|
PLATE 4.5 TI LC-DCP 4H 70MM
|
Facility
|
IP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 5H 88MM
|
Facility
|
IP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 5H 88MM
|
Facility
|
OP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem Medicaid |
$638.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Humana KY Medicaid |
$638.89
|
| Rate for Payer: Kentucky WC Medicaid |
$645.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 6H 106MM
|
Facility
|
OP
|
$1,562.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.12 |
| Max. Negotiated Rate |
$1,499.98 |
| Rate for Payer: Aetna Commercial |
$1,203.11
|
| Rate for Payer: Anthem Medicaid |
$537.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,218.73
|
| Rate for Payer: Cash Price |
$781.24
|
| Rate for Payer: Cigna Commercial |
$1,296.86
|
| Rate for Payer: First Health Commercial |
$1,484.36
|
| Rate for Payer: Humana Commercial |
$1,328.11
|
| Rate for Payer: Humana KY Medicaid |
$537.34
|
| Rate for Payer: Kentucky WC Medicaid |
$542.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$548.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.37
|
| Rate for Payer: PHCS Commercial |
$1,499.98
|
| Rate for Payer: United Healthcare All Payer |
$1,374.98
|
|
|
PLATE 4.5 TI LC-DCP 6H 106MM
|
Facility
|
IP
|
$1,562.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$203.12 |
| Max. Negotiated Rate |
$1,499.98 |
| Rate for Payer: Aetna Commercial |
$1,203.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,218.73
|
| Rate for Payer: Cash Price |
$781.24
|
| Rate for Payer: Cigna Commercial |
$1,296.86
|
| Rate for Payer: First Health Commercial |
$1,484.36
|
| Rate for Payer: Humana Commercial |
$1,328.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,281.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,153.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$468.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,374.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,171.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$312.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$203.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$484.37
|
| Rate for Payer: PHCS Commercial |
$1,499.98
|
| Rate for Payer: United Healthcare All Payer |
$1,374.98
|
|
|
PLATE 4.5 TI LC-DCP 7H 124MM
|
Facility
|
IP
|
$1,582.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$1,518.73 |
| Rate for Payer: Aetna Commercial |
$1,218.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,233.97
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,313.07
|
| Rate for Payer: First Health Commercial |
$1,502.91
|
| Rate for Payer: Humana Commercial |
$1,344.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.42
|
| Rate for Payer: PHCS Commercial |
$1,518.73
|
| Rate for Payer: United Healthcare All Payer |
$1,392.17
|
|
|
PLATE 4.5 TI LC-DCP 7H 124MM
|
Facility
|
OP
|
$1,582.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$205.66 |
| Max. Negotiated Rate |
$1,518.73 |
| Rate for Payer: Aetna Commercial |
$1,218.15
|
| Rate for Payer: Anthem Medicaid |
$544.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,233.97
|
| Rate for Payer: Cash Price |
$791.00
|
| Rate for Payer: Cigna Commercial |
$1,313.07
|
| Rate for Payer: First Health Commercial |
$1,502.91
|
| Rate for Payer: Humana Commercial |
$1,344.71
|
| Rate for Payer: Humana KY Medicaid |
$544.05
|
| Rate for Payer: Kentucky WC Medicaid |
$549.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,297.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,167.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$474.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$554.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,392.17
|
| Rate for Payer: Ohio Health Group HMO |
$1,186.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$316.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$205.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$490.42
|
| Rate for Payer: PHCS Commercial |
$1,518.73
|
| Rate for Payer: United Healthcare All Payer |
$1,392.17
|
|
|
PLATE 4.5 TI LC-DCP 8H 142MM
|
Facility
|
IP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 8H 142MM
|
Facility
|
OP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem Medicaid |
$638.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Humana KY Medicaid |
$638.89
|
| Rate for Payer: Kentucky WC Medicaid |
$645.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 9H 160MM
|
Facility
|
IP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4.5 TI LC-DCP 9H 160MM
|
Facility
|
OP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem Medicaid |
$638.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Humana KY Medicaid |
$638.89
|
| Rate for Payer: Kentucky WC Medicaid |
$645.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE 4 HOLE TUBULAR STRAIGHT
|
Facility
|
OP
|
$1,546.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.98 |
| Max. Negotiated Rate |
$1,484.19 |
| Rate for Payer: Aetna Commercial |
$1,190.44
|
| Rate for Payer: Anthem Medicaid |
$531.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.90
|
| Rate for Payer: Cash Price |
$773.02
|
| Rate for Payer: Cigna Commercial |
$1,283.20
|
| Rate for Payer: First Health Commercial |
$1,468.73
|
| Rate for Payer: Humana Commercial |
$1,314.13
|
| Rate for Payer: Humana KY Medicaid |
$531.68
|
| Rate for Payer: Kentucky WC Medicaid |
$537.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,267.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$542.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,360.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,159.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.27
