|
PLATE LCKNG RECON 3.5 10H*118
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE LCKNG RECON 3.5 12H*142
|
Facility
|
IP
|
$4,282.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.73 |
| Max. Negotiated Rate |
$4,111.14 |
| Rate for Payer: Aetna Commercial |
$3,297.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.30
|
| Rate for Payer: Cash Price |
$2,141.22
|
| Rate for Payer: Cigna Commercial |
$3,554.43
|
| Rate for Payer: First Health Commercial |
$4,068.32
|
| Rate for Payer: Humana Commercial |
$3,640.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,425.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,725.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,954.88
|
| Rate for Payer: PHCS Commercial |
$4,111.14
|
| Rate for Payer: United Healthcare All Payer |
$3,768.55
|
|
|
PLATE LCKNG RECON 3.5 12H*142
|
Facility
|
OP
|
$4,282.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.73 |
| Max. Negotiated Rate |
$4,111.14 |
| Rate for Payer: Aetna Commercial |
$3,297.48
|
| Rate for Payer: Anthem Medicaid |
$1,472.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.30
|
| Rate for Payer: Cash Price |
$2,141.22
|
| Rate for Payer: Cigna Commercial |
$3,554.43
|
| Rate for Payer: First Health Commercial |
$4,068.32
|
| Rate for Payer: Humana Commercial |
$3,640.07
|
| Rate for Payer: Humana KY Medicaid |
$1,472.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,502.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,425.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,725.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,954.88
|
| Rate for Payer: PHCS Commercial |
$4,111.14
|
| Rate for Payer: United Healthcare All Payer |
$3,768.55
|
|
|
PLATE LCKNG RECON 3.5 14H*166
|
Facility
|
OP
|
$4,462.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.84 |
| Max. Negotiated Rate |
$4,284.30 |
| Rate for Payer: Aetna Commercial |
$3,436.36
|
| Rate for Payer: Anthem Medicaid |
$1,534.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,480.99
|
| Rate for Payer: Cash Price |
$2,231.41
|
| Rate for Payer: Cigna Commercial |
$3,704.13
|
| Rate for Payer: First Health Commercial |
$4,239.67
|
| Rate for Payer: Humana Commercial |
$3,793.39
|
| Rate for Payer: Humana KY Medicaid |
$1,534.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.34
|
| Rate for Payer: PHCS Commercial |
$4,284.30
|
| Rate for Payer: United Healthcare All Payer |
$3,927.27
|
|
|
PLATE LCKNG RECON 3.5 14H*166
|
Facility
|
IP
|
$4,462.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.84 |
| Max. Negotiated Rate |
$4,284.30 |
| Rate for Payer: Aetna Commercial |
$3,436.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,480.99
|
| Rate for Payer: Cash Price |
$2,231.41
|
| Rate for Payer: Cigna Commercial |
$3,704.13
|
| Rate for Payer: First Health Commercial |
$4,239.67
|
| Rate for Payer: Humana Commercial |
$3,793.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.34
|
| Rate for Payer: PHCS Commercial |
$4,284.30
|
| Rate for Payer: United Healthcare All Payer |
$3,927.27
|
|
|
PLATE LCKNG RECON 3.5 4H*46
|
Facility
|
IP
|
$3,588.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.61 |
| Max. Negotiated Rate |
$3,445.14 |
| Rate for Payer: Aetna Commercial |
$2,763.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,799.18
|
| Rate for Payer: Cash Price |
$1,794.34
|
| Rate for Payer: Cigna Commercial |
$2,978.61
|
| Rate for Payer: First Health Commercial |
$3,409.26
|
| Rate for Payer: Humana Commercial |
$3,050.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,942.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,648.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,158.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,691.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,870.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.20
|
| Rate for Payer: PHCS Commercial |
$3,445.14
|
| Rate for Payer: United Healthcare All Payer |
$3,158.05
|
|
|
PLATE LCKNG RECON 3.5 4H*46
|
Facility
|
OP
|
$3,588.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.61 |
| Max. Negotiated Rate |
$3,445.14 |
| Rate for Payer: Aetna Commercial |
$2,763.29
|
| Rate for Payer: Anthem Medicaid |
$1,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,799.18
|
| Rate for Payer: Cash Price |
$1,794.34
|
| Rate for Payer: Cigna Commercial |
$2,978.61
|
| Rate for Payer: First Health Commercial |
$3,409.26
|
| Rate for Payer: Humana Commercial |
$3,050.39
|
