|
PLATE RECON 8 HOLE - STERILE
|
Facility
|
IP
|
$4,154.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,246.20 |
| Max. Negotiated Rate |
$3,987.84 |
| Rate for Payer: Aetna Commercial |
$3,198.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,240.12
|
| Rate for Payer: Cash Price |
$2,077.00
|
| Rate for Payer: Cigna Commercial |
$3,447.82
|
| Rate for Payer: First Health Commercial |
$3,946.30
|
| Rate for Payer: Humana Commercial |
$3,530.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,406.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,065.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,246.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,655.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,115.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,323.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,613.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,866.26
|
| Rate for Payer: PHCS Commercial |
$3,987.84
|
| Rate for Payer: United Healthcare All Payer |
$3,655.52
|
|
|
PLATE RECON FULL MAND 5528930
|
Facility
|
IP
|
$7,915.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.55 |
| Max. Negotiated Rate |
$7,598.55 |
| Rate for Payer: Aetna Commercial |
$6,094.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,173.82
|
| Rate for Payer: Cash Price |
$3,957.58
|
| Rate for Payer: Cigna Commercial |
$6,569.58
|
| Rate for Payer: First Health Commercial |
$7,519.40
|
| Rate for Payer: Humana Commercial |
$6,727.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,490.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,841.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,965.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,936.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,332.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,886.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,461.46
|
| Rate for Payer: PHCS Commercial |
$7,598.55
|
| Rate for Payer: United Healthcare All Payer |
$6,965.34
|
|
|
PLATE RECON FULL MAND 5528930
|
Facility
|
OP
|
$7,915.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,374.55 |
| Max. Negotiated Rate |
$7,598.55 |
| Rate for Payer: Aetna Commercial |
$6,094.67
|
| Rate for Payer: Anthem Medicaid |
$2,722.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,173.82
|
| Rate for Payer: Cash Price |
$3,957.58
|
| Rate for Payer: Cigna Commercial |
$6,569.58
|
| Rate for Payer: First Health Commercial |
$7,519.40
|
| Rate for Payer: Humana Commercial |
$6,727.89
|
| Rate for Payer: Humana KY Medicaid |
$2,722.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,749.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,490.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,841.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,374.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,776.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,965.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,936.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,332.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,886.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,461.46
|
| Rate for Payer: PHCS Commercial |
$7,598.55
|
| Rate for Payer: United Healthcare All Payer |
$6,965.34
|
|
|
PLATE RECON FULL MAND 5528934
|
Facility
|
OP
|
$7,733.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.94 |
| Max. Negotiated Rate |
$7,423.81 |
| Rate for Payer: Aetna Commercial |
$5,954.52
|
| Rate for Payer: Anthem Medicaid |
$2,659.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.85
|
| Rate for Payer: Cash Price |
$3,866.57
|
| Rate for Payer: Cigna Commercial |
$6,418.51
|
| Rate for Payer: First Health Commercial |
$7,346.48
|
| Rate for Payer: Humana Commercial |
$6,573.17
|
| Rate for Payer: Humana KY Medicaid |
$2,659.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,686.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,707.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,712.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,186.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,727.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,335.87
|
| Rate for Payer: PHCS Commercial |
$7,423.81
|
| Rate for Payer: United Healthcare All Payer |
$6,805.16
|
|
|
PLATE RECON FULL MAND 5528934
|
Facility
|
IP
|
$7,733.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,319.94 |
| Max. Negotiated Rate |
$7,423.81 |
| Rate for Payer: Aetna Commercial |
$5,954.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,031.85
|
| Rate for Payer: Cash Price |
$3,866.57
|
| Rate for Payer: Cigna Commercial |
$6,418.51
|
| Rate for Payer: First Health Commercial |
$7,346.48
|
| Rate for Payer: Humana Commercial |
$6,573.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,341.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,707.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,319.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,805.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,799.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,186.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,727.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,335.87
|
| Rate for Payer: PHCS Commercial |
