|
PLATE 8H 1/3 TUB W/COLLAR 93MM
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE 8H 3.5*111MM SM FRAG
|
Facility
|
IP
|
$3,538.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.06 |
| Max. Negotiated Rate |
$3,397.40 |
| Rate for Payer: Aetna Commercial |
$2,725.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,760.39
|
| Rate for Payer: Cash Price |
$1,769.48
|
| Rate for Payer: Cigna Commercial |
$2,937.34
|
| Rate for Payer: First Health Commercial |
$3,362.01
|
| Rate for Payer: Humana Commercial |
$3,008.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,611.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,114.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,654.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.08
|
| Rate for Payer: PHCS Commercial |
$3,397.40
|
| Rate for Payer: United Healthcare All Payer |
$3,114.28
|
|
|
PLATE 8H 3.5*111MM SM FRAG
|
Facility
|
OP
|
$3,538.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.06 |
| Max. Negotiated Rate |
$3,397.40 |
| Rate for Payer: Aetna Commercial |
$2,725.00
|
| Rate for Payer: Anthem Medicaid |
$1,217.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,760.39
|
| Rate for Payer: Cash Price |
$1,769.48
|
| Rate for Payer: Cigna Commercial |
$2,937.34
|
| Rate for Payer: First Health Commercial |
$3,362.01
|
| Rate for Payer: Humana Commercial |
$3,008.12
|
| Rate for Payer: Humana KY Medicaid |
$1,217.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,229.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,901.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,611.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,061.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,241.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,114.28
|
| Rate for Payer: Ohio Health Group HMO |
$2,654.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$707.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$460.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,097.08
|
| Rate for Payer: PHCS Commercial |
$3,397.40
|
| Rate for Payer: United Healthcare All Payer |
$3,114.28
|
|
|
PLATE 8H LOCKING FIB
|
Facility
|
IP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
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
|
|
|
PLATE 8H LOCKING FIB
|
Facility
|
OP
|
$3,232.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$420.22 |
| Max. Negotiated Rate |
$3,103.20 |
| 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
|
| Rate for Payer: Aetna Commercial |
$2,489.02
|
|
|
PLATE 8 HOLE L
|
Facility
|
OP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem Medicaid |
$1,653.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Humana KY Medicaid |
$1,653.30
|
| Rate for Payer: Kentucky WC Medicaid |
$1,670.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,686.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
|
PLATE 8 HOLE L
|
Facility
|
IP
|
$4,807.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$624.98 |
| Max. Negotiated Rate |
$4,615.20 |
| Rate for Payer: Aetna Commercial |
$3,701.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,749.85
|
| Rate for Payer: Cash Price |
$2,403.75
|
| Rate for Payer: Cigna Commercial |
$3,990.22
|
| Rate for Payer: First Health Commercial |
$4,567.12
|
| Rate for Payer: Humana Commercial |
$4,086.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,942.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,547.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,442.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,230.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,605.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$961.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$624.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,490.32
|
| Rate for Payer: PHCS Commercial |
$4,615.20
|
| Rate for Payer: United Healthcare All Payer |
$4,230.60
|
|
|
PLATE 8H RECON 3.5*112MM
|
Facility
|
OP
|
$4,337.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.86 |
| Max. Negotiated Rate |
$4,163.88 |
| Rate for Payer: Aetna Commercial |
$3,339.78
|
| Rate for Payer: Anthem Medicaid |
$1,491.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,383.16
|
| Rate for Payer: Cash Price |
$2,168.69
|
| Rate for Payer: Cigna Commercial |
$3,600.03
|
| Rate for Payer: First Health Commercial |
$4,120.51
|
| Rate for Payer: Humana Commercial |
$3,686.77
|
| Rate for Payer: Humana KY Medicaid |
$1,491.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,506.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,556.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,200.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,521.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,816.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,344.59
|
| Rate for Payer: PHCS Commercial |
$4,163.88
|
| Rate for Payer: United Healthcare All Payer |
$3,816.89
|
|
|
PLATE 8H RECON 3.5*112MM
|
Facility
|
IP
|
$4,337.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$563.86 |
| Max. Negotiated Rate |
$4,163.88 |
| Rate for Payer: Aetna Commercial |
$3,339.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,383.16
|
| Rate for Payer: Cash Price |
$2,168.69
|
| Rate for Payer: Cigna Commercial |
$3,600.03
|
| Rate for Payer: First Health Commercial |
$4,120.51
|
| Rate for Payer: Humana Commercial |
$3,686.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,556.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,200.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,301.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,816.89
|
| Rate for Payer: Ohio Health Group HMO |
