|
PLATE RECON HEMI MAND 5528922
|
Facility
|
IP
|
$6,804.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.64 |
| Max. Negotiated Rate |
$6,532.76 |
| Rate for Payer: Aetna Commercial |
$5,239.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,307.87
|
| Rate for Payer: Cash Price |
$3,402.48
|
| Rate for Payer: Cigna Commercial |
$5,648.12
|
| Rate for Payer: First Health Commercial |
$6,464.71
|
| Rate for Payer: Humana Commercial |
$5,784.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,103.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,360.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.54
|
| Rate for Payer: PHCS Commercial |
$6,532.76
|
| Rate for Payer: United Healthcare All Payer |
$5,988.36
|
|
|
PLATE RECON HEMI MAND L 6*17
|
Facility
|
IP
|
$7,094.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.30 |
| Max. Negotiated Rate |
$6,810.84 |
| Rate for Payer: Aetna Commercial |
$5,462.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,533.81
|
| Rate for Payer: Cash Price |
$3,547.31
|
| Rate for Payer: Cigna Commercial |
$5,888.54
|
| Rate for Payer: First Health Commercial |
$6,739.90
|
| Rate for Payer: Humana Commercial |
$6,030.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,817.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,235.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,243.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,320.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.34
|
| Rate for Payer: PHCS Commercial |
$6,810.84
|
| Rate for Payer: United Healthcare All Payer |
$6,243.27
|
|
|
PLATE RECON HEMI MAND L 6*17
|
Facility
|
OP
|
$7,094.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.30 |
| Max. Negotiated Rate |
$6,810.84 |
| Rate for Payer: Aetna Commercial |
$5,462.87
|
| Rate for Payer: Anthem Medicaid |
$2,439.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,533.81
|
| Rate for Payer: Cash Price |
$3,547.31
|
| Rate for Payer: Cigna Commercial |
$5,888.54
|
| Rate for Payer: First Health Commercial |
$6,739.90
|
| Rate for Payer: Humana Commercial |
$6,030.44
|
| Rate for Payer: Humana KY Medicaid |
$2,439.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,464.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,817.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,235.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,243.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,320.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.34
|
| Rate for Payer: PHCS Commercial |
$6,810.84
|
| Rate for Payer: United Healthcare All Payer |
$6,243.27
|
|
|
PLATE RECON HEMI MAND R 6*17
|
Facility
|
OP
|
$7,094.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.30 |
| Max. Negotiated Rate |
$6,810.84 |
| Rate for Payer: Aetna Commercial |
$5,462.87
|
| Rate for Payer: Anthem Medicaid |
$2,439.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,533.81
|
| Rate for Payer: Cash Price |
$3,547.31
|
| Rate for Payer: Cigna Commercial |
$5,888.54
|
| Rate for Payer: First Health Commercial |
$6,739.90
|
| Rate for Payer: Humana Commercial |
$6,030.44
|
| Rate for Payer: Humana KY Medicaid |
$2,439.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,464.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,817.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,235.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,488.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,243.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,320.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.34
|
| Rate for Payer: PHCS Commercial |
$6,810.84
|
| Rate for Payer: United Healthcare All Payer |
$6,243.27
|
|
|
PLATE RECON HEMI MAND R 6*17
|
Facility
|
IP
|
$7,094.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.30 |
| Max. Negotiated Rate |
$6,810.84 |
| Rate for Payer: Aetna Commercial |
$5,462.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,533.81
|
| Rate for Payer: Cash Price |
$3,547.31
|
| Rate for Payer: Cigna Commercial |
$5,888.54
|
| Rate for Payer: First Health Commercial |
$6,739.90
|
| Rate for Payer: Humana Commercial |
$6,030.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,817.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,235.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,128.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,243.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,320.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,418.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$922.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,199.34
|
| Rate for Payer: PHCS Commercial |
$6,810.84
|
| Rate for Payer: United Healthcare All Payer |
$6,243.27
|
|
|
PLATE RECON LCK 3.5 12 142MM
|
Facility
|
OP
|
$4,330.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$4,157.06 |
| Rate for Payer: Aetna Commercial |
$3,334.31
|
| Rate for Payer: Anthem Medicaid |
$1,489.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,377.61
|
| Rate for Payer: Cash Price |
$2,165.14
|
| Rate for Payer: Cigna Commercial |
$3,594.12
|
| Rate for Payer: First Health Commercial |
$4,113.76
|
| Rate for Payer: Humana Commercial |
$3,680.73
|
| Rate for Payer: Humana KY Medicaid |