|
| Rate for Payer: PHCS Commercial |
$1,484.19
|
| Rate for Payer: United Healthcare All Payer |
$1,360.51
|
|
|
PLATE 4 HOLE TUBULAR STRAIGHT
|
Facility
|
IP
|
$1,546.03
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$200.98 |
| Max. Negotiated Rate |
$1,484.19 |
| Rate for Payer: Aetna Commercial |
$1,190.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,205.90
|
| Rate for Payer: Cash Price |
$773.02
|
| Rate for Payer: Cigna Commercial |
$1,283.20
|
| Rate for Payer: First Health Commercial |
$1,468.73
|
| Rate for Payer: Humana Commercial |
$1,314.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,267.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,140.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$463.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,360.51
|
| Rate for Payer: Ohio Health Group HMO |
$1,159.52
|
| Rate for Payer: Ohio Health Group PPO Differential |
$309.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$200.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$479.27
|
| Rate for Payer: PHCS Commercial |
$1,484.19
|
| Rate for Payer: United Healthcare All Payer |
$1,360.51
|
|
|
PLATE 4H STR
|
Facility
|
IP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Aetna Commercial |
$3,634.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
|
|
PLATE 4H STR
|
Facility
|
OP
|
$4,720.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.60 |
| Max. Negotiated Rate |
$4,531.20 |
| Rate for Payer: Anthem Medicaid |
$1,623.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,681.60
|
| Rate for Payer: Cash Price |
$2,360.00
|
| Rate for Payer: Cigna Commercial |
$3,917.60
|
| Rate for Payer: First Health Commercial |
$4,484.00
|
| Rate for Payer: Humana Commercial |
$4,012.00
|
| Rate for Payer: Humana KY Medicaid |
$1,623.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,639.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,870.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,483.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,416.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,655.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,153.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,540.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$944.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$613.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.20
|
| Rate for Payer: PHCS Commercial |
$4,531.20
|
| Rate for Payer: United Healthcare All Payer |
$4,153.60
|
| Rate for Payer: Aetna Commercial |
$3,634.40
|
|
|
PLATE 5H 1/3 TUB W/COLLAR 57MM
|
Facility
|
OP
|
$2,036.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.77 |
| Max. Negotiated Rate |
$1,955.19 |
| Rate for Payer: Aetna Commercial |
$1,568.23
|
| Rate for Payer: Anthem Medicaid |
$700.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,588.59
|
| Rate for Payer: Cash Price |
$1,018.33
|
| Rate for Payer: Cigna Commercial |
$1,690.43
|
| Rate for Payer: First Health Commercial |
$1,934.83
|
| Rate for Payer: Humana Commercial |
$1,731.16
|
| Rate for Payer: Humana KY Medicaid |
$700.41
|
| Rate for Payer: Kentucky WC Medicaid |
$707.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$714.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.36
|
| Rate for Payer: PHCS Commercial |
$1,955.19
|
| Rate for Payer: United Healthcare All Payer |
$1,792.26
|
|
|
PLATE 5H 1/3 TUB W/COLLAR 57MM
|
Facility
|
IP
|
$2,036.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$264.77 |
| Max. Negotiated Rate |
$1,955.19 |
| Rate for Payer: Aetna Commercial |
$1,568.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,588.59
|
| Rate for Payer: Cash Price |
$1,018.33
|
| Rate for Payer: Cigna Commercial |
$1,690.43
|
| Rate for Payer: First Health Commercial |
$1,934.83
|
| Rate for Payer: Humana Commercial |
$1,731.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,670.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,503.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$611.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,792.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,527.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$407.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$264.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$631.36
|
| Rate for Payer: PHCS Commercial |
$1,955.19
|
| Rate for Payer: United Healthcare All Payer |
$1,792.26
|
|
|
PLATE 5H 3.5*72MM SM FRAG
|
Facility
|
IP
|
$4,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.72 |
| Max. Negotiated Rate |
$4,074.24 |
| Rate for Payer: Aetna Commercial |
$3,267.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.32
|
| Rate for Payer: Cash Price |
$2,122.00
|
| Rate for Payer: Cigna Commercial |
$3,522.52
|
| Rate for Payer: First Health Commercial |
$4,031.80
|
| Rate for Payer: Humana Commercial |
$3,607.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,734.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.64
|
| Rate for Payer: PHCS Commercial |
$4,074.24
|
| Rate for Payer: United Healthcare All Payer |
$3,734.72
|
|
|
PLATE 5H 3.5*72MM SM FRAG
|
Facility
|
OP
|
$4,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$551.72 |
| Max. Negotiated Rate |
$4,074.24 |
| Rate for Payer: Aetna Commercial |
$3,267.88
|
| Rate for Payer: Anthem Medicaid |
$1,459.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,310.32
|
| Rate for Payer: Cash Price |
$2,122.00
|
| Rate for Payer: Cigna Commercial |
$3,522.52
|
| Rate for Payer: First Health Commercial |
$4,031.80
|
| Rate for Payer: Humana Commercial |
$3,607.40
|
| Rate for Payer: Humana KY Medicaid |
