|
PLATE LOCK DIST FIB SS RT 10H
|
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 RT 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 SS RT 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 SS RT 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 SS RT 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 SS RT 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 SS RT 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 SS RT 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 LOCKING 4 HOLE 80MM LFT
|
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 LOCKING 4 HOLE 80MM LFT
|
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 LOCKING RECON 3.5MM 10H
|
Facility
|
IP
|
$4,167.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.25 |
| Max. Negotiated Rate |
$4,000.80 |
| Rate for Payer: Aetna Commercial |
$3,208.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,250.65
|
| Rate for Payer: Cash Price |
$2,083.75
|
| Rate for Payer: Cigna Commercial |
$3,459.03
|
| Rate for Payer: First Health Commercial |
$3,959.12
|
| Rate for Payer: Humana Commercial |
$3,542.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,417.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,075.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,250.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,667.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,125.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,875.57
|
| Rate for Payer: PHCS Commercial |
$4,000.80
|
| Rate for Payer: United Healthcare All Payer |
$3,667.40
|
|
|
PLATE LOCKING RECON 3.5MM 10H
|
Facility
|
OP
|
$4,167.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.25 |
| Max. Negotiated Rate |
$4,000.80 |
| Rate for Payer: Aetna Commercial |
$3,208.97
|
| Rate for Payer: Anthem Medicaid |
$1,433.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,250.65
|
| Rate for Payer: Cash Price |
$2,083.75
|
| Rate for Payer: Cigna Commercial |
$3,459.03
|
| Rate for Payer: First Health Commercial |
$3,959.12
|
| Rate for Payer: Humana Commercial |
$3,542.38
|
| Rate for Payer: Humana KY Medicaid |
$1,433.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,447.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,417.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,075.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,250.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,461.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,667.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,125.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,334.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,625.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,875.57
|
| Rate for Payer: PHCS Commercial |
$4,000.80
|
| Rate for Payer: United Healthcare All Payer |
$3,667.40
|
|
|
PLATE LOCKING RECON 3.5MM 12H
|
Facility
|
OP
|
$4,325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.50 |
| Max. Negotiated Rate |
$4,152.00 |
| Rate for Payer: Aetna Commercial |
$3,330.25
|
| Rate for Payer: Anthem Medicaid |
$1,487.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,589.75
|
| Rate for Payer: First Health Commercial |
$4,108.75
|
| Rate for Payer: Humana Commercial |
$3,676.25
|
| Rate for Payer: Humana KY Medicaid |
$1,487.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,502.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,297.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,517.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,762.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.25
|
| Rate for Payer: PHCS Commercial |
$4,152.00
|
| Rate for Payer: United Healthcare All Payer |
$3,806.00
|
|
|
PLATE LOCKING RECON 3.5MM 12H
|
Facility
|
IP
|
$4,325.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.50 |
| Max. Negotiated Rate |
$4,152.00 |
| Rate for Payer: Aetna Commercial |
$3,330.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,373.50
|
| Rate for Payer: Cash Price |
$2,162.50
|
| Rate for Payer: Cigna Commercial |
$3,589.75
|
| Rate for Payer: First Health Commercial |
$4,108.75
|
| Rate for Payer: Humana Commercial |
$3,676.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,546.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,191.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,297.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,806.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,243.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,460.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,762.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,984.25
|
| Rate for Payer: PHCS Commercial |
$4,152.00
|
| Rate for Payer: United Healthcare All Payer |
$3,806.00
|
|
|
PLATE LOCKING RECON 3.5MM 4H
|
Facility
|
IP
|
$3,616.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.88 |
| Max. Negotiated Rate |
$3,471.60 |
| Rate for Payer: Aetna Commercial |
$2,784.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,820.68
|
| Rate for Payer: Cash Price |
$1,808.12
|
| Rate for Payer: Cigna Commercial |
$3,001.49
|
| Rate for Payer: First Health Commercial |
$3,435.44
|
| Rate for Payer: Humana Commercial |
$3,073.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,965.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,668.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,084.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,182.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,712.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,893.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,146.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.21
|
| Rate for Payer: PHCS Commercial |
$3,471.60
|
| Rate for Payer: United Healthcare All Payer |
$3,182.30
|
|
|
PLATE LOCKING RECON 3.5MM 4H
|
Facility
|
OP
|
$3,616.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,084.88 |
| Max. Negotiated Rate |
$3,471.60 |
| Rate for Payer: Aetna Commercial |
$2,784.51
|
| Rate for Payer: Anthem Medicaid |
$1,243.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,820.68
|
| Rate for Payer: Cash Price |
$1,808.12
|
| Rate for Payer: Cigna Commercial |
$3,001.49
|
| Rate for Payer: First Health Commercial |
$3,435.44
|
| Rate for Payer: Humana Commercial |
$3,073.81
|
| Rate for Payer: Humana KY Medicaid |
$1,243.63
|
| Rate for Payer: Kentucky WC Medicaid |
