|
PLATE LOCK DIST FIB LEFT 10H
|
Facility
|
IP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
|
PLATE LOCK DIST FIB LEFT 12H
|
Facility
|
OP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem Medicaid |
$1,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Humana KY Medicaid |
$1,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,891.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,910.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
|
PLATE LOCK DIST FIB LEFT 12H
|
Facility
|
IP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
|
PLATE LOCK DIST FIB LEFT 14H
|
Facility
|
IP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
|
PLATE LOCK DIST FIB LEFT 14H
|
Facility
|
OP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem Medicaid |
$1,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Humana KY Medicaid |
$1,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,891.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,910.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
|
PLATE LOCK DIST FIB LEFT 8H
|
Facility
|
IP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
|
PLATE LOCK DIST FIB LEFT 8H
|
Facility
|
OP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem Medicaid |
$1,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Humana KY Medicaid |
$1,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,891.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,910.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
|
PLATE LOCK DIST FIB SS 10H R
|
Facility
|
OP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem Medicaid |
$1,783.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Humana KY Medicaid |
$1,783.98
|
| Rate for Payer: Kentucky WC Medicaid |
$1,802.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,819.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
PLATE LOCK DIST FIB SS 10H R
|
Facility
|
IP
|
$5,187.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.25 |
| Max. Negotiated Rate |
$4,980.00 |
| Rate for Payer: Aetna Commercial |
$3,994.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,046.25
|
| Rate for Payer: Cash Price |
$2,593.75
|
| Rate for Payer: Cigna Commercial |
$4,305.62
|
| Rate for Payer: First Health Commercial |
$4,928.12
|
| Rate for Payer: Humana Commercial |
$4,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,253.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,828.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,556.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,565.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,150.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,513.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,579.38
|
| Rate for Payer: PHCS Commercial |
$4,980.00
|
| Rate for Payer: United Healthcare All Payer |
$4,565.00
|
|
|
PLATE LOCK DIST FIB SS LEFT 4H
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Aetna Commercial |
$3,404.60
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem Medicaid |
$1,520.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,448.82
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cash Price |
$2,210.78
|
| Rate for Payer: Cigna Commercial |
$3,669.89
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$4,200.48
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana Commercial |
$3,758.33
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Humana KY Medicaid |
$1,520.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,536.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,625.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,263.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,326.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,551.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,890.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,316.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,537.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,846.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,050.88
|
| Rate for Payer: PHCS Commercial |
$4,244.70
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,890.97
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
PLATE LOCK DIST FIB SS LEFT 4H
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Aetna Commercial |
$3,404.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,448.82
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cash Price |
$2,210.78
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: Cigna Commercial |
$3,669.89
|
| Rate for Payer: First Health Commercial |
$4,200.48
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,758.33
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,625.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,263.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,326.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,890.97
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,316.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,537.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,846.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,050.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: PHCS Commercial |
$4,244.70
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
| Rate for Payer: United Healthcare All Payer |
$3,890.97
|
|
|
PLATE LOCK DIST FIB SS LEFT 5H
|
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 LOCK DIST FIB SS LEFT 5H
|
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 LOCK DIST FIB SS LEFT 6H
|
Facility
|
IP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
PLATE LOCK DIST FIB SS LEFT 6H
|
Facility
|
OP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem Medicaid |
$1,622.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Humana KY Medicaid |
$1,622.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
PLATE LOCK DIST FIB SS LEFT 8H
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE LOCK DIST FIB SS LEFT 8H
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE LOCK DIST FIB SS RGHT 4H
|
Facility
|
OP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem Medicaid |
$1,397.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Humana KY Medicaid |
$1,397.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,411.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,425.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
PLATE LOCK DIST FIB SS RGHT 4H
|
Facility
|
IP
|
$4,062.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,218.75 |
| Max. Negotiated Rate |
$3,900.00 |
| Rate for Payer: Aetna Commercial |
$3,128.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,168.75
|
| Rate for Payer: Cash Price |
$2,031.25
|
| Rate for Payer: Cigna Commercial |
$3,371.88
|
| Rate for Payer: First Health Commercial |
$3,859.38
|
| Rate for Payer: Humana Commercial |
$3,453.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,331.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,998.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,218.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,575.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,046.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,250.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,534.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,803.12
|
| Rate for Payer: PHCS Commercial |
$3,900.00
|
| Rate for Payer: United Healthcare All Payer |
$3,575.00
|
|
|
PLATE LOCK DIST FIB SS RGHT 5H
|
Facility
|
IP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
PLATE LOCK DIST FIB SS RGHT 5H
|
Facility
|
OP
|
$4,437.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.25 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$3,416.88
|
| Rate for Payer: Anthem Medicaid |
$1,526.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,461.25
|
| Rate for Payer: Cash Price |
$2,218.75
|
| Rate for Payer: Cigna Commercial |
$3,683.12
|
| Rate for Payer: First Health Commercial |
$4,215.62
|
| Rate for Payer: Humana Commercial |
$3,771.88
|
| Rate for Payer: Humana KY Medicaid |
$1,526.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,541.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,638.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,274.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,331.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,556.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,905.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,328.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,550.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,860.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,061.88
|
| Rate for Payer: PHCS Commercial |
$4,260.00
|
| Rate for Payer: United Healthcare All Payer |
$3,905.00
|
|
|
PLATE LOCK DIST FIB SS RGHT 6H
|
Facility
|
OP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem Medicaid |
$1,622.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Humana KY Medicaid |
$1,622.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
PLATE LOCK DIST FIB SS RGHT 6H
|
Facility
|
IP
|
$4,718.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,415.62 |
| Max. Negotiated Rate |
$4,530.00 |
| Rate for Payer: Aetna Commercial |
$3,633.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,680.62
|
| Rate for Payer: Cash Price |
$2,359.38
|
| Rate for Payer: Cigna Commercial |
$3,916.56
|
| Rate for Payer: First Health Commercial |
$4,482.81
|
| Rate for Payer: Humana Commercial |
$4,010.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,869.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,482.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,415.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,152.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,539.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,775.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,105.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,255.94
|
| Rate for Payer: PHCS Commercial |
$4,530.00
|
| Rate for Payer: United Healthcare All Payer |
$4,152.50
|
|
|
PLATE LOCK DIST FIB SS RGHT 8H
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE LOCK DIST FIB SS RGHT 8H
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
