|
PLATE 5 MET HOOK STD R
|
Facility
|
IP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE 5 MET HOOK STD R
|
Facility
|
OP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem Medicaid |
$2,462.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Humana KY Medicaid |
$2,462.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,512.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE 5TH MET HOOK
|
Facility
|
IP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
|
|
PLATE 5TH MET HOOK
|
Facility
|
OP
|
$8,713.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,132.69 |
| Max. Negotiated Rate |
$8,364.48 |
| Rate for Payer: Aetna Commercial |
$6,709.01
|
| Rate for Payer: Anthem Medicaid |
$2,996.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,796.14
|
| Rate for Payer: Cash Price |
$4,356.50
|
| Rate for Payer: Cigna Commercial |
$7,231.79
|
| Rate for Payer: First Health Commercial |
$8,277.35
|
| Rate for Payer: Humana Commercial |
$7,406.05
|
| Rate for Payer: Humana KY Medicaid |
$2,996.40
|
| Rate for Payer: Kentucky WC Medicaid |
$3,026.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,144.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,430.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,613.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,056.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,667.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,534.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,742.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,132.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,701.03
|
| Rate for Payer: PHCS Commercial |
$8,364.48
|
| Rate for Payer: United Healthcare All Payer |
$7,667.44
|
|
|
PLATE 6H 1/3 TUB W/COLLAR 69MM
|
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 6H 1/3 TUB W/COLLAR 69MM
|
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 6H 3.5*85MM SM FRAG
|
Facility
|
IP
|
$3,477.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.06 |
| Max. Negotiated Rate |
$3,338.30 |
| Rate for Payer: Aetna Commercial |
$2,677.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.37
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cigna Commercial |
$2,886.24
|
| Rate for Payer: First Health Commercial |
$3,303.53
|
| Rate for Payer: Humana Commercial |
$2,955.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.99
|
| Rate for Payer: PHCS Commercial |
$3,338.30
|
| Rate for Payer: United Healthcare All Payer |
$3,060.11
|
|
|
PLATE 6H 3.5*85MM SM FRAG
|
Facility
|
OP
|
$3,477.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$452.06 |
| Max. Negotiated Rate |
$3,338.30 |
| Rate for Payer: Aetna Commercial |
$2,677.60
|
| Rate for Payer: Anthem Medicaid |
$1,195.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,712.37
|
| Rate for Payer: Cash Price |
$1,738.70
|
| Rate for Payer: Cigna Commercial |
$2,886.24
|
| Rate for Payer: First Health Commercial |
$3,303.53
|
| Rate for Payer: Humana Commercial |
$2,955.79
|
| Rate for Payer: Humana KY Medicaid |
$1,195.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,208.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,851.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,566.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,043.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,219.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,060.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,608.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$695.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$452.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,077.99
|
| Rate for Payer: PHCS Commercial |
$3,338.30
|
| Rate for Payer: United Healthcare All Payer |
$3,060.11
|
|
|
PLATE 6 HOLE TUBULAR STRAIGHT
|
Facility
|
OP
|
$1,067.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$1,025.20 |
| Rate for Payer: Aetna Commercial |
$822.30
|
| Rate for Payer: Anthem Medicaid |
$367.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$832.98
|
| Rate for Payer: Cash Price |
$533.96
|
| Rate for Payer: Cigna Commercial |
$886.37
|
| Rate for Payer: First Health Commercial |
$1,014.52
|
| Rate for Payer: Humana Commercial |
$907.73
|
| Rate for Payer: Humana KY Medicaid |
$367.26
|
| Rate for Payer: Kentucky WC Medicaid |
$371.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$875.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$374.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$939.77
|
| Rate for Payer: Ohio Health Group HMO |
$800.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.06
|
| Rate for Payer: PHCS Commercial |
$1,025.20
|
| Rate for Payer: United Healthcare All Payer |
$939.77
|
|
|
PLATE 6 HOLE TUBULAR STRAIGHT
|
Facility
|
IP
|
$1,067.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$138.83 |
| Max. Negotiated Rate |
$1,025.20 |
| Rate for Payer: Aetna Commercial |
$822.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$832.98
|
| Rate for Payer: Cash Price |
$533.96
|