$1,489.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,504.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,550.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,195.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,519.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,810.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,247.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$866.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.38
|
| Rate for Payer: PHCS Commercial |
$4,157.06
|
| Rate for Payer: United Healthcare All Payer |
$3,810.64
|
|
|
PLATE RECON LCK 3.5 12 142MM
|
Facility
|
IP
|
$4,330.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$562.94 |
| Max. Negotiated Rate |
$4,157.06 |
| Rate for Payer: Aetna Commercial |
$3,334.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,377.61
|
| Rate for Payer: Cash Price |
$2,165.14
|
| Rate for Payer: Cigna Commercial |
$3,594.12
|
| Rate for Payer: First Health Commercial |
$4,113.76
|
| Rate for Payer: Humana Commercial |
$3,680.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,550.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,195.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,299.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,810.64
|
| Rate for Payer: Ohio Health Group HMO |
$3,247.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$866.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$562.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.38
|
| Rate for Payer: PHCS Commercial |
$4,157.06
|
| Rate for Payer: United Healthcare All Payer |
$3,810.64
|
|
|
PLATE RECON LCK 3.5M 10 118MM
|
Facility
|
IP
|
$4,187.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.42 |
| Max. Negotiated Rate |
$4,020.31 |
| Rate for Payer: Aetna Commercial |
$3,224.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,266.50
|
| Rate for Payer: Cash Price |
$2,093.91
|
| Rate for Payer: Cigna Commercial |
$3,475.89
|
| Rate for Payer: First Health Commercial |
$3,978.43
|
| Rate for Payer: Humana Commercial |
$3,559.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,434.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,090.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,256.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,685.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,140.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.22
|
| Rate for Payer: PHCS Commercial |
$4,020.31
|
| Rate for Payer: United Healthcare All Payer |
$3,685.28
|
|
|
PLATE RECON LCK 3.5M 10 118MM
|
Facility
|
OP
|
$4,187.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.42 |
| Max. Negotiated Rate |
$4,020.31 |
| Rate for Payer: Aetna Commercial |
$3,224.62
|
| Rate for Payer: Anthem Medicaid |
$1,440.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,266.50
|
| Rate for Payer: Cash Price |
$2,093.91
|
| Rate for Payer: Cigna Commercial |
$3,475.89
|
| Rate for Payer: First Health Commercial |
$3,978.43
|
| Rate for Payer: Humana Commercial |
$3,559.65
|
| Rate for Payer: Humana KY Medicaid |
$1,440.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,454.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,434.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,090.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,256.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,469.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,685.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,140.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$837.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,298.22
|
| Rate for Payer: PHCS Commercial |
$4,020.31
|
| Rate for Payer: United Healthcare All Payer |
$3,685.28
|
|
|
PLATE RECON LCK 3.5M 4 46MM
|
Facility
|
IP
|
$3,682.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.76 |
| Max. Negotiated Rate |
$3,535.47 |
| Rate for Payer: Aetna Commercial |
$2,835.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.57
|
| Rate for Payer: Cash Price |
$1,841.39
|
| Rate for Payer: Cigna Commercial |
$3,056.71
|
| Rate for Payer: First Health Commercial |
$3,498.64
|
| Rate for Payer: Humana Commercial |
$3,130.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,019.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,717.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,240.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,762.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.66
|
| Rate for Payer: PHCS Commercial |
$3,535.47
|
| Rate for Payer: United Healthcare All Payer |
$3,240.85
|
|
|
PLATE RECON LCK 3.5M 4 46MM
|
Facility
|
OP
|
$3,682.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.76 |
| Max. Negotiated Rate |
$3,535.47 |
| Rate for Payer: Aetna Commercial |
$2,835.74
|
| Rate for Payer: Anthem Medicaid |
$1,266.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,872.57
|
| Rate for Payer: Cash Price |
$1,841.39
|
| Rate for Payer: Cigna Commercial |
$3,056.71
|
| Rate for Payer: First Health Commercial |
$3,498.64
|
| Rate for Payer: Humana Commercial |
$3,130.36
|
| Rate for Payer: Humana KY Medicaid |
$1,266.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,279.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,019.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,717.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,104.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,291.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,240.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,762.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$736.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$478.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,141.66