$1,459.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,474.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,480.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,132.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,273.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,488.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,734.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,183.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$848.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$551.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,315.64
|
| Rate for Payer: PHCS Commercial |
$4,074.24
|
| Rate for Payer: United Healthcare All Payer |
$3,734.72
|
|
|
PLATE 5 HOLE LATERAL MALLEOLAR
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,985.60 |
| Rate for Payer: Aetna Commercial |
$2,394.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.80
|
| Rate for Payer: Cash Price |
$1,555.00
|
| Rate for Payer: Cigna Commercial |
$2,581.30
|
| Rate for Payer: First Health Commercial |
$2,954.50
|
| Rate for Payer: Humana Commercial |
$2,643.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.10
|
| Rate for Payer: PHCS Commercial |
$2,985.60
|
| Rate for Payer: United Healthcare All Payer |
$2,736.80
|
|
|
PLATE 5 HOLE LATERAL MALLEOLAR
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,985.60 |
| Rate for Payer: Aetna Commercial |
$2,394.70
|
| Rate for Payer: Anthem Medicaid |
$1,069.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.80
|
| Rate for Payer: Cash Price |
$1,555.00
|
| Rate for Payer: Cigna Commercial |
$2,581.30
|
| Rate for Payer: First Health Commercial |
$2,954.50
|
| Rate for Payer: Humana Commercial |
$2,643.50
|
| Rate for Payer: Humana KY Medicaid |
$1,069.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,090.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.10
|
| Rate for Payer: PHCS Commercial |
$2,985.60
|
| Rate for Payer: United Healthcare All Payer |
$2,736.80
|
|
|
PLATE 5 HOLE TUBULAR STRAIGHT
|
Facility
|
IP
|
$1,082.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.69 |
| Max. Negotiated Rate |
$1,038.91 |
| Rate for Payer: Aetna Commercial |
$833.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.12
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cigna Commercial |
$898.23
|
| Rate for Payer: First Health Commercial |
$1,028.09
|
| Rate for Payer: Humana Commercial |
$919.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$887.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$798.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$952.34
|
| Rate for Payer: Ohio Health Group HMO |
$811.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.48
|
| Rate for Payer: PHCS Commercial |
$1,038.91
|
| Rate for Payer: United Healthcare All Payer |
$952.34
|
|
|
PLATE 5 HOLE TUBULAR STRAIGHT
|
Facility
|
OP
|
$1,082.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.69 |
| Max. Negotiated Rate |
$1,038.91 |
| Rate for Payer: Aetna Commercial |
$833.29
|
| Rate for Payer: Anthem Medicaid |
$372.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.12
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cigna Commercial |
$898.23
|
| Rate for Payer: First Health Commercial |
$1,028.09
|
| Rate for Payer: Humana Commercial |
$919.87
|
| Rate for Payer: Humana KY Medicaid |
$372.17
|
| Rate for Payer: Kentucky WC Medicaid |
$375.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$887.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$798.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$379.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$952.34
|
| Rate for Payer: Ohio Health Group HMO |
$811.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.48
|
| Rate for Payer: PHCS Commercial |
$1,038.91
|
| Rate for Payer: United Healthcare All Payer |
$952.34
|
|
|
PLATE 5H RECON 3.5*70MM
|
Facility
|
IP
|
$3,812.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.65 |
| Max. Negotiated Rate |
$3,660.15 |
| Rate for Payer: Aetna Commercial |
$2,935.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,973.87
|
| Rate for Payer: Cash Price |
$1,906.33
|
| Rate for Payer: Cigna Commercial |
$3,164.51
|
| Rate for Payer: First Health Commercial |
$3,622.03
|
| Rate for Payer: Humana Commercial |
$3,240.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,126.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,813.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.92
|
| Rate for Payer: PHCS Commercial |
$3,660.15
|
| Rate for Payer: United Healthcare All Payer |
$3,355.14
|
|
|
PLATE 5H RECON 3.5*70MM
|
Facility
|
OP
|
$3,812.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.65 |
| Max. Negotiated Rate |
$3,660.15 |
| Rate for Payer: Aetna Commercial |
$2,935.75
|
| Rate for Payer: Anthem Medicaid |
$1,311.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,973.87
|
| Rate for Payer: Cash Price |
$1,906.33
|
| Rate for Payer: Cigna Commercial |
$3,164.51
|
| Rate for Payer: First Health Commercial |
$3,622.03
|
| Rate for Payer: Humana Commercial |
$3,240.76
|
| Rate for Payer: Humana KY Medicaid |
$1,311.17
|
| Rate for Payer: Kentucky WC Medicaid |
$1,324.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,126.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,813.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,143.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,337.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,355.14
|
| Rate for Payer: Ohio Health Group HMO |
$2,859.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$762.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$495.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,181.92
|
| Rate for Payer: PHCS Commercial |
$3,660.15
|
| Rate for Payer: United Healthcare All Payer |
$3,355.14
|
|