| Rate for Payer: Cigna Commercial |
$886.37
|
| Rate for Payer: First Health Commercial |
$1,014.52
|
| Rate for Payer: Humana Commercial |
$907.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$875.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$788.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$320.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$939.77
|
| Rate for Payer: Ohio Health Group HMO |
$800.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$213.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$138.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$331.06
|
| Rate for Payer: PHCS Commercial |
$1,025.20
|
| Rate for Payer: United Healthcare All Payer |
$939.77
|
|
|
PLATE 6H RECON 3.5*84MM
|
Facility
|
IP
|
$4,150.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.52 |
| Max. Negotiated Rate |
$3,984.15 |
| Rate for Payer: Aetna Commercial |
$3,195.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,237.12
|
| Rate for Payer: Cash Price |
$2,075.08
|
| Rate for Payer: Cigna Commercial |
$3,444.63
|
| Rate for Payer: First Health Commercial |
$3,942.65
|
| Rate for Payer: Humana Commercial |
$3,527.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,403.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,062.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,652.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$830.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.55
|
| Rate for Payer: PHCS Commercial |
$3,984.15
|
| Rate for Payer: United Healthcare All Payer |
$3,652.14
|
|
|
PLATE 6H RECON 3.5*84MM
|
Facility
|
OP
|
$4,150.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$539.52 |
| Max. Negotiated Rate |
$3,984.15 |
| Rate for Payer: Humana Commercial |
$3,527.64
|
| Rate for Payer: Humana KY Medicaid |
$1,427.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,441.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,403.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,062.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,245.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,455.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,652.14
|
| Rate for Payer: Ohio Health Group HMO |
$3,112.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$830.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$539.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,286.55
|
| Rate for Payer: PHCS Commercial |
$3,984.15
|
| Rate for Payer: United Healthcare All Payer |
$3,652.14
|
| Rate for Payer: Aetna Commercial |
$3,195.62
|
| Rate for Payer: Anthem Medicaid |
$1,427.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,237.12
|
| Rate for Payer: Cash Price |
$2,075.08
|
| Rate for Payer: Cigna Commercial |
$3,444.63
|
| Rate for Payer: First Health Commercial |
$3,942.65
|
|
|
PLATE 6H STR
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
PLATE 6H STR
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$695.50 |
| Max. Negotiated Rate |
$5,136.00 |
| Rate for Payer: Aetna Commercial |
$4,119.50
|
| Rate for Payer: Anthem Medicaid |
$1,839.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,173.00
|
| Rate for Payer: Cash Price |
$2,675.00
|
| Rate for Payer: Cigna Commercial |
$4,440.50
|
| Rate for Payer: First Health Commercial |
$5,082.50
|
| Rate for Payer: Humana Commercial |
$4,547.50
|
| Rate for Payer: Humana KY Medicaid |
$1,839.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,858.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,387.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,948.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,605.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,708.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,012.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,070.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$695.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,658.50
|
| Rate for Payer: PHCS Commercial |
$5,136.00
|
| Rate for Payer: United Healthcare All Payer |
$4,708.00
|
|
|
PLATE 6H STR W/BAR MAND LOCK
|
Facility
|
OP
|
$5,248.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.30 |
| Max. Negotiated Rate |
$5,038.56 |
| Rate for Payer: Aetna Commercial |
$4,041.34
|
| Rate for Payer: Anthem Medicaid |
$1,804.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,093.83
|
| Rate for Payer: Cash Price |
$2,624.25
|
| Rate for Payer: Cigna Commercial |
$4,356.26
|
| Rate for Payer: First Health Commercial |
$4,986.08
|
| Rate for Payer: Humana Commercial |
$4,461.22
|
| Rate for Payer: Humana KY Medicaid |
$1,804.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,823.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,303.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,873.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,574.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,841.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,618.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,936.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,049.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,627.04
