|
PLATE LCK LAT DST FIB 3.5 3H L
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LCK LAT DST FIB 3.5 3H L
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LCK LAT DST FIB 3.5 3H R
|
Facility
|
IP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LCK LAT DST FIB 3.5 3H R
|
Facility
|
OP
|
$4,673.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,402.12 |
| Max. Negotiated Rate |
$4,486.80 |
| Rate for Payer: Aetna Commercial |
$3,598.79
|
| Rate for Payer: Anthem Medicaid |
$1,607.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,645.53
|
| Rate for Payer: Cash Price |
$2,336.88
|
| Rate for Payer: Cigna Commercial |
$3,879.21
|
| Rate for Payer: First Health Commercial |
$4,440.06
|
| Rate for Payer: Humana Commercial |
$3,972.69
|
| Rate for Payer: Humana KY Medicaid |
$1,607.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,623.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,832.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,449.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,639.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,112.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,505.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,739.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,066.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,224.89
|
| Rate for Payer: PHCS Commercial |
$4,486.80
|
| Rate for Payer: United Healthcare All Payer |
$4,112.90
|
|
|
PLATE LCK LAT DST FIB 3.5 4H L
|
Facility
|
OP
|
$4,133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.90 |
| Max. Negotiated Rate |
$3,967.68 |
| Rate for Payer: Aetna Commercial |
$3,182.41
|
| Rate for Payer: Anthem Medicaid |
$1,421.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.74
|
| Rate for Payer: Cash Price |
$2,066.50
|
| Rate for Payer: Cigna Commercial |
$3,430.39
|
| Rate for Payer: First Health Commercial |
$3,926.35
|
| Rate for Payer: Humana Commercial |
$3,513.05
|
| Rate for Payer: Humana KY Medicaid |
$1,421.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,435.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,449.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.77
|
| Rate for Payer: PHCS Commercial |
$3,967.68
|
| Rate for Payer: United Healthcare All Payer |
$3,637.04
|
|
|
PLATE LCK LAT DST FIB 3.5 4H L
|
Facility
|
IP
|
$4,133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.90 |
| Max. Negotiated Rate |
$3,967.68 |
| Rate for Payer: Aetna Commercial |
$3,182.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.74
|
| Rate for Payer: Cash Price |
$2,066.50
|
| Rate for Payer: Cigna Commercial |
$3,430.39
|
| Rate for Payer: First Health Commercial |
$3,926.35
|
| Rate for Payer: Humana Commercial |
$3,513.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.77
|
| Rate for Payer: PHCS Commercial |
$3,967.68
|
| Rate for Payer: United Healthcare All Payer |
$3,637.04
|
|
|
PLATE LCK LAT DST FIB 3.5 4H R
|
Facility
|
IP
|
$4,119.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.85 |
| Max. Negotiated Rate |
$3,954.72 |
| Rate for Payer: Aetna Commercial |
$3,172.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,213.21
|
| Rate for Payer: Cash Price |
$2,059.75
|
| Rate for Payer: Cigna Commercial |
$3,419.18
|
| Rate for Payer: First Health Commercial |
$3,913.53
|
| Rate for Payer: Humana Commercial |
$3,501.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,040.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,625.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.45
|
| Rate for Payer: PHCS Commercial |
$3,954.72
|
| Rate for Payer: United Healthcare All Payer |
$3,625.16
|
|
|
PLATE LCK LAT DST FIB 3.5 4H R
|
Facility
|
OP
|
$4,119.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,235.85 |
| Max. Negotiated Rate |
$3,954.72 |
| Rate for Payer: Aetna Commercial |
$3,172.01
|
| Rate for Payer: Anthem Medicaid |
$1,416.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,213.21
|
| Rate for Payer: Cash Price |
$2,059.75
|
| Rate for Payer: Cigna Commercial |
$3,419.18
|
| Rate for Payer: First Health Commercial |
$3,913.53
|
| Rate for Payer: Humana Commercial |
$3,501.57
|
| Rate for Payer: Humana KY Medicaid |
$1,416.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,431.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,377.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,040.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,235.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,445.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,625.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,089.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,295.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,583.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,842.45
|
| Rate for Payer: PHCS Commercial |
$3,954.72
|