$7,423.81
|
| Rate for Payer: United Healthcare All Payer |
$6,805.16
|
|
|
PLATE RECON HEMI 6*17 H 34D L
|
Facility
|
OP
|
$12,641.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,792.41 |
| Max. Negotiated Rate |
$12,135.70 |
| Rate for Payer: Aetna Commercial |
$9,733.84
|
| Rate for Payer: Anthem Medicaid |
$4,347.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,860.25
|
| Rate for Payer: Cash Price |
$6,320.67
|
| Rate for Payer: Cigna Commercial |
$10,492.32
|
| Rate for Payer: First Health Commercial |
$12,009.28
|
| Rate for Payer: Humana Commercial |
$10,745.15
|
| Rate for Payer: Humana KY Medicaid |
$4,347.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,391.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,365.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,329.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,792.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,434.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,124.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,481.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,113.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,997.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.53
|
| Rate for Payer: PHCS Commercial |
$12,135.70
|
| Rate for Payer: United Healthcare All Payer |
$11,124.39
|
|
|
PLATE RECON HEMI 6*17 H 34D L
|
Facility
|
IP
|
$12,641.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,792.41 |
| Max. Negotiated Rate |
$12,135.70 |
| Rate for Payer: Aetna Commercial |
$9,733.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,860.25
|
| Rate for Payer: Cash Price |
$6,320.67
|
| Rate for Payer: Cigna Commercial |
$10,492.32
|
| Rate for Payer: First Health Commercial |
$12,009.28
|
| Rate for Payer: Humana Commercial |
$10,745.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,365.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,329.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,124.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,481.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,113.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,997.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.53
|
| Rate for Payer: PHCS Commercial |
$12,135.70
|
| Rate for Payer: United Healthcare All Payer |
$11,124.39
|
|
|
PLATE RECON HEMI 6*17 H 34D R
|
Facility
|
IP
|
$12,641.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,792.41 |
| Max. Negotiated Rate |
$12,135.70 |
| Rate for Payer: Aetna Commercial |
$9,733.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,860.25
|
| Rate for Payer: Cash Price |
$6,320.67
|
| Rate for Payer: Cigna Commercial |
$10,492.32
|
| Rate for Payer: First Health Commercial |
$12,009.28
|
| Rate for Payer: Humana Commercial |
$10,745.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,365.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,329.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,792.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,124.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,481.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,113.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,997.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.53
|
| Rate for Payer: PHCS Commercial |
$12,135.70
|
| Rate for Payer: United Healthcare All Payer |
$11,124.39
|
|
|
PLATE RECON HEMI 6*17 H 34D R
|
Facility
|
OP
|
$12,641.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,792.41 |
| Max. Negotiated Rate |
$12,135.70 |
| Rate for Payer: Aetna Commercial |
$9,733.84
|
| Rate for Payer: Anthem Medicaid |
$4,347.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,860.25
|
| Rate for Payer: Cash Price |
$6,320.67
|
| Rate for Payer: Cigna Commercial |
$10,492.32
|
| Rate for Payer: First Health Commercial |
$12,009.28
|
| Rate for Payer: Humana Commercial |
$10,745.15
|
| Rate for Payer: Humana KY Medicaid |
$4,347.36
|
| Rate for Payer: Kentucky WC Medicaid |
$4,391.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,365.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,329.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,792.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,434.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,124.39
|
| Rate for Payer: Ohio Health Group HMO |
$9,481.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,113.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,997.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,722.53
|
| Rate for Payer: PHCS Commercial |
$12,135.70
|
| Rate for Payer: United Healthcare All Payer |
$11,124.39
|
|
|
PLATE RECON HEMI MAND 5528922
|
Facility
|
OP
|
$7,004.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.49 |
| Max. Negotiated Rate |
$6,724.76 |
| Rate for Payer: Aetna Commercial |
$5,393.82
|
| Rate for Payer: Anthem Medicaid |
$2,409.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.87
|
| Rate for Payer: Cash Price |
$3,502.48
|
| Rate for Payer: Cigna Commercial |
$5,814.12
|
| Rate for Payer: First Health Commercial |
$6,654.71
|
| Rate for Payer: Humana Commercial |
$5,954.22
|
| Rate for Payer: Humana KY Medicaid |
$2,409.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,603.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.42