|
| Rate for Payer: PHCS Commercial |
$5,038.56
|
| Rate for Payer: United Healthcare All Payer |
$4,618.68
|
|
|
PLATE 6H STR W/BAR MAND LOCK
|
Facility
|
IP
|
$5,248.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$682.30 |
| Max. Negotiated Rate |
$5,038.56 |
| Rate for Payer: Aetna Commercial |
$4,041.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,093.83
|
| Rate for Payer: Cash Price |
$2,624.25
|
| Rate for Payer: Cigna Commercial |
$4,356.26
|
| Rate for Payer: First Health Commercial |
$4,986.08
|
| Rate for Payer: Humana Commercial |
$4,461.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,303.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,873.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,574.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,618.68
|
| Rate for Payer: Ohio Health Group HMO |
$3,936.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,049.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$682.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,627.04
|
| Rate for Payer: PHCS Commercial |
$5,038.56
|
| Rate for Payer: United Healthcare All Payer |
$4,618.68
|
|
|
PLATE 7H 1/3 TUB W/COLLAR 81MM
|
Facility
|
OP
|
$2,051.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.69 |
| Max. Negotiated Rate |
$1,969.41 |
| Rate for Payer: Aetna Commercial |
$1,579.63
|
| Rate for Payer: Anthem Medicaid |
$705.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.15
|
| Rate for Payer: Cash Price |
$1,025.73
|
| Rate for Payer: Cigna Commercial |
$1,702.72
|
| Rate for Payer: First Health Commercial |
$1,948.90
|
| Rate for Payer: Humana Commercial |
$1,743.75
|
| Rate for Payer: Humana KY Medicaid |
$705.50
|
| Rate for Payer: Kentucky WC Medicaid |
$712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$719.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,538.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.96
|
| Rate for Payer: PHCS Commercial |
$1,969.41
|
| Rate for Payer: United Healthcare All Payer |
$1,805.29
|
|
|
PLATE 7H 1/3 TUB W/COLLAR 81MM
|
Facility
|
IP
|
$2,051.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.69 |
| Max. Negotiated Rate |
$1,969.41 |
| Rate for Payer: Aetna Commercial |
$1,579.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,600.15
|
| Rate for Payer: Cash Price |
$1,025.73
|
| Rate for Payer: Cigna Commercial |
$1,702.72
|
| Rate for Payer: First Health Commercial |
$1,948.90
|
| Rate for Payer: Humana Commercial |
$1,743.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,682.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,513.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$615.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,805.29
|
| Rate for Payer: Ohio Health Group HMO |
$1,538.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$410.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$266.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$635.96
|
| Rate for Payer: PHCS Commercial |
$1,969.41
|
| Rate for Payer: United Healthcare All Payer |
$1,805.29
|
|
|
PLATE 7H 210MM 350817
|
Facility
|
OP
|
$5,049.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.37 |
| Max. Negotiated Rate |
$4,847.04 |
| Rate for Payer: Aetna Commercial |
$3,887.73
|
| Rate for Payer: Anthem Medicaid |
$1,736.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,938.22
|
| Rate for Payer: Cash Price |
$2,524.50
|
| Rate for Payer: Cigna Commercial |
$4,190.67
|
| Rate for Payer: First Health Commercial |
$4,796.55
|
| Rate for Payer: Humana Commercial |
$4,291.65
|
| Rate for Payer: Humana KY Medicaid |
$1,736.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,754.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,140.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,726.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,771.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,443.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.19
|
| Rate for Payer: PHCS Commercial |
$4,847.04
|
| Rate for Payer: United Healthcare All Payer |
$4,443.12
|
|
|
PLATE 7H 210MM 350817
|
Facility
|
IP
|
$5,049.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$656.37 |
| Max. Negotiated Rate |
$4,847.04 |
| Rate for Payer: Aetna Commercial |
$3,887.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,938.22
|
| Rate for Payer: Cash Price |
$2,524.50
|
| Rate for Payer: Cigna Commercial |
$4,190.67
|
| Rate for Payer: First Health Commercial |
$4,796.55
|
| Rate for Payer: Humana Commercial |
$4,291.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,140.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,726.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,514.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,443.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,786.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,009.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$656.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,565.19