| Rate for Payer: United Healthcare All Payer |
$3,625.16
|
|
|
PLATE LCK LAT DST FIB 3.5 5H L
|
Facility
|
OP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem Medicaid |
$1,463.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Humana KY Medicaid |
$1,463.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,478.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,492.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE LCK LAT DST FIB 3.5 5H L
|
Facility
|
IP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE LCK LAT DST FIB 3.5 5H R
|
Facility
|
OP
|
$4,241.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.30 |
| Max. Negotiated Rate |
$4,071.36 |
| Rate for Payer: Aetna Commercial |
$3,265.57
|
| Rate for Payer: Anthem Medicaid |
$1,458.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,307.98
|
| Rate for Payer: Cash Price |
$2,120.50
|
| Rate for Payer: Cigna Commercial |
$3,520.03
|
| Rate for Payer: First Health Commercial |
$4,028.95
|
| Rate for Payer: Humana Commercial |
$3,604.85
|
| Rate for Payer: Humana KY Medicaid |
$1,458.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,473.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,477.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,129.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,487.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,732.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,689.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,926.29
|
| Rate for Payer: PHCS Commercial |
$4,071.36
|
| Rate for Payer: United Healthcare All Payer |
$3,732.08
|
|
|
PLATE LCK LAT DST FIB 3.5 5H R
|
Facility
|
IP
|
$4,241.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,272.30 |
| Max. Negotiated Rate |
$4,071.36 |
| Rate for Payer: Aetna Commercial |
$3,265.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,307.98
|
| Rate for Payer: Cash Price |
$2,120.50
|
| Rate for Payer: Cigna Commercial |
$3,520.03
|
| Rate for Payer: First Health Commercial |
$4,028.95
|
| Rate for Payer: Humana Commercial |
$3,604.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,477.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,129.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,272.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,732.08
|
| Rate for Payer: Ohio Health Group HMO |
$3,180.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,392.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,689.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,926.29
|
| Rate for Payer: PHCS Commercial |
$4,071.36
|
| Rate for Payer: United Healthcare All Payer |
$3,732.08
|
|
|
PLATE LCK LAT DST FIB 3.5 7H L
|
Facility
|
OP
|
$4,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$4,200.96 |
| Rate for Payer: Aetna Commercial |
$3,369.52
|
| Rate for Payer: Anthem Medicaid |
$1,504.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.28
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cigna Commercial |
$3,632.08
|
| Rate for Payer: First Health Commercial |
$4,157.20
|
| Rate for Payer: Humana Commercial |
$3,719.60
|
| Rate for Payer: Humana KY Medicaid |
$1,504.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,520.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,312.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,535.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,850.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.44
|
| Rate for Payer: PHCS Commercial |
$4,200.96
|
| Rate for Payer: United Healthcare All Payer |
$3,850.88
|
|
|
PLATE LCK LAT DST FIB 3.5 7H L
|
Facility
|
IP
|
$4,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$4,200.96 |
| Rate for Payer: Aetna Commercial |
$3,369.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.28
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cigna Commercial |
$3,632.08
|
| Rate for Payer: First Health Commercial |
$4,157.20
|
| Rate for Payer: Humana Commercial |
$3,719.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,312.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,850.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.44
|
| Rate for Payer: PHCS Commercial |
$4,200.96
|
| Rate for Payer: United Healthcare All Payer |
$3,850.88
|
|
|
PLATE LCK LAT DST FIB 3.5 7H R
|
Facility
|
OP
|
$3,797.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.29 |
| Max. Negotiated Rate |
$3,645.73 |
| Rate for Payer: Aetna Commercial |
$2,924.18
|
| Rate for Payer: Anthem Medicaid |
$1,306.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,962.16
|
| Rate for Payer: Cash Price |
$1,898.82
|
| Rate for Payer: Cigna Commercial |
$3,152.04
|
| Rate for Payer: First Health Commercial |
$3,607.76
|
| Rate for Payer: Humana Commercial |
$3,227.99
|
| Rate for Payer: Humana KY Medicaid |