|
| Rate for Payer: PHCS Commercial |
$3,535.47
|
| Rate for Payer: United Healthcare All Payer |
$3,240.85
|
|
|
PLATE RECON LCK 3.5M 6 70MM
|
Facility
|
OP
|
$3,928.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.75 |
| Max. Negotiated Rate |
$3,771.67 |
| Rate for Payer: Aetna Commercial |
$3,025.19
|
| Rate for Payer: Anthem Medicaid |
$1,351.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.48
|
| Rate for Payer: Cash Price |
$1,964.41
|
| Rate for Payer: Cigna Commercial |
$3,260.92
|
| Rate for Payer: First Health Commercial |
$3,732.38
|
| Rate for Payer: Humana Commercial |
$3,339.50
|
| Rate for Payer: Humana KY Medicaid |
$1,351.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,364.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,378.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.93
|
| Rate for Payer: PHCS Commercial |
$3,771.67
|
| Rate for Payer: United Healthcare All Payer |
$3,457.36
|
|
|
PLATE RECON LCK 3.5M 6 70MM
|
Facility
|
IP
|
$3,928.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.75 |
| Max. Negotiated Rate |
$3,771.67 |
| Rate for Payer: Aetna Commercial |
$3,025.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,064.48
|
| Rate for Payer: Cash Price |
$1,964.41
|
| Rate for Payer: Cigna Commercial |
$3,260.92
|
| Rate for Payer: First Health Commercial |
$3,732.38
|
| Rate for Payer: Humana Commercial |
$3,339.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,221.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,899.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,178.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,457.36
|
| Rate for Payer: Ohio Health Group HMO |
$2,946.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$785.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$510.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,217.93
|
| Rate for Payer: PHCS Commercial |
$3,771.67
|
| Rate for Payer: United Healthcare All Payer |
$3,457.36
|
|
|
PLATE RECON LCK 3.5M 8 94MM
|
Facility
|
IP
|
$4,103.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.47 |
| Max. Negotiated Rate |
$3,939.50 |
| Rate for Payer: Aetna Commercial |
$3,159.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.85
|
| Rate for Payer: Cash Price |
$2,051.82
|
| Rate for Payer: Cigna Commercial |
$3,406.03
|
| Rate for Payer: First Health Commercial |
$3,898.47
|
| Rate for Payer: Humana Commercial |
$3,488.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,077.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.13
|
| Rate for Payer: PHCS Commercial |
$3,939.50
|
| Rate for Payer: United Healthcare All Payer |
$3,611.21
|
|
|
PLATE RECON LCK 3.5M 8 94MM
|
Facility
|
OP
|
$4,103.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.47 |
| Max. Negotiated Rate |
$3,939.50 |
| Rate for Payer: Aetna Commercial |
$3,159.81
|
| Rate for Payer: Anthem Medicaid |
$1,411.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.85
|
| Rate for Payer: Cash Price |
$2,051.82
|
| Rate for Payer: Cigna Commercial |
$3,406.03
|
| Rate for Payer: First Health Commercial |
$3,898.47
|
| Rate for Payer: Humana Commercial |
$3,488.10
|
| Rate for Payer: Humana KY Medicaid |
$1,411.25
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,028.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,231.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,611.21
|
| Rate for Payer: Ohio Health Group HMO |
$3,077.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,272.13
|
| Rate for Payer: PHCS Commercial |
$3,939.50
|
| Rate for Payer: United Healthcare All Payer |
$3,611.21
|
|
|
PLATE RECON LK 3.5MM 14 166MM
|
Facility
|
IP
|
$4,498.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.82 |
| Max. Negotiated Rate |
$4,318.68 |
| Rate for Payer: Aetna Commercial |
$3,463.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.92
|
| Rate for Payer: Cash Price |
$2,249.31
|
| Rate for Payer: Cigna Commercial |
$3,733.85
|
| Rate for Payer: First Health Commercial |
$4,273.69
|
| Rate for Payer: Humana Commercial |
$3,823.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.57
|
| Rate for Payer: PHCS Commercial |
$4,318.68
|
| Rate for Payer: United Healthcare All Payer |
$3,958.79
|
|
|
PLATE RECON LK 3.5MM 14 166MM
|
Facility
|
OP
|
$4,498.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$584.82 |
| Max. Negotiated Rate |
$4,318.68 |
| Rate for Payer: Kentucky WC Medicaid |
$1,562.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,688.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,319.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,349.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,578.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,958.79
|
| Rate for Payer: Ohio Health Group HMO |
$3,373.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$899.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$584.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,394.57
|
| Rate for Payer: PHCS Commercial |
$4,318.68
|
| Rate for Payer: United Healthcare All Payer |
$3,958.79
|
| Rate for Payer: Aetna Commercial |
$3,463.94
|
| Rate for Payer: Anthem Medicaid |
$1,547.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,508.92
|
| Rate for Payer: Cash Price |
$2,249.31
|
| Rate for Payer: Cigna Commercial |
$3,733.85
|
| Rate for Payer: First Health Commercial |
$4,273.69
|