|
| Rate for Payer: PHCS Commercial |
$6,724.76
|
| Rate for Payer: United Healthcare All Payer |
$6,164.36
|
|
|
PLATE RECON HEMI MAND 5528922
|
Facility
|
IP
|
$7,004.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.49 |
| Max. Negotiated Rate |
$6,724.76 |
| Rate for Payer: Aetna Commercial |
$5,393.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,463.87
|
| Rate for Payer: Cash Price |
$3,502.48
|
| Rate for Payer: Cigna Commercial |
$5,814.12
|
| Rate for Payer: First Health Commercial |
$6,654.71
|
| Rate for Payer: Humana Commercial |
$5,954.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,169.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,253.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,603.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.42
|
| Rate for Payer: PHCS Commercial |
$6,724.76
|
| Rate for Payer: United Healthcare All Payer |
$6,164.36
|
|
|
PLATE RECON HEMI MAND L 6*17
|
Facility
|
OP
|
$7,294.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,188.39 |
| Max. Negotiated Rate |
$7,002.84 |
| Rate for Payer: Aetna Commercial |
$5,616.87
|
| Rate for Payer: Anthem Medicaid |
$2,508.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,689.81
|
| Rate for Payer: Cash Price |
$3,647.31
|
| Rate for Payer: Cigna Commercial |
$6,054.54
|
| Rate for Payer: First Health Commercial |
$6,929.90
|
| Rate for Payer: Humana Commercial |
$6,200.44
|
| Rate for Payer: Humana KY Medicaid |
$2,508.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,534.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,981.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,383.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,188.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,419.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,470.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,835.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,346.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,033.29
|
| Rate for Payer: PHCS Commercial |
$7,002.84
|
| Rate for Payer: United Healthcare All Payer |
$6,419.27
|
|
|
PLATE RECON HEMI MAND L 6*17
|
Facility
|
IP
|
$7,294.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,188.39 |
| Max. Negotiated Rate |
$7,002.84 |
| Rate for Payer: Aetna Commercial |
$5,616.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,689.81
|
| Rate for Payer: Cash Price |
$3,647.31
|
| Rate for Payer: Cigna Commercial |
$6,054.54
|
| Rate for Payer: First Health Commercial |
$6,929.90
|
| Rate for Payer: Humana Commercial |
$6,200.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,981.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,383.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,188.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,419.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,470.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,835.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,346.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,033.29
|
| Rate for Payer: PHCS Commercial |
$7,002.84
|
| Rate for Payer: United Healthcare All Payer |
$6,419.27
|
|
|
PLATE RECON HEMI MAND R 6*17
|
Facility
|
OP
|
$7,294.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,188.39 |
| Max. Negotiated Rate |
$7,002.84 |
| Rate for Payer: Aetna Commercial |
$5,616.87
|
| Rate for Payer: Anthem Medicaid |
$2,508.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,689.81
|
| Rate for Payer: Cash Price |
$3,647.31
|
| Rate for Payer: Cigna Commercial |
$6,054.54
|
| Rate for Payer: First Health Commercial |
$6,929.90
|
| Rate for Payer: Humana Commercial |
$6,200.44
|
| Rate for Payer: Humana KY Medicaid |
$2,508.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,534.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,981.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,383.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,188.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,558.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,419.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,470.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,835.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,346.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,033.29
|
| Rate for Payer: PHCS Commercial |
$7,002.84
|
| Rate for Payer: United Healthcare All Payer |
$6,419.27
|
|
|
PLATE RECON HEMI MAND R 6*17
|
Facility
|
IP
|
$7,294.63
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,188.39 |
| Max. Negotiated Rate |
$7,002.84 |
| Rate for Payer: Aetna Commercial |
$5,616.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,689.81
|
| Rate for Payer: Cash Price |
$3,647.31
|
| Rate for Payer: Cigna Commercial |
$6,054.54
|
| Rate for Payer: First Health Commercial |
$6,929.90
|
| Rate for Payer: Humana Commercial |
$6,200.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,981.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,383.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,188.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,419.27
|
| Rate for Payer: Ohio Health Group HMO |
