|
PLATE LOCKING SS STR 4H
|
Facility
|
OP
|
$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 Medicaid |
$1,268.13
|
| 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: Humana KY Medicaid |
$1,268.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,281.04
|
| 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: Molina Healthcare Medicaid |
$1,293.58
|
| 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
|
|
|
PLATE LOCKING SS STR 6H
|
Facility
|
OP
|
$3,870.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.09 |
| Max. Negotiated Rate |
$3,715.50 |
| Rate for Payer: Aetna Commercial |
$2,980.14
|
| Rate for Payer: Anthem Medicaid |
$1,331.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.84
|
| Rate for Payer: Cash Price |
$1,935.16
|
| Rate for Payer: Cigna Commercial |
$3,212.36
|
| Rate for Payer: First Health Commercial |
$3,676.79
|
| Rate for Payer: Humana Commercial |
$3,289.76
|
| Rate for Payer: Humana KY Medicaid |
$1,331.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,173.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,096.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.51
|
| Rate for Payer: PHCS Commercial |
$3,715.50
|
| Rate for Payer: United Healthcare All Payer |
$3,405.87
|
|
|
PLATE LOCKING SS STR 6H
|
Facility
|
IP
|
$3,870.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,161.09 |
| Max. Negotiated Rate |
$3,715.50 |
| Rate for Payer: Aetna Commercial |
$2,980.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.84
|
| Rate for Payer: Cash Price |
$1,935.16
|
| Rate for Payer: Cigna Commercial |
$3,212.36
|
| Rate for Payer: First Health Commercial |
$3,676.79
|
| Rate for Payer: Humana Commercial |
$3,289.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,173.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,856.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,161.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.87
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,096.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,367.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,670.51
|
| Rate for Payer: PHCS Commercial |
$3,715.50
|
| Rate for Payer: United Healthcare All Payer |
$3,405.87
|
|
|
PLATE LOCKING SS STR 7H
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE LOCKING SS STR 7H
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE LOCKING SS STR 8H
|
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 LOCKING SS STR 8H
|
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 LAT HOOK SS 3H
|
Facility
|
IP
|
$4,756.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.88 |
| Max. Negotiated Rate |
$4,566.00 |
| Rate for Payer: Aetna Commercial |
$3,662.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,709.88
|
| Rate for Payer: Cash Price |
$2,378.12
|
| Rate for Payer: Cigna Commercial |
$3,947.69
|
| Rate for Payer: First Health Commercial |
$4,518.44
|
| Rate for Payer: Humana Commercial |
$4,042.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,900.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,510.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,426.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,185.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,567.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,805.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,137.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,281.81
|
| Rate for Payer: PHCS Commercial |
$4,566.00
|
| Rate for Payer: United Healthcare All Payer |
$4,185.50
|
|
|
PLATE LOCK LAT HOOK SS 3H
|
Facility
|
OP
|
$4,756.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.88 |
| Max. Negotiated Rate |
$4,566.00 |
| Rate for Payer: Aetna Commercial |
$3,662.31
|
| Rate for Payer: Anthem Medicaid |
$1,635.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,709.88
|
| Rate for Payer: Cash Price |
$2,378.12
|
| Rate for Payer: Cigna Commercial |
$3,947.69
|
| Rate for Payer: First Health Commercial |
$4,518.44
|
| Rate for Payer: Humana Commercial |
$4,042.81
|
| Rate for Payer: Humana KY Medicaid |
$1,635.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,652.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,900.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,510.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,426.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,668.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,185.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,567.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,805.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,137.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,281.81
|
| Rate for Payer: PHCS Commercial |
$4,566.00
|
| Rate for Payer: United Healthcare All Payer |
$4,185.50
|
|
|
PLATE LOCK LAT HOOK SS 5H
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
PLATE LOCK LAT HOOK SS 5H
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
PLATE LOCK LAT HOOK SS 7H
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
PLATE LOCK LAT HOOK SS 7H
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
PLATE LOCK MEDIAL HOOK SS 3H
|
Facility
|
OP
|
$5,248.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.53 |
| Max. Negotiated Rate |
$5,038.50 |
| Rate for Payer: Aetna Commercial |
$4,041.30
|
| Rate for Payer: Anthem Medicaid |
$1,804.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,093.78
|
| Rate for Payer: Cash Price |
$2,624.22
|
| Rate for Payer: Cigna Commercial |
$4,356.21
|
| Rate for Payer: First Health Commercial |
$4,986.02
|
| Rate for Payer: Humana Commercial |
$4,461.17
|
| Rate for Payer: Humana KY Medicaid |
$1,804.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,823.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,303.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,873.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,574.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,841.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,618.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,936.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,198.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,621.42
|
| Rate for Payer: PHCS Commercial |
$5,038.50
|
| Rate for Payer: United Healthcare All Payer |
$4,618.63
|
|
|
PLATE LOCK MEDIAL HOOK SS 3H
|
Facility
|
IP
|
$5,248.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,574.53 |
| Max. Negotiated Rate |
$5,038.50 |
| Rate for Payer: Aetna Commercial |
$4,041.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,093.78
|
| Rate for Payer: Cash Price |
$2,624.22
|
| Rate for Payer: Cigna Commercial |
$4,356.21
|
| Rate for Payer: First Health Commercial |
$4,986.02
|
| Rate for Payer: Humana Commercial |
$4,461.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,303.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,873.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,574.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,618.63
|
| Rate for Payer: Ohio Health Group HMO |