$1,306.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,319.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,114.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,332.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,848.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,303.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.37
|
| Rate for Payer: PHCS Commercial |
$3,645.73
|
| Rate for Payer: United Healthcare All Payer |
$3,341.92
|
|
|
PLATE LCK LAT DST FIB 3.5 7H R
|
Facility
|
IP
|
$3,797.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,139.29 |
| Max. Negotiated Rate |
$3,645.73 |
| Rate for Payer: Aetna Commercial |
$2,924.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,962.16
|
| Rate for Payer: Cash Price |
$1,898.82
|
| Rate for Payer: Cigna Commercial |
$3,152.04
|
| Rate for Payer: First Health Commercial |
$3,607.76
|
| Rate for Payer: Humana Commercial |
$3,227.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,114.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,802.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,139.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,341.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,848.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,038.11
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,303.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,620.37
|
| Rate for Payer: PHCS Commercial |
$3,645.73
|
| Rate for Payer: United Healthcare All Payer |
$3,341.92
|
|
|
PLATE LCK LAT DST FIB 3.5 9H L
|
Facility
|
IP
|
$4,733.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.12 |
| Max. Negotiated Rate |
$4,544.40 |
| Rate for Payer: Aetna Commercial |
$3,644.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.32
|
| Rate for Payer: Cash Price |
$2,366.88
|
| Rate for Payer: Cigna Commercial |
$3,929.01
|
| Rate for Payer: First Health Commercial |
$4,497.06
|
| Rate for Payer: Humana Commercial |
$4,023.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,787.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,118.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,266.29
|
| Rate for Payer: PHCS Commercial |
$4,544.40
|
| Rate for Payer: United Healthcare All Payer |
$4,165.70
|
|
|
PLATE LCK LAT DST FIB 3.5 9H L
|
Facility
|
OP
|
$4,733.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,420.12 |
| Max. Negotiated Rate |
$4,544.40 |
| Rate for Payer: Aetna Commercial |
$3,644.99
|
| Rate for Payer: Anthem Medicaid |
$1,627.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,692.32
|
| Rate for Payer: Cash Price |
$2,366.88
|
| Rate for Payer: Cigna Commercial |
$3,929.01
|
| Rate for Payer: First Health Commercial |
$4,497.06
|
| Rate for Payer: Humana Commercial |
$4,023.69
|
| Rate for Payer: Humana KY Medicaid |
$1,627.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,881.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,493.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,420.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,165.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,550.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,787.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,118.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,266.29
|
| Rate for Payer: PHCS Commercial |
$4,544.40
|
| Rate for Payer: United Healthcare All Payer |
$4,165.70
|
|
|
PLATE LCKNG COMPR 6H L 84MM
|
Facility
|
OP
|
$1,542.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.84 |
| Max. Negotiated Rate |
$1,481.09 |
| Rate for Payer: Aetna Commercial |
$1,187.96
|
| Rate for Payer: Anthem Medicaid |
$530.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,203.38
|
| Rate for Payer: Cash Price |
$771.40
|
| Rate for Payer: Cigna Commercial |
$1,280.52
|
| Rate for Payer: First Health Commercial |
$1,465.66
|
| Rate for Payer: Humana Commercial |
$1,311.38
|
| Rate for Payer: Humana KY Medicaid |
$530.57
|
| Rate for Payer: Kentucky WC Medicaid |
$535.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,265.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$541.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,342.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.53
|
| Rate for Payer: PHCS Commercial |
$1,481.09
|
| Rate for Payer: United Healthcare All Payer |
$1,357.66
|
|
|
PLATE LCKNG COMPR 6H L 84MM
|
Facility
|
IP
|
$1,542.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$462.84 |
| Max. Negotiated Rate |
$1,481.09 |
| Rate for Payer: Aetna Commercial |
$1,187.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,203.38
|
| Rate for Payer: Cash Price |
$771.40
|
| Rate for Payer: Cigna Commercial |
$1,280.52
|
| Rate for Payer: First Health Commercial |
$1,465.66
|
| Rate for Payer: Humana Commercial |
$1,311.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,265.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,138.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$462.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,357.66
