|
SCREW KREULOCK AR-8935CL-12
|
Facility
|
OP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem Medicaid |
$1,129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Humana KY Medicaid |
$1,129.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-24
|
Facility
|
IP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-24
|
Facility
|
OP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem Medicaid |
$1,129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Humana KY Medicaid |
$1,129.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-26
|
Facility
|
IP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-26
|
Facility
|
OP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem Medicaid |
$1,129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Humana KY Medicaid |
$1,129.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-28
|
Facility
|
IP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-28
|
Facility
|
OP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem Medicaid |
$1,129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Humana KY Medicaid |
$1,129.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-30
|
Facility
|
OP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem Medicaid |
$1,129.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Humana KY Medicaid |
$1,129.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,140.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK AR-8935CL-30
|
Facility
|
IP
|
$3,284.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$426.94 |
| Max. Negotiated Rate |
$3,152.76 |
| Rate for Payer: Aetna Commercial |
$2,528.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,561.61
|
| Rate for Payer: Cash Price |
$1,642.06
|
| Rate for Payer: Cigna Commercial |
$2,725.82
|
| Rate for Payer: First Health Commercial |
$3,119.91
|
| Rate for Payer: Humana Commercial |
$2,791.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,692.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,423.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.03
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$656.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$426.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.08
|
| Rate for Payer: PHCS Commercial |
$3,152.76
|
| Rate for Payer: United Healthcare All Payer |
$2,890.03
|
|
|
SCREW KREULOCK TI 3.0*10
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*10
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*12
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*12
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*14
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*14
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*16
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*16
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*18
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*18
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*20
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW KREULOCK TI 3.0*20
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| Rate for Payer: Aetna Commercial |
$2,489.02
|
| Rate for Payer: Anthem Medicaid |
$1,111.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,521.35
|
| Rate for Payer: Cash Price |
$1,616.25
|
| Rate for Payer: Cigna Commercial |
$2,682.98
|
| Rate for Payer: First Health Commercial |
$3,070.88
|
| Rate for Payer: Humana Commercial |
$2,747.62
|
| Rate for Payer: Humana KY Medicaid |
$1,111.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,122.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,650.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,385.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$969.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,133.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,844.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,424.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$646.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$420.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,002.08
|
| Rate for Payer: PHCS Commercial |
$3,103.20
|
| Rate for Payer: United Healthcare All Payer |
$2,844.60
|
|
|
SCREW LAG 2.0*24MM
|
Facility
|
IP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
SCREW LAG 2.0*24MM
|
Facility
|
OP
|
$1,857.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.48 |
| Max. Negotiated Rate |
$1,783.20 |
| Rate for Payer: Aetna Commercial |
$1,430.28
|
| Rate for Payer: Anthem Medicaid |
$638.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,448.85
|
| Rate for Payer: Cash Price |
$928.75
|
| Rate for Payer: Cigna Commercial |
$1,541.72
|
| Rate for Payer: First Health Commercial |
$1,764.62
|
| Rate for Payer: Humana Commercial |
$1,578.88
|
| Rate for Payer: Humana KY Medicaid |
$638.79
|
| Rate for Payer: Kentucky WC Medicaid |
$645.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,370.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.60
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.82
|
| Rate for Payer: PHCS Commercial |
$1,783.20
|
| Rate for Payer: United Healthcare All Payer |
$1,634.60
|
|
|
SCREW LCK 3.5*20
|
Facility
|
OP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem Medicaid |
$674.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Humana KY Medicaid |
$674.90
|
| Rate for Payer: Kentucky WC Medicaid |
$681.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$688.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
|
SCREW LCK 3.5*20
|
Facility
|
IP
|
$1,962.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.12 |
| Max. Negotiated Rate |
$1,884.00 |
| Rate for Payer: Aetna Commercial |
$1,511.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,530.75
|
| Rate for Payer: Cash Price |
$981.25
|
| Rate for Payer: Cigna Commercial |
$1,628.88
|
| Rate for Payer: First Health Commercial |
$1,864.38
|
| Rate for Payer: Humana Commercial |
$1,668.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,609.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,448.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$588.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,727.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,471.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$392.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$255.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$608.38
|
| Rate for Payer: PHCS Commercial |
$1,884.00
|
| Rate for Payer: United Healthcare All Payer |
$1,727.00
|
|
