$1,920.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.05 |
| Max. Negotiated Rate |
$1,843.35 |
| Rate for Payer: Aetna Commercial |
$1,478.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,497.72
|
| Rate for Payer: Cash Price |
$960.08
|
| Rate for Payer: Cigna Commercial |
$1,593.73
|
| Rate for Payer: First Health Commercial |
$1,824.15
|
| Rate for Payer: Humana Commercial |
$1,632.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,574.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,417.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$576.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,689.74
|
| Rate for Payer: Ohio Health Group HMO |
$1,440.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,670.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,324.91
|
| Rate for Payer: PHCS Commercial |
$1,843.35
|
| Rate for Payer: United Healthcare All Payer |
$1,689.74
|
|
|
PLATE LCK 1/3 TUB 8H L102MM
|
Facility
|
IP
|
$1,971.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.55 |
| Max. Negotiated Rate |
$1,892.97 |
| Rate for Payer: Aetna Commercial |
$1,518.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.04
|
| Rate for Payer: Cash Price |
$985.92
|
| Rate for Payer: Cigna Commercial |
$1,636.63
|
| Rate for Payer: First Health Commercial |
$1,873.25
|
| Rate for Payer: Humana Commercial |
$1,676.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,577.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,715.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.57
|
| Rate for Payer: PHCS Commercial |
$1,892.97
|
| Rate for Payer: United Healthcare All Payer |
$1,735.22
|
|
|
PLATE LCK 1/3 TUB 8H L102MM
|
Facility
|
OP
|
$1,971.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.55 |
| Max. Negotiated Rate |
$1,892.97 |
| Rate for Payer: Aetna Commercial |
$1,518.32
|
| Rate for Payer: Anthem Medicaid |
$678.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.04
|
| Rate for Payer: Cash Price |
$985.92
|
| Rate for Payer: Cigna Commercial |
$1,636.63
|
| Rate for Payer: First Health Commercial |
$1,873.25
|
| Rate for Payer: Humana Commercial |
$1,676.06
|
| Rate for Payer: Humana KY Medicaid |
$678.12
|
| Rate for Payer: Kentucky WC Medicaid |
$685.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,616.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.22
|
| Rate for Payer: Ohio Health Group HMO |
$1,478.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,577.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,715.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.57
|
| Rate for Payer: PHCS Commercial |
$1,892.97
|
| Rate for Payer: United Healthcare All Payer |
$1,735.22
|
|
|
PLATE LCK CMP 10H 3.5*154
|
Facility
|
OP
|
$3,398.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.62 |
| Max. Negotiated Rate |
$3,262.80 |
| Rate for Payer: Aetna Commercial |
$2,617.04
|
| Rate for Payer: Anthem Medicaid |
$1,168.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.03
|
| Rate for Payer: Cash Price |
$1,699.38
|
| Rate for Payer: Cigna Commercial |
$2,820.96
|
| Rate for Payer: First Health Commercial |
$3,228.81
|
| Rate for Payer: Humana Commercial |
$2,888.94
|
| Rate for Payer: Humana KY Medicaid |
$1,168.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,180.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,192.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,990.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.14
|
| Rate for Payer: PHCS Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Payer |
$2,990.90
|
|
|
PLATE LCK CMP 10H 3.5*154
|
Facility
|
IP
|
$3,398.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,019.62 |
| Max. Negotiated Rate |
$3,262.80 |
| Rate for Payer: Aetna Commercial |
$2,617.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,651.03
|
| Rate for Payer: Cash Price |
$1,699.38
|
| Rate for Payer: Cigna Commercial |
$2,820.96
|
| Rate for Payer: First Health Commercial |
$3,228.81
|
| Rate for Payer: Humana Commercial |
$2,888.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,786.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,508.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,019.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,990.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,549.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,719.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,956.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,345.14
|
| Rate for Payer: PHCS Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Payer |
$2,990.90
|
|
|
PLATE LCK CMP 12H 3.5*183
|
Facility
|
IP
|
$3,552.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.75 |
| Max. Negotiated Rate |
$3,410.40 |
| Rate for Payer: Aetna Commercial |
$2,735.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,770.95
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: Cigna Commercial |
$2,948.57
|
| Rate for Payer: First Health Commercial |
$3,374.88
|
| Rate for Payer: Humana Commercial |
$3,019.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,913.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,621.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,065.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,126.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,664.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,842.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,090.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,451.22