|
| Rate for Payer: Ohio Health Group HMO |
$1,157.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,234.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,342.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,064.53
|
| Rate for Payer: PHCS Commercial |
$1,481.09
|
| Rate for Payer: United Healthcare All Payer |
$1,357.66
|
|
|
PLATE LCKNG COMPR 7H L97MM
|
Facility
|
IP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
PLATE LCKNG COMPR 7H L97MM
|
Facility
|
OP
|
$2,105.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$631.68 |
| Max. Negotiated Rate |
$2,021.38 |
| Rate for Payer: Aetna Commercial |
$1,621.31
|
| Rate for Payer: Anthem Medicaid |
$724.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,642.37
|
| Rate for Payer: Cash Price |
$1,052.80
|
| Rate for Payer: Cigna Commercial |
$1,747.65
|
| Rate for Payer: First Health Commercial |
$2,000.32
|
| Rate for Payer: Humana Commercial |
$1,789.76
|
| Rate for Payer: Humana KY Medicaid |
$724.12
|
| Rate for Payer: Kentucky WC Medicaid |
$731.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,726.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,553.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$631.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$738.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,852.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,579.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,831.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,452.86
|
| Rate for Payer: PHCS Commercial |
$2,021.38
|
| Rate for Payer: United Healthcare All Payer |
$1,852.93
|
|
|
PLATE LCKNG COMPR 8H L110MM
|
Facility
|
IP
|
$2,196.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.04 |
| Max. Negotiated Rate |
$2,108.93 |
| Rate for Payer: Aetna Commercial |
$1,691.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.50
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cigna Commercial |
$1,823.34
|
| Rate for Payer: First Health Commercial |
$2,086.96
|
| Rate for Payer: Humana Commercial |
$1,867.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,801.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,933.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,911.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.79
|
| Rate for Payer: PHCS Commercial |
$2,108.93
|
| Rate for Payer: United Healthcare All Payer |
$1,933.18
|
|
|
PLATE LCKNG COMPR 8H L110MM
|
Facility
|
OP
|
$2,196.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$659.04 |
| Max. Negotiated Rate |
$2,108.93 |
| Rate for Payer: Aetna Commercial |
$1,691.54
|
| Rate for Payer: Anthem Medicaid |
$755.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,713.50
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cigna Commercial |
$1,823.34
|
| Rate for Payer: First Health Commercial |
$2,086.96
|
| Rate for Payer: Humana Commercial |
$1,867.28
|
| Rate for Payer: Humana KY Medicaid |
$755.48
|
| Rate for Payer: Kentucky WC Medicaid |
$763.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,801.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,621.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$659.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$770.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,933.18
|
| Rate for Payer: Ohio Health Group HMO |
$1,647.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,757.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,911.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,515.79
|
| Rate for Payer: PHCS Commercial |
$2,108.93
|
| Rate for Payer: United Healthcare All Payer |
$1,933.18
|
|
|
PLATE LCKNG RECON 3.5 10H*118
|
Facility
|
OP
|
$4,129.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,238.94 |
| Max. Negotiated Rate |
$3,964.62 |
| Rate for Payer: Aetna Commercial |
$3,179.95
|
| Rate for Payer: Anthem Medicaid |
$1,420.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,221.25
|
| Rate for Payer: Cash Price |
$2,064.91
|
| Rate for Payer: Cigna Commercial |
$3,427.74
|
| Rate for Payer: First Health Commercial |
$3,923.32
|
| Rate for Payer: Humana Commercial |
$3,510.34
|
| Rate for Payer: Humana KY Medicaid |
$1,420.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,434.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,386.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,448.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,634.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,097.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,303.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,592.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,849.57
|
| Rate for Payer: PHCS Commercial |
$3,964.62
|
| Rate for Payer: United Healthcare All Payer |
$3,634.23
|
|