| Rate for Payer: Humana KY Medicaid |
$1,234.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,942.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,648.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,258.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,158.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,691.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,870.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.20
|
| Rate for Payer: PHCS Commercial |
$3,445.14
|
| Rate for Payer: United Healthcare All Payer |
$3,158.05
|
|
|
PLATE LCKNG RECON 3.5 6H*70
|
Facility
|
OP
|
$3,852.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$3,698.22 |
| Rate for Payer: Aetna Commercial |
$2,966.28
|
| Rate for Payer: Anthem Medicaid |
$1,324.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.80
|
| Rate for Payer: Cash Price |
$1,926.16
|
| Rate for Payer: Cigna Commercial |
$3,197.42
|
| Rate for Payer: First Health Commercial |
$3,659.69
|
| Rate for Payer: Humana Commercial |
$3,274.46
|
| Rate for Payer: Humana KY Medicaid |
$1,324.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,338.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,843.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,351.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,390.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.09
|
| Rate for Payer: PHCS Commercial |
$3,698.22
|
| Rate for Payer: United Healthcare All Payer |
$3,390.03
|
|
|
PLATE LCKNG RECON 3.5 6H*70
|
Facility
|
IP
|
$3,852.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$3,698.22 |
| Rate for Payer: Aetna Commercial |
$2,966.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.80
|
| Rate for Payer: Cash Price |
$1,926.16
|
| Rate for Payer: Cigna Commercial |
$3,197.42
|
| Rate for Payer: First Health Commercial |
$3,659.69
|
| Rate for Payer: Humana Commercial |
$3,274.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,843.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,390.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.09
|
| Rate for Payer: PHCS Commercial |
$3,698.22
|
| Rate for Payer: United Healthcare All Payer |
$3,390.03
|
|
|
PLATE LCKNG RECON 3.5 8H*94
|
Facility
|
IP
|
$4,039.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.89 |
| Max. Negotiated Rate |
$3,878.04 |
| Rate for Payer: Aetna Commercial |
$3,110.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.90
|
| Rate for Payer: Cash Price |
$2,019.81
|
| Rate for Payer: Cigna Commercial |
$3,352.88
|
| Rate for Payer: First Health Commercial |
$3,837.64
|
| Rate for Payer: Humana Commercial |
$3,433.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,312.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,981.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.34
|
| Rate for Payer: PHCS Commercial |
$3,878.04
|
| Rate for Payer: United Healthcare All Payer |
$3,554.87
|
|
|
PLATE LCKNG RECON 3.5 8H*94
|
Facility
|
OP
|
$4,039.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.89 |
| Max. Negotiated Rate |
$3,878.04 |
| Rate for Payer: Aetna Commercial |
$3,110.51
|
| Rate for Payer: Anthem Medicaid |
$1,389.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.90
|
| Rate for Payer: Cash Price |
$2,019.81
|
| Rate for Payer: Cigna Commercial |
$3,352.88
|
| Rate for Payer: First Health Commercial |
$3,837.64
|
| Rate for Payer: Humana Commercial |
$3,433.68
|
| Rate for Payer: Humana KY Medicaid |
$1,389.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,403.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,312.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,981.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,417.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.34
|
| Rate for Payer: PHCS Commercial |
$3,878.04
|
| Rate for Payer: United Healthcare All Payer |
$3,554.87
|
|
|
PLATE LCK RECON 2.7M 10H*81M
|
Facility
|
OP
|
$4,164.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.35 |
| Max. Negotiated Rate |
$3,997.92 |
| Rate for Payer: Aetna Commercial |
$3,206.66
|
| Rate for Payer: Anthem Medicaid |
$1,432.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,248.31
|
| Rate for Payer: Cash Price |
$2,082.25
|
| Rate for Payer: Cigna Commercial |
$3,456.53
|
| Rate for Payer: First Health Commercial |
$3,956.28
|
| Rate for Payer: Humana Commercial |
$3,539.82
|
| Rate for Payer: Humana KY Medicaid |