|
| Rate for Payer: PHCS Commercial |
$3,410.40
|
| Rate for Payer: United Healthcare All Payer |
$3,126.20
|
|
|
PLATE LCK CMP 12H 3.5*183
|
Facility
|
OP
|
$3,552.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,065.75 |
| Max. Negotiated Rate |
$3,410.40 |
| Rate for Payer: Aetna Commercial |
$2,735.43
|
| Rate for Payer: Anthem Medicaid |
$1,221.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,770.95
|
| Rate for Payer: Cash Price |
$1,776.25
|
| Rate for Payer: Cigna Commercial |
$2,948.57
|
| Rate for Payer: First Health Commercial |
$3,374.88
|
| Rate for Payer: Humana Commercial |
$3,019.62
|
| Rate for Payer: Humana KY Medicaid |
$1,221.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,234.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,913.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,621.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,065.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,246.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,126.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,664.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,842.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,090.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,451.22
|
| Rate for Payer: PHCS Commercial |
$3,410.40
|
| Rate for Payer: United Healthcare All Payer |
$3,126.20
|
|
|
PLATE LCK CMP 4H 3.5*67
|
Facility
|
IP
|
$3,057.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.25 |
| Max. Negotiated Rate |
$2,935.20 |
| Rate for Payer: Aetna Commercial |
$2,354.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,384.85
|
| Rate for Payer: Cash Price |
$1,528.75
|
| Rate for Payer: Cigna Commercial |
$2,537.72
|
| Rate for Payer: First Health Commercial |
$2,904.62
|
| Rate for Payer: Humana Commercial |
$2,598.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,507.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,256.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$917.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,690.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,293.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,446.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,660.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.68
|
| Rate for Payer: PHCS Commercial |
$2,935.20
|
| Rate for Payer: United Healthcare All Payer |
$2,690.60
|
|
|
PLATE LCK CMP 4H 3.5*67
|
Facility
|
OP
|
$3,057.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$917.25 |
| Max. Negotiated Rate |
$2,935.20 |
| Rate for Payer: Aetna Commercial |
$2,354.28
|
| Rate for Payer: Anthem Medicaid |
$1,051.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,384.85
|
| Rate for Payer: Cash Price |
$1,528.75
|
| Rate for Payer: Cigna Commercial |
$2,537.72
|
| Rate for Payer: First Health Commercial |
$2,904.62
|
| Rate for Payer: Humana Commercial |
$2,598.88
|
| Rate for Payer: Humana KY Medicaid |
$1,051.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,062.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,507.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,256.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$917.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,072.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,690.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,293.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,446.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,660.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.68
|
| Rate for Payer: PHCS Commercial |
$2,935.20
|
| Rate for Payer: United Healthcare All Payer |
$2,690.60
|
|
|
PLATE LCK CMP 6H 3.5*96
|
Facility
|
IP
|
$3,196.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.88 |
| Max. Negotiated Rate |
$3,068.40 |
| Rate for Payer: Aetna Commercial |
$2,461.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,493.07
|
| Rate for Payer: Cash Price |
$1,598.12
|
| Rate for Payer: Cigna Commercial |
$2,652.89
|
| Rate for Payer: First Health Commercial |
$3,036.44
|
| Rate for Payer: Humana Commercial |
$2,716.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,620.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,358.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,812.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,397.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,557.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,780.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.41
|
| Rate for Payer: PHCS Commercial |
$3,068.40
|
| Rate for Payer: United Healthcare All Payer |
$2,812.70
|
|
|
PLATE LCK CMP 6H 3.5*96
|
Facility
|
OP
|
$3,196.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.88 |
| Max. Negotiated Rate |
$3,068.40 |
| Rate for Payer: Aetna Commercial |
$2,461.11
|
| Rate for Payer: Anthem Medicaid |
$1,099.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,493.07
|
| Rate for Payer: Cash Price |
$1,598.12
|
| Rate for Payer: Cigna Commercial |
$2,652.89
|
| Rate for Payer: First Health Commercial |
$3,036.44
|
| Rate for Payer: Humana Commercial |
$2,716.81
|
| Rate for Payer: Humana KY Medicaid |