| Rate for Payer: Humana Commercial |
$3,823.83
|
| Rate for Payer: Humana KY Medicaid |
$1,547.08
|
|
|
PLATE RECON LT 4H
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE RECON LT 4H
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem Medicaid |
$1,209.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Humana KY Medicaid |
$1,209.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE RECON RT 4H
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem Medicaid |
$1,209.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Humana KY Medicaid |
$1,209.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,221.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,233.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE RECON RT 4H
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$457.08 |
| Max. Negotiated Rate |
$3,375.36 |
| Rate for Payer: Aetna Commercial |
$2,707.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,742.48
|
| Rate for Payer: Cash Price |
$1,758.00
|
| Rate for Payer: Cigna Commercial |
$2,918.28
|
| Rate for Payer: First Health Commercial |
$3,340.20
|
| Rate for Payer: Humana Commercial |
$2,988.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,883.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,594.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,054.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,094.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,637.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$703.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$457.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,089.96
|
| Rate for Payer: PHCS Commercial |
$3,375.36
|
| Rate for Payer: United Healthcare All Payer |
$3,094.08
|
|
|
PLATE REDUCT WIRE 1.25 LG STOP
|
Facility
|
OP
|
$1,969.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.99 |
| Max. Negotiated Rate |
$1,890.41 |
| Rate for Payer: Aetna Commercial |
$1,516.27
|
| Rate for Payer: Anthem Medicaid |
$677.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,535.96
|
| Rate for Payer: Cash Price |
$984.59
|
| Rate for Payer: Cigna Commercial |
$1,634.42
|
| Rate for Payer: First Health Commercial |
$1,870.72
|
| Rate for Payer: Humana Commercial |
$1,673.80
|
| Rate for Payer: Humana KY Medicaid |
$677.20
|
| Rate for Payer: Kentucky WC Medicaid |
$684.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,614.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$690.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,732.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.45
|
| Rate for Payer: PHCS Commercial |
$1,890.41
|
| Rate for Payer: United Healthcare All Payer |
$1,732.88
|
|
|
PLATE REDUCT WIRE 1.25 LG STOP
|
Facility
|
IP
|
$1,969.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.99 |
| Max. Negotiated Rate |
$1,890.41 |
| Rate for Payer: Aetna Commercial |
$1,516.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,535.96
|
| Rate for Payer: Cash Price |
$984.59
|
| Rate for Payer: Cigna Commercial |
$1,634.42
|
| Rate for Payer: First Health Commercial |
$1,870.72
|
| Rate for Payer: Humana Commercial |
$1,673.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,614.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$590.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,732.88
|
| Rate for Payer: Ohio Health Group HMO |
$1,476.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$393.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$610.45
|
| Rate for Payer: PHCS Commercial |
$1,890.41
|
| Rate for Payer: United Healthcare All Payer |
$1,732.88
|
|
|
PLATE REDUCT WIRE 1.25 SM STOP
|
Facility
|
IP
|
$1,942.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.53 |
| Max. Negotiated Rate |
$1,864.82 |
| Rate for Payer: Aetna Commercial |
$1,495.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.17
|
| Rate for Payer: Cash Price |
$971.26
|
| Rate for Payer: Cigna Commercial |
$1,612.29
|
| Rate for Payer: First Health Commercial |
$1,845.39
|
| Rate for Payer: Humana Commercial |
$1,651.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,433.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.18
|
| Rate for Payer: PHCS Commercial |
$1,864.82
|
| Rate for Payer: United Healthcare All Payer |
$1,709.42
|
|
|
PLATE REDUCT WIRE 1.25 SM STOP
|
Facility
|
OP
|
$1,942.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.53 |
| Max. Negotiated Rate |
$1,864.82 |
| Rate for Payer: Aetna Commercial |
$1,495.74
|
| Rate for Payer: Anthem Medicaid |
$668.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.17
|
| Rate for Payer: Cash Price |
$971.26
|
| Rate for Payer: Cigna Commercial |
$1,612.29
|
| Rate for Payer: First Health Commercial |
$1,845.39
|
| Rate for Payer: Humana Commercial |
$1,651.14
|
| Rate for Payer: Humana KY Medicaid |
$668.03
|
| Rate for Payer: Kentucky WC Medicaid |
$674.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,592.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,433.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$681.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,709.42
|
| Rate for Payer: Ohio Health Group HMO |
$1,456.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$388.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$252.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$602.18
|
| Rate for Payer: PHCS Commercial |
$1,864.82
|
| Rate for Payer: United Healthcare All Payer |
$1,709.42
|
|