$1,432.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,446.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,073.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,460.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,123.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,331.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,623.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.51
|
| Rate for Payer: PHCS Commercial |
$3,997.92
|
| Rate for Payer: United Healthcare All Payer |
$3,664.76
|
|
|
PLATE LCK RECON 2.7M 10H*81M
|
Facility
|
IP
|
$4,164.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,249.35 |
| Max. Negotiated Rate |
$3,997.92 |
| Rate for Payer: Aetna Commercial |
$3,206.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,248.31
|
| Rate for Payer: Cash Price |
$2,082.25
|
| Rate for Payer: Cigna Commercial |
$3,456.53
|
| Rate for Payer: First Health Commercial |
$3,956.28
|
| Rate for Payer: Humana Commercial |
$3,539.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,414.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,073.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,249.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,664.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,123.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,331.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,623.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,873.51
|
| Rate for Payer: PHCS Commercial |
$3,997.92
|
| Rate for Payer: United Healthcare All Payer |
$3,664.76
|
|
|
PLATE LCK RECON 2.7M 12H*97M
|
Facility
|
OP
|
$4,344.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.46 |
| Max. Negotiated Rate |
$4,171.08 |
| Rate for Payer: Aetna Commercial |
$3,345.56
|
| Rate for Payer: Anthem Medicaid |
$1,494.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.01
|
| Rate for Payer: Cash Price |
$2,172.44
|
| Rate for Payer: Cigna Commercial |
$3,606.25
|
| Rate for Payer: First Health Commercial |
$4,127.64
|
| Rate for Payer: Humana Commercial |
$3,693.15
|
| Rate for Payer: Humana KY Medicaid |
$1,494.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,509.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,524.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,823.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,258.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,780.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.97
|
| Rate for Payer: PHCS Commercial |
$4,171.08
|
| Rate for Payer: United Healthcare All Payer |
$3,823.49
|
|
|
PLATE LCK RECON 2.7M 12H*97M
|
Facility
|
IP
|
$4,344.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.46 |
| Max. Negotiated Rate |
$4,171.08 |
| Rate for Payer: Aetna Commercial |
$3,345.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,389.01
|
| Rate for Payer: Cash Price |
$2,172.44
|
| Rate for Payer: Cigna Commercial |
$3,606.25
|
| Rate for Payer: First Health Commercial |
$4,127.64
|
| Rate for Payer: Humana Commercial |
$3,693.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,562.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,206.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,303.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,823.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,258.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,475.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,780.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,997.97
|
| Rate for Payer: PHCS Commercial |
$4,171.08
|
| Rate for Payer: United Healthcare All Payer |
$3,823.49
|
|
|
PLATE LCK RECON 2.7M 14H*113M
|
Facility
|
OP
|
$4,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,372.14 |
| Max. Negotiated Rate |
$4,390.86 |
| Rate for Payer: Aetna Commercial |
$3,521.83
|
| Rate for Payer: Anthem Medicaid |
$1,572.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,567.57
|
| Rate for Payer: Cash Price |
$2,286.91
|
| Rate for Payer: Cigna Commercial |
$3,796.26
|
| Rate for Payer: First Health Commercial |
$4,345.12
|
| Rate for Payer: Humana Commercial |
$3,887.74
|
| Rate for Payer: Humana KY Medicaid |
$1,572.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,588.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,750.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,604.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,979.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,155.93
|
| Rate for Payer: PHCS Commercial |
$4,390.86
|
| Rate for Payer: United Healthcare All Payer |
$4,024.95
|
|
|
PLATE LCK RECON 2.7M 14H*113M