$1,099.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,110.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,620.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,358.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,121.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,812.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,397.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,557.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,780.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,205.41
|
| Rate for Payer: PHCS Commercial |
$3,068.40
|
| Rate for Payer: United Healthcare All Payer |
$2,812.70
|
|
|
PLATE LCK CMP 8H 3.5*125
|
Facility
|
OP
|
$3,316.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.88 |
| Max. Negotiated Rate |
$3,183.60 |
| Rate for Payer: Aetna Commercial |
$2,553.51
|
| Rate for Payer: Anthem Medicaid |
$1,140.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.68
|
| Rate for Payer: Cash Price |
$1,658.12
|
| Rate for Payer: Cigna Commercial |
$2,752.49
|
| Rate for Payer: First Health Commercial |
$3,150.44
|
| Rate for Payer: Humana Commercial |
$2,818.81
|
| Rate for Payer: Humana KY Medicaid |
$1,140.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,152.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,163.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,918.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,487.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,653.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,885.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.21
|
| Rate for Payer: PHCS Commercial |
$3,183.60
|
| Rate for Payer: United Healthcare All Payer |
$2,918.30
|
|
|
PLATE LCK CMP 8H 3.5*125
|
Facility
|
IP
|
$3,316.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.88 |
| Max. Negotiated Rate |
$3,183.60 |
| Rate for Payer: Aetna Commercial |
$2,553.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,586.68
|
| Rate for Payer: Cash Price |
$1,658.12
|
| Rate for Payer: Cigna Commercial |
$2,752.49
|
| Rate for Payer: First Health Commercial |
$3,150.44
|
| Rate for Payer: Humana Commercial |
$2,818.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,719.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,447.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$994.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,918.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,487.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,653.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,885.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.21
|
| Rate for Payer: PHCS Commercial |
$3,183.60
|
| Rate for Payer: United Healthcare All Payer |
$2,918.30
|
|
|
PLATE LCK COMP BRD 10H 5.0*191
|
Facility
|
IP
|
$3,428.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.40 |
| Max. Negotiated Rate |
$3,290.88 |
| Rate for Payer: Aetna Commercial |
$2,639.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,673.84
|
| Rate for Payer: Cash Price |
$1,714.00
|
| Rate for Payer: Cigna Commercial |
$2,845.24
|
| Rate for Payer: First Health Commercial |
$3,256.60
|
| Rate for Payer: Humana Commercial |
$2,913.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,810.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,529.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,016.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,742.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,982.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,365.32
|
| Rate for Payer: PHCS Commercial |
$3,290.88
|
| Rate for Payer: United Healthcare All Payer |
$3,016.64
|
|
|
PLATE LCK COMP BRD 10H 5.0*191
|
Facility
|
OP
|
$3,428.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,028.40 |
| Max. Negotiated Rate |
$3,290.88 |
| Rate for Payer: Aetna Commercial |
$2,639.56
|
| Rate for Payer: Anthem Medicaid |
$1,178.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,673.84
|
| Rate for Payer: Cash Price |
$1,714.00
|
| Rate for Payer: Cigna Commercial |
$2,845.24
|
| Rate for Payer: First Health Commercial |
$3,256.60
|
| Rate for Payer: Humana Commercial |
$2,913.80
|
| Rate for Payer: Humana KY Medicaid |
$1,178.89
|
| Rate for Payer: Kentucky WC Medicaid |
$1,190.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,810.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,529.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,028.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,202.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,016.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,571.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,742.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,982.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,365.32
|
| Rate for Payer: PHCS Commercial |
$3,290.88
|
| Rate for Payer: United Healthcare All Payer |
$3,016.64
|
|
|
PLATE LCK COMP NAR 8H 5.0*151M
|
Facility
|
OP
|
$2,238.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$2,149.13 |
| Rate for Payer: Aetna Commercial |
$1,723.78
|
| Rate for Payer: Anthem Medicaid |
$769.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,746.17
|
| Rate for Payer: Cash Price |
$1,119.34
|
| Rate for Payer: Cigna Commercial |
$1,858.10
|
| Rate for Payer: First Health Commercial |
$2,126.75
|
| Rate for Payer: Humana Commercial |
$1,902.88
|
| Rate for Payer: Humana KY Medicaid |
$769.88
|
| Rate for Payer: Kentucky WC Medicaid |