$5,470.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,835.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,346.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,033.29
|
| Rate for Payer: PHCS Commercial |
$7,002.84
|
| Rate for Payer: United Healthcare All Payer |
$6,419.27
|
|
|
PLATE RECON LCK 3.5 12 142MM
|
Facility
|
IP
|
$4,282.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.73 |
| Max. Negotiated Rate |
$4,111.14 |
| Rate for Payer: Aetna Commercial |
$3,297.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.30
|
| Rate for Payer: Cash Price |
$2,141.22
|
| Rate for Payer: Cigna Commercial |
$3,554.43
|
| Rate for Payer: First Health Commercial |
$4,068.32
|
| Rate for Payer: Humana Commercial |
$3,640.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,425.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,725.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,954.88
|
| Rate for Payer: PHCS Commercial |
$4,111.14
|
| Rate for Payer: United Healthcare All Payer |
$3,768.55
|
|
|
PLATE RECON LCK 3.5 12 142MM
|
Facility
|
OP
|
$4,282.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,284.73 |
| Max. Negotiated Rate |
$4,111.14 |
| Rate for Payer: Aetna Commercial |
$3,297.48
|
| Rate for Payer: Anthem Medicaid |
$1,472.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,340.30
|
| Rate for Payer: Cash Price |
$2,141.22
|
| Rate for Payer: Cigna Commercial |
$3,554.43
|
| Rate for Payer: First Health Commercial |
$4,068.32
|
| Rate for Payer: Humana Commercial |
$3,640.07
|
| Rate for Payer: Humana KY Medicaid |
$1,472.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,487.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,511.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,160.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,284.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,502.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,768.55
|
| Rate for Payer: Ohio Health Group HMO |
$3,211.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,425.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,725.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,954.88
|
| Rate for Payer: PHCS Commercial |
$4,111.14
|
| Rate for Payer: United Healthcare All Payer |
$3,768.55
|
|
|
PLATE RECON LCK 3.5M 10 118MM
|
Facility
|
OP
|
$4,129.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,238.94 |
| Max. Negotiated Rate |
$3,964.62 |
| Rate for Payer: Aetna Commercial |
$3,179.95
|
| Rate for Payer: Anthem Medicaid |
$1,420.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,221.25
|
| Rate for Payer: Cash Price |
$2,064.91
|
| Rate for Payer: Cigna Commercial |
$3,427.74
|
| Rate for Payer: First Health Commercial |
$3,923.32
|
| Rate for Payer: Humana Commercial |
$3,510.34
|
| Rate for Payer: Humana KY Medicaid |
$1,420.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,434.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,386.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,448.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,634.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,097.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,303.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,592.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,849.57
|
| Rate for Payer: PHCS Commercial |
$3,964.62
|
| Rate for Payer: United Healthcare All Payer |
$3,634.23
|
|
|
PLATE RECON LCK 3.5M 10 118MM
|
Facility
|
IP
|
$4,129.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,238.94 |
| Max. Negotiated Rate |
$3,964.62 |
| Rate for Payer: Aetna Commercial |
$3,179.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,221.25
|
| Rate for Payer: Cash Price |
$2,064.91
|
| Rate for Payer: Cigna Commercial |
$3,427.74
|
| Rate for Payer: First Health Commercial |
$3,923.32
|
| Rate for Payer: Humana Commercial |
$3,510.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,386.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,047.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,238.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,634.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,097.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,303.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,592.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,849.57
|
| Rate for Payer: PHCS Commercial |
$3,964.62
|
| Rate for Payer: United Healthcare All Payer |
$3,634.23
|
|
|
PLATE RECON LCK 3.5M 4 46MM
|
Facility
|
IP
|
$3,588.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.61 |
| Max. Negotiated Rate |
$3,445.14 |
| Rate for Payer: Aetna Commercial |
$2,763.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,799.18
|
| Rate for Payer: Cash Price |
$1,794.34
|
| Rate for Payer: Cigna Commercial |
$2,978.61
|
| Rate for Payer: First Health Commercial |
$3,409.26
|
| Rate for Payer: Humana Commercial |
$3,050.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,942.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,648.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,158.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,691.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,870.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.20
|