$1,256.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,965.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,668.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,084.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,268.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,182.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,712.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,893.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,146.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,495.21
|
| Rate for Payer: PHCS Commercial |
$3,471.60
|
| Rate for Payer: United Healthcare All Payer |
$3,182.30
|
|
|
PLATE LOCKING RECON 3.5MM 6H
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE LOCKING RECON 3.5MM 6H
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE LOCKING RECON 3.5MM 8H
|
Facility
|
IP
|
$4,088.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.62 |
| Max. Negotiated Rate |
$3,925.20 |
| Rate for Payer: Aetna Commercial |
$3,148.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,189.22
|
| Rate for Payer: Cash Price |
$2,044.38
|
| Rate for Payer: Cigna Commercial |
$3,393.66
|
| Rate for Payer: First Health Commercial |
$3,884.31
|
| Rate for Payer: Humana Commercial |
$3,475.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,017.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,598.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,271.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,557.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,821.24
|
| Rate for Payer: PHCS Commercial |
$3,925.20
|
| Rate for Payer: United Healthcare All Payer |
$3,598.10
|
|
|
PLATE LOCKING RECON 3.5MM 8H
|
Facility
|
OP
|
$4,088.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.62 |
| Max. Negotiated Rate |
$3,925.20 |
| Rate for Payer: Aetna Commercial |
$3,148.34
|
| Rate for Payer: Anthem Medicaid |
$1,406.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,189.22
|
| Rate for Payer: Cash Price |
$2,044.38
|
| Rate for Payer: Cigna Commercial |
$3,393.66
|
| Rate for Payer: First Health Commercial |
$3,884.31
|
| Rate for Payer: Humana Commercial |
$3,475.44
|
| Rate for Payer: Humana KY Medicaid |
$1,406.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,420.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,352.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,017.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,434.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,598.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,066.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,271.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,557.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,821.24
|
| Rate for Payer: PHCS Commercial |
$3,925.20
|
| Rate for Payer: United Healthcare All Payer |
$3,598.10
|
|
|
PLATE LOCKING SS STR 10H
|
Facility
|
OP
|
$4,231.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,269.38 |
| Max. Negotiated Rate |
$4,062.00 |
| Rate for Payer: Aetna Commercial |
$3,258.06
|
| Rate for Payer: Anthem Medicaid |
$1,455.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,300.38
|
| Rate for Payer: Cash Price |
$2,115.62
|
| Rate for Payer: Cigna Commercial |
$3,511.94
|
| Rate for Payer: First Health Commercial |
$4,019.69
|
| Rate for Payer: Humana Commercial |
$3,596.56
|
| Rate for Payer: Humana KY Medicaid |
$1,455.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,469.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,469.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,122.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,484.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,723.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,173.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,681.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.56
|
| Rate for Payer: PHCS Commercial |
$4,062.00
|
| Rate for Payer: United Healthcare All Payer |
$3,723.50
|
|
|
PLATE LOCKING SS STR 10H
|
Facility
|
IP
|
$4,231.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,269.38 |
| Max. Negotiated Rate |
$4,062.00 |
| Rate for Payer: Aetna Commercial |
$3,258.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,300.38
|
| Rate for Payer: Cash Price |
$2,115.62
|
| Rate for Payer: Cigna Commercial |
$3,511.94
|
| Rate for Payer: First Health Commercial |
$4,019.69
|
| Rate for Payer: Humana Commercial |
$3,596.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,469.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,122.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,269.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,723.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,173.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,385.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,681.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,919.56
|
| Rate for Payer: PHCS Commercial |
$4,062.00
|
| Rate for Payer: United Healthcare All Payer |
$3,723.50
|
|
|
PLATE LOCKING SS STR 12H
|
Facility
|
OP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem Medicaid |
$1,584.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Humana KY Medicaid |
$1,584.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,615.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE LOCKING SS STR 12H
|
Facility
|
IP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE LOCKING SS STR 4H
|
Facility
|
IP
|
$3,687.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,106.25 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$2,839.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,876.25
|
| Rate for Payer: Cash Price |
$1,843.75
|
| Rate for Payer: Cigna Commercial |
$3,060.62
|
| Rate for Payer: First Health Commercial |
$3,503.12
|
| Rate for Payer: Humana Commercial |
$3,134.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,023.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,721.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,106.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,245.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,765.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,950.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,208.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,544.38
|
| Rate for Payer: PHCS Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare All Payer |
$3,245.00
|
|