$777.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,835.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,652.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$671.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$785.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,970.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,679.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,790.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,947.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.69
|
| Rate for Payer: PHCS Commercial |
$2,149.13
|
| Rate for Payer: United Healthcare All Payer |
$1,970.04
|
|
|
PLATE LCK COMP NAR 8H 5.0*151M
|
Facility
|
IP
|
$2,238.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$671.60 |
| Max. Negotiated Rate |
$2,149.13 |
| Rate for Payer: Aetna Commercial |
$1,723.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,746.17
|
| Rate for Payer: Cash Price |
$1,119.34
|
| Rate for Payer: Cigna Commercial |
$1,858.10
|
| Rate for Payer: First Health Commercial |
$2,126.75
|
| Rate for Payer: Humana Commercial |
$1,902.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,835.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,652.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$671.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,970.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,679.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,790.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,947.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,544.69
|
| Rate for Payer: PHCS Commercial |
$2,149.13
|
| Rate for Payer: United Healthcare All Payer |
$1,970.04
|
|
|
PLATE LCK DIST FIB RT 4 HOLE
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE LCK DIST FIB RT 4 HOLE
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$17.71
|
| Rate for Payer: Anthem Medicaid |
$7.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.94
|
| Rate for Payer: Cash Price |
$11.50
|
| Rate for Payer: Cigna Commercial |
$19.09
|
| Rate for Payer: First Health Commercial |
$21.85
|
| Rate for Payer: Humana Commercial |
$19.55
|
| Rate for Payer: Humana KY Medicaid |
$7.91
|
| Rate for Payer: Kentucky WC Medicaid |
$7.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$8.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$20.24
|
| Rate for Payer: Ohio Health Group HMO |
$17.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$18.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$20.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.87
|
| Rate for Payer: PHCS Commercial |
$22.08
|
| Rate for Payer: United Healthcare All Payer |
$20.24
|
|
|
PLATE LCK DIST FIB RT 5 HOLE
|
Facility
|
IP
|
$4,854.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.41 |
| Max. Negotiated Rate |
$4,660.50 |
| Rate for Payer: Aetna Commercial |
$3,738.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.66
|
| Rate for Payer: Cash Price |
$2,427.34
|
| Rate for Payer: Cigna Commercial |
$4,029.39
|
| Rate for Payer: First Health Commercial |
$4,611.96
|
| Rate for Payer: Humana Commercial |
$4,126.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,883.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.74
|
| Rate for Payer: PHCS Commercial |
$4,660.50
|
| Rate for Payer: United Healthcare All Payer |
$4,272.13
|
|
|
PLATE LCK DIST FIB RT 5 HOLE
|
Facility
|
OP
|
$4,854.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,456.41 |
| Max. Negotiated Rate |
$4,660.50 |
| Rate for Payer: Aetna Commercial |
$3,738.11
|
| Rate for Payer: Anthem Medicaid |
$1,669.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,786.66
|
| Rate for Payer: Cash Price |
$2,427.34
|
| Rate for Payer: Cigna Commercial |
$4,029.39
|
| Rate for Payer: First Health Commercial |
$4,611.96
|
| Rate for Payer: Humana Commercial |
$4,126.49
|
| Rate for Payer: Humana KY Medicaid |
$1,669.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,686.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,980.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,582.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,456.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,703.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,272.13
|
| Rate for Payer: Ohio Health Group HMO |
$3,641.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,883.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,223.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,349.74
|
| Rate for Payer: PHCS Commercial |
$4,660.50
|
| Rate for Payer: United Healthcare All Payer |
$4,272.13
|
|
|
PLATE LCK DIST FIB RT 6 HOLE
|
Facility
|
IP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
|
PLATE LCK DIST FIB RT 6 HOLE
|
Facility
|
OP
|
$5,150.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,545.00 |
| Max. Negotiated Rate |
$4,944.00 |
| Rate for Payer: Aetna Commercial |
$3,965.50
|
| Rate for Payer: Anthem Medicaid |
$1,771.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.00
|
| Rate for Payer: Cash Price |
$2,575.00
|
| Rate for Payer: Cigna Commercial |
$4,274.50
|
| Rate for Payer: First Health Commercial |
$4,892.50
|
| Rate for Payer: Humana Commercial |
$4,377.50
|
| Rate for Payer: Humana KY Medicaid |
$1,771.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,800.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,120.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,480.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,553.50
|
| Rate for Payer: PHCS Commercial |
$4,944.00
|
| Rate for Payer: United Healthcare All Payer |
$4,532.00
|
|