| Rate for Payer: PHCS Commercial |
$3,445.14
|
| Rate for Payer: United Healthcare All Payer |
$3,158.05
|
|
|
PLATE RECON LCK 3.5M 4 46MM
|
Facility
|
OP
|
$3,588.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,076.61 |
| Max. Negotiated Rate |
$3,445.14 |
| Rate for Payer: Aetna Commercial |
$2,763.29
|
| Rate for Payer: Anthem Medicaid |
$1,234.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,799.18
|
| Rate for Payer: Cash Price |
$1,794.34
|
| Rate for Payer: Cigna Commercial |
$2,978.61
|
| Rate for Payer: First Health Commercial |
$3,409.26
|
| Rate for Payer: Humana Commercial |
$3,050.39
|
| Rate for Payer: Humana KY Medicaid |
$1,234.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,246.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,942.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,648.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,076.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,258.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,158.05
|
| Rate for Payer: Ohio Health Group HMO |
$2,691.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,870.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,122.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.20
|
| Rate for Payer: PHCS Commercial |
$3,445.14
|
| Rate for Payer: United Healthcare All Payer |
$3,158.05
|
|
|
PLATE RECON LCK 3.5M 6 70MM
|
Facility
|
IP
|
$3,852.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$3,698.22 |
| Rate for Payer: Aetna Commercial |
$2,966.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.80
|
| Rate for Payer: Cash Price |
$1,926.16
|
| Rate for Payer: Cigna Commercial |
$3,197.42
|
| Rate for Payer: First Health Commercial |
$3,659.69
|
| Rate for Payer: Humana Commercial |
$3,274.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,843.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,390.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.09
|
| Rate for Payer: PHCS Commercial |
$3,698.22
|
| Rate for Payer: United Healthcare All Payer |
$3,390.03
|
|
|
PLATE RECON LCK 3.5M 6 70MM
|
Facility
|
OP
|
$3,852.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,155.69 |
| Max. Negotiated Rate |
$3,698.22 |
| Rate for Payer: Aetna Commercial |
$2,966.28
|
| Rate for Payer: Anthem Medicaid |
$1,324.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,004.80
|
| Rate for Payer: Cash Price |
$1,926.16
|
| Rate for Payer: Cigna Commercial |
$3,197.42
|
| Rate for Payer: First Health Commercial |
$3,659.69
|
| Rate for Payer: Humana Commercial |
$3,274.46
|
| Rate for Payer: Humana KY Medicaid |
$1,324.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,338.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,158.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,843.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,155.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,351.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,390.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,889.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,081.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,351.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,658.09
|
| Rate for Payer: PHCS Commercial |
$3,698.22
|
| Rate for Payer: United Healthcare All Payer |
$3,390.03
|
|
|
PLATE RECON LCK 3.5M 8 94MM
|
Facility
|
IP
|
$4,039.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.89 |
| Max. Negotiated Rate |
$3,878.04 |
| Rate for Payer: Aetna Commercial |
$3,110.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.90
|
| Rate for Payer: Cash Price |
$2,019.81
|
| Rate for Payer: Cigna Commercial |
$3,352.88
|
| Rate for Payer: First Health Commercial |
$3,837.64
|
| Rate for Payer: Humana Commercial |
$3,433.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,312.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,981.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.34
|
| Rate for Payer: PHCS Commercial |
$3,878.04
|
| Rate for Payer: United Healthcare All Payer |
$3,554.87
|
|
|
PLATE RECON LCK 3.5M 8 94MM
|
Facility
|
OP
|
$4,039.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.89 |
| Max. Negotiated Rate |
$3,878.04 |
| Rate for Payer: Aetna Commercial |
$3,110.51
|
| Rate for Payer: Anthem Medicaid |
$1,389.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.90
|
| Rate for Payer: Cash Price |
$2,019.81
|
| Rate for Payer: Cigna Commercial |
$3,352.88
|
| Rate for Payer: First Health Commercial |
$3,837.64
|
| Rate for Payer: Humana Commercial |
$3,433.68
|
| Rate for Payer: Humana KY Medicaid |
$1,389.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,403.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,312.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,981.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,417.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,554.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,029.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,231.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,514.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,787.34
|
| Rate for Payer: PHCS Commercial |
$3,878.04
|
| Rate for Payer: United Healthcare All Payer |
$3,554.87
|
|