$3,936.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,198.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,566.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,621.42
|
| Rate for Payer: PHCS Commercial |
$5,038.50
|
| Rate for Payer: United Healthcare All Payer |
$4,618.63
|
|
|
PLATE LOCK MEDIAL HOOK SS 5H
|
Facility
|
OP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem Medicaid |
$1,751.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Humana KY Medicaid |
$1,751.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,769.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,786.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE LOCK MEDIAL HOOK SS 5H
|
Facility
|
IP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE LOCK MEDIAL HOOK SS 7H
|
Facility
|
IP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE LOCK MEDIAL HOOK SS 7H
|
Facility
|
OP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem Medicaid |
$1,751.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Humana KY Medicaid |
$1,751.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,769.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,786.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE LOCK STERNAL 11H JLT
|
Facility
|
IP
|
$5,236.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.99 |
| Max. Negotiated Rate |
$5,027.16 |
| Rate for Payer: Aetna Commercial |
$4,032.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,084.56
|
| Rate for Payer: Cash Price |
$2,618.31
|
| Rate for Payer: Cigna Commercial |
$4,346.39
|
| Rate for Payer: First Health Commercial |
$4,974.79
|
| Rate for Payer: Humana Commercial |
$4,451.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,294.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,864.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,570.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,608.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,927.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,189.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,555.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,613.27
|
| Rate for Payer: PHCS Commercial |
$5,027.16
|
| Rate for Payer: United Healthcare All Payer |
$4,608.23
|
|
|
PLATE LOCK STERNAL 11H JLT
|
Facility
|
OP
|
$5,236.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,570.99 |
| Max. Negotiated Rate |
$5,027.16 |
| Rate for Payer: Aetna Commercial |
$4,032.20
|
| Rate for Payer: Anthem Medicaid |
$1,800.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,084.56
|
| Rate for Payer: Cash Price |
$2,618.31
|
| Rate for Payer: Cigna Commercial |
$4,346.39
|
| Rate for Payer: First Health Commercial |
$4,974.79
|
| Rate for Payer: Humana Commercial |
$4,451.13
|
| Rate for Payer: Humana KY Medicaid |
$1,800.87
|
| Rate for Payer: Kentucky WC Medicaid |
$1,819.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,294.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,864.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,570.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,837.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,608.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,927.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,189.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,555.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,613.27
|
| Rate for Payer: PHCS Commercial |
$5,027.16
|
| Rate for Payer: United Healthcare All Payer |
$4,608.23
|
|
|
PLATE LOCK STERNAL 14H Y SHP
|
Facility
|
IP
|
$4,713.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.05 |
| Max. Negotiated Rate |
$4,524.96 |
| Rate for Payer: Aetna Commercial |
$3,629.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.53
|
| Rate for Payer: Cash Price |
$2,356.75
|
| Rate for Payer: Cigna Commercial |
$3,912.20
|
| Rate for Payer: First Health Commercial |
$4,477.82
|
| Rate for Payer: Humana Commercial |
$4,006.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.32
|
| Rate for Payer: PHCS Commercial |
$4,524.96
|
| Rate for Payer: United Healthcare All Payer |
$4,147.88
|
|
|
PLATE LOCK STERNAL 14H Y SHP
|
Facility
|
OP
|
$4,713.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.05 |
| Max. Negotiated Rate |
$4,524.96 |
| Rate for Payer: Aetna Commercial |
$3,629.39
|
| Rate for Payer: Anthem Medicaid |
$1,620.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.53
|
| Rate for Payer: Cash Price |
$2,356.75
|
| Rate for Payer: Cigna Commercial |
$3,912.20
|
| Rate for Payer: First Health Commercial |
$4,477.82
|
| Rate for Payer: Humana Commercial |
$4,006.47
|
| Rate for Payer: Humana KY Medicaid |
$1,620.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,637.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,653.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.32
|
| Rate for Payer: PHCS Commercial |
$4,524.96
|
| Rate for Payer: United Healthcare All Payer |
$4,147.88
|
|
|
PLATE LOCK STERNAL 18H LADDER
|
Facility
|
IP
|
$6,675.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.61 |
| Max. Negotiated Rate |
$6,408.36 |
| Rate for Payer: Aetna Commercial |
$5,140.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,206.79
|
| Rate for Payer: Cash Price |
$3,337.68
|
| Rate for Payer: Cigna Commercial |
$5,540.56
|
| Rate for Payer: First Health Commercial |
$6,341.60
|
| Rate for Payer: Humana Commercial |
$5,674.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,473.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,926.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,002.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,874.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,006.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,807.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,606.01
|
| Rate for Payer: PHCS Commercial |
$6,408.36
|
| Rate for Payer: United Healthcare All Payer |
$5,874.33
|
|
|
PLATE LOCK STERNAL 18H LADDER
|
Facility
|
OP
|
$6,675.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,002.61 |
| Max. Negotiated Rate |
$6,408.36 |
| Rate for Payer: Aetna Commercial |
$5,140.03
|
| Rate for Payer: Anthem Medicaid |
$2,295.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,206.79
|
| Rate for Payer: Cash Price |
$3,337.68
|
| Rate for Payer: Cigna Commercial |
$5,540.56
|
| Rate for Payer: First Health Commercial |
$6,341.60
|
| Rate for Payer: Humana Commercial |
$5,674.06
|
| Rate for Payer: Humana KY Medicaid |
$2,295.66
|
| Rate for Payer: Kentucky WC Medicaid |
$2,319.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,473.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,926.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,002.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,341.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,874.33
|
| Rate for Payer: Ohio Health Group HMO |
$5,006.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,340.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,807.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,606.01
|
| Rate for Payer: PHCS Commercial |
$6,408.36
|
| Rate for Payer: United Healthcare All Payer |
$5,874.33
|
|