|
Facility
|
IP
|
$4,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,372.14 |
| Max. Negotiated Rate |
$4,390.86 |
| Rate for Payer: Aetna Commercial |
$3,521.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,567.57
|
| Rate for Payer: Cash Price |
$2,286.91
|
| Rate for Payer: Cigna Commercial |
$3,796.26
|
| Rate for Payer: First Health Commercial |
$4,345.12
|
| Rate for Payer: Humana Commercial |
$3,887.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,750.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,375.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,372.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,024.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,430.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,659.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,979.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,155.93
|
| Rate for Payer: PHCS Commercial |
$4,390.86
|
| Rate for Payer: United Healthcare All Payer |
$4,024.95
|
|
|
PLATE LCK RECON 2.7MM 4H*32MM
|
Facility
|
OP
|
$3,630.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.09 |
| Max. Negotiated Rate |
$3,485.10 |
| Rate for Payer: Aetna Commercial |
$2,795.34
|
| Rate for Payer: Anthem Medicaid |
$1,248.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,831.64
|
| Rate for Payer: Cash Price |
$1,815.16
|
| Rate for Payer: Cigna Commercial |
$3,013.16
|
| Rate for Payer: First Health Commercial |
$3,448.79
|
| Rate for Payer: Humana Commercial |
$3,085.76
|
| Rate for Payer: Humana KY Medicaid |
$1,248.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,261.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,976.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,679.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,273.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,194.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,722.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,904.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,158.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.91
|
| Rate for Payer: PHCS Commercial |
$3,485.10
|
| Rate for Payer: United Healthcare All Payer |
$3,194.67
|
|
|
PLATE LCK RECON 2.7MM 4H*32MM
|
Facility
|
IP
|
$3,630.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,089.09 |
| Max. Negotiated Rate |
$3,485.10 |
| Rate for Payer: Aetna Commercial |
$2,795.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,831.64
|
| Rate for Payer: Cash Price |
$1,815.16
|
| Rate for Payer: Cigna Commercial |
$3,013.16
|
| Rate for Payer: First Health Commercial |
$3,448.79
|
| Rate for Payer: Humana Commercial |
$3,085.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,976.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,679.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,089.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,194.67
|
| Rate for Payer: Ohio Health Group HMO |
$2,722.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,904.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,158.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,504.91
|
| Rate for Payer: PHCS Commercial |
$3,485.10
|
| Rate for Payer: United Healthcare All Payer |
$3,194.67
|
|
|
PLATE LCK RECON 2.7MM 6H*48MM
|
Facility
|
OP
|
$3,907.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.34 |
| Max. Negotiated Rate |
$3,751.50 |
| Rate for Payer: Aetna Commercial |
$3,009.01
|
| Rate for Payer: Anthem Medicaid |
$1,343.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.09
|
| Rate for Payer: Cash Price |
$1,953.91
|
| Rate for Payer: Cigna Commercial |
$3,243.48
|
| Rate for Payer: First Health Commercial |
$3,712.42
|
| Rate for Payer: Humana Commercial |
$3,321.64
|
| Rate for Payer: Humana KY Medicaid |
$1,343.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,357.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,370.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,696.39
|
| Rate for Payer: PHCS Commercial |
$3,751.50
|
| Rate for Payer: United Healthcare All Payer |
$3,438.87
|
|
|
PLATE LCK RECON 2.7MM 6H*48MM
|
Facility
|
IP
|
$3,907.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,172.34 |
| Max. Negotiated Rate |
$3,751.50 |
| Rate for Payer: Aetna Commercial |
$3,009.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,048.09
|
| Rate for Payer: Cash Price |
$1,953.91
|
| Rate for Payer: Cigna Commercial |
$3,243.48
|
| Rate for Payer: First Health Commercial |
$3,712.42
|