|
| Rate for Payer: PHCS Commercial |
$4,847.04
|
| Rate for Payer: United Healthcare All Payer |
$4,443.12
|
|
|
PLATE 7H LATERAL MALLEOLAR
|
Facility
|
OP
|
$5,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.80 |
| Max. Negotiated Rate |
$5,337.60 |
| Rate for Payer: Aetna Commercial |
$4,281.20
|
| Rate for Payer: Anthem Medicaid |
$1,912.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,336.80
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cigna Commercial |
$4,614.80
|
| Rate for Payer: First Health Commercial |
$5,282.00
|
| Rate for Payer: Humana Commercial |
$4,726.00
|
| Rate for Payer: Humana KY Medicaid |
$1,912.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,931.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,950.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,892.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,723.60
|
| Rate for Payer: PHCS Commercial |
$5,337.60
|
| Rate for Payer: United Healthcare All Payer |
$4,892.80
|
|
|
PLATE 7H LATERAL MALLEOLAR
|
Facility
|
IP
|
$5,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$722.80 |
| Max. Negotiated Rate |
$5,337.60 |
| Rate for Payer: Aetna Commercial |
$4,281.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,336.80
|
| Rate for Payer: Cash Price |
$2,780.00
|
| Rate for Payer: Cigna Commercial |
$4,614.80
|
| Rate for Payer: First Health Commercial |
$5,282.00
|
| Rate for Payer: Humana Commercial |
$4,726.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,559.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,103.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,892.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,170.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$722.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,723.60
|
| Rate for Payer: PHCS Commercial |
$5,337.60
|
| Rate for Payer: United Healthcare All Payer |
$4,892.80
|
|
|
PLATE 7H RECON 3.5*98MM
|
Facility
|
IP
|
$4,249.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.38 |
| Max. Negotiated Rate |
$4,079.15 |
| Rate for Payer: Aetna Commercial |
$3,271.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.31
|
| Rate for Payer: Cash Price |
$2,124.55
|
| Rate for Payer: Cigna Commercial |
$3,526.76
|
| Rate for Payer: First Health Commercial |
$4,036.65
|
| Rate for Payer: Humana Commercial |
$3,611.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.22
|
| Rate for Payer: PHCS Commercial |
$4,079.15
|
| Rate for Payer: United Healthcare All Payer |
$3,739.22
|
|
|
PLATE 7H RECON 3.5*98MM
|
Facility
|
OP
|
$4,249.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.38 |
| Max. Negotiated Rate |
$4,079.15 |
| Rate for Payer: Aetna Commercial |
$3,271.81
|
| Rate for Payer: Anthem Medicaid |
$1,461.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,314.31
|
| Rate for Payer: Cash Price |
$2,124.55
|
| Rate for Payer: Cigna Commercial |
$3,526.76
|
| Rate for Payer: First Health Commercial |
$4,036.65
|
| Rate for Payer: Humana Commercial |
$3,611.74
|
| Rate for Payer: Humana KY Medicaid |
$1,461.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,484.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,135.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,274.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,739.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,186.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$849.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$552.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.22
|
| Rate for Payer: PHCS Commercial |
$4,079.15
|
| Rate for Payer: United Healthcare All Payer |
$3,739.22
|
|
|
PLATE 8H 1/3 TUB W/COLLAR 93MM
|
Facility
|
OP
|
$2,084.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$271.01 |
| Max. Negotiated Rate |
$2,001.29 |
| Rate for Payer: Aetna Commercial |
$1,605.20
|
| Rate for Payer: Anthem Medicaid |
$716.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,626.05
|
| Rate for Payer: Cash Price |
$1,042.34
|
| Rate for Payer: Cigna Commercial |
$1,730.28
|
| Rate for Payer: First Health Commercial |
$1,980.45
|
| Rate for Payer: Humana Commercial |
$1,771.98
|
| Rate for Payer: Humana KY Medicaid |
$716.92
|
| Rate for Payer: Kentucky WC Medicaid |
$724.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,709.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,538.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$625.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$731.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,834.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,563.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$416.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$271.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$646.25
|
| Rate for Payer: PHCS Commercial |
$2,001.29
|
| Rate for Payer: United Healthcare All Payer |
$1,834.52
|
|