| Rate for Payer: Humana Commercial |
$3,321.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,204.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,883.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,172.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,438.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,930.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,126.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,399.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,696.39
|
| Rate for Payer: PHCS Commercial |
$3,751.50
|
| Rate for Payer: United Healthcare All Payer |
$3,438.87
|
|
|
PLATE LCK RECON 2.7MM 8H*65MM
|
Facility
|
IP
|
$4,088.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.46 |
| Max. Negotiated Rate |
$3,924.66 |
| Rate for Payer: Aetna Commercial |
$3,147.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.79
|
| Rate for Payer: Cash Price |
$2,044.09
|
| Rate for Payer: Cigna Commercial |
$3,393.20
|
| Rate for Payer: First Health Commercial |
$3,883.78
|
| Rate for Payer: Humana Commercial |
$3,474.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,017.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,270.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,556.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.85
|
| Rate for Payer: PHCS Commercial |
$3,924.66
|
| Rate for Payer: United Healthcare All Payer |
$3,597.61
|
|
|
PLATE LCK RECON 2.7MM 8H*65MM
|
Facility
|
OP
|
$4,088.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.46 |
| Max. Negotiated Rate |
$3,924.66 |
| Rate for Payer: Aetna Commercial |
$3,147.91
|
| Rate for Payer: Anthem Medicaid |
$1,405.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,188.79
|
| Rate for Payer: Cash Price |
$2,044.09
|
| Rate for Payer: Cigna Commercial |
$3,393.20
|
| Rate for Payer: First Health Commercial |
$3,883.78
|
| Rate for Payer: Humana Commercial |
$3,474.96
|
| Rate for Payer: Humana KY Medicaid |
$1,405.93
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,017.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,597.61
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,270.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,556.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,820.85
|
| Rate for Payer: PHCS Commercial |
$3,924.66
|
| Rate for Payer: United Healthcare All Payer |
$3,597.61
|
|
|
PLATE LCK STERNAL 4H STR T=1.8
|
Facility
|
IP
|
$4,048.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.59 |
| Max. Negotiated Rate |
$3,886.68 |
| Rate for Payer: Aetna Commercial |
$3,117.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.92
|
| Rate for Payer: Cash Price |
$2,024.31
|
| Rate for Payer: Cigna Commercial |
$3,360.35
|
| Rate for Payer: First Health Commercial |
$3,846.19
|
| Rate for Payer: Humana Commercial |
$3,441.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,319.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,562.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,238.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,522.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,793.55
|
| Rate for Payer: PHCS Commercial |
$3,886.68
|
| Rate for Payer: United Healthcare All Payer |
$3,562.79
|
|
|
PLATE LCK STERNAL 4H STR T=1.8
|
Facility
|
OP
|
$4,048.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,214.59 |
| Max. Negotiated Rate |
$3,886.68 |
| Rate for Payer: Aetna Commercial |
$3,117.44
|
| Rate for Payer: Anthem Medicaid |
$1,392.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,157.92
|
| Rate for Payer: Cash Price |
$2,024.31
|
| Rate for Payer: Cigna Commercial |
$3,360.35
|
| Rate for Payer: First Health Commercial |
$3,846.19
|
| Rate for Payer: Humana Commercial |
$3,441.33
|
| Rate for Payer: Humana KY Medicaid |
$1,392.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,406.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,319.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,987.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,214.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,420.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,562.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,036.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,238.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,522.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,793.55
|
| Rate for Payer: PHCS Commercial |
$3,886.68
|
| Rate for Payer: United Healthcare All Payer |
$3,562.79
|
|