$3,253.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$867.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$563.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,344.59
|
| Rate for Payer: PHCS Commercial |
$4,163.88
|
| Rate for Payer: United Healthcare All Payer |
$3,816.89
|
|
|
PLATE 8H STR
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE 8H STR
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE 9H 3.5*124MM SM FRAG
|
Facility
|
OP
|
$3,552.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.81 |
| Max. Negotiated Rate |
$3,410.30 |
| Rate for Payer: Aetna Commercial |
$2,735.35
|
| Rate for Payer: Anthem Medicaid |
$1,221.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,770.87
|
| Rate for Payer: Cash Price |
$1,776.20
|
| Rate for Payer: Cigna Commercial |
$2,948.49
|
| Rate for Payer: First Health Commercial |
$3,374.78
|
| Rate for Payer: Humana Commercial |
$3,019.54
|
| Rate for Payer: Humana KY Medicaid |
$1,221.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,234.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,912.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,621.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,065.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,246.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,126.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,664.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.24
|
| Rate for Payer: PHCS Commercial |
$3,410.30
|
| Rate for Payer: United Healthcare All Payer |
$3,126.11
|
|
|
PLATE 9H 3.5*124MM SM FRAG
|
Facility
|
IP
|
$3,552.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$461.81 |
| Max. Negotiated Rate |
$3,410.30 |
| Rate for Payer: Aetna Commercial |
$2,735.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,770.87
|
| Rate for Payer: Cash Price |
$1,776.20
|
| Rate for Payer: Cigna Commercial |
$2,948.49
|
| Rate for Payer: First Health Commercial |
$3,374.78
|
| Rate for Payer: Humana Commercial |
$3,019.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,912.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,621.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,065.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,126.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,664.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$710.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$461.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,101.24
|
| Rate for Payer: PHCS Commercial |
$3,410.30
|
| Rate for Payer: United Healthcare All Payer |
$3,126.11
|
|
|
PLATE ACE 4 HOLE LEFT
|
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 ACE 4 HOLE LEFT
|
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 ACE 6 HOLE LEFT
|
Facility
|
IP
|
$2,109.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.24 |
| Max. Negotiated Rate |
$2,025.12 |
| Rate for Payer: Aetna Commercial |
$1,624.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.41
|
| Rate for Payer: Cash Price |
$1,054.75
|
| Rate for Payer: Cigna Commercial |
$1,750.88
|
| Rate for Payer: First Health Commercial |
$2,004.02
|
| Rate for Payer: Humana Commercial |
$1,793.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.94
|
| Rate for Payer: PHCS Commercial |
$2,025.12
|
| Rate for Payer: United Healthcare All Payer |
$1,856.36
|
|
|
PLATE ACE 6 HOLE LEFT
|
Facility
|
OP
|
$2,109.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.24 |
| Max. Negotiated Rate |
$2,025.12 |
| Rate for Payer: Aetna Commercial |
$1,624.32
|
| Rate for Payer: Anthem Medicaid |
$725.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.41
|
| Rate for Payer: Cash Price |
$1,054.75
|
| Rate for Payer: Cigna Commercial |
$1,750.88
|
| Rate for Payer: First Health Commercial |
$2,004.02
|
| Rate for Payer: Humana Commercial |
$1,793.08
|
| Rate for Payer: Humana KY Medicaid |
$725.46
|
| Rate for Payer: Kentucky WC Medicaid |
$732.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.94
|
| Rate for Payer: PHCS Commercial |
$2,025.12
|
| Rate for Payer: United Healthcare All Payer |
$1,856.36
|
|
|
PLATE ACE 8-HOLE LEFT
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
|
|
PLATE ACE 8-HOLE LEFT
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
PLATE ACE 8-HOLE RIGHT
|
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 ACE 8-HOLE RIGHT
|
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 ACE (L) 4 HOLE RIGHT
|
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 ACE (L) 4 HOLE RIGHT
|
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 ACU-LOC 2 VDR EXT NEUTRL
|
Facility
|
IP
|
$4,100.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.06 |
| Max. Negotiated Rate |
$3,936.48 |
| Rate for Payer: Aetna Commercial |
$3,157.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.39
|
| Rate for Payer: Cash Price |
$2,050.25
|
| Rate for Payer: Cigna Commercial |
$3,403.42
|
| Rate for Payer: First Health Commercial |
$3,895.48
|
| Rate for Payer: Humana Commercial |
$3,485.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,026.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.16
|
| Rate for Payer: PHCS Commercial |
$3,936.48
|
| Rate for Payer: United Healthcare All Payer |
$3,608.44
|
|
|
PLATE ACU-LOC 2 VDR EXT NEUTRL
|
Facility
|
OP
|
$4,100.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.06 |
| Max. Negotiated Rate |
$3,936.48 |
| Rate for Payer: Aetna Commercial |
$3,157.38
|
| Rate for Payer: Anthem Medicaid |
$1,410.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,198.39
|
| Rate for Payer: Cash Price |
$2,050.25
|
| Rate for Payer: Cigna Commercial |
$3,403.42
|
| Rate for Payer: First Health Commercial |
$3,895.48
|
| Rate for Payer: Humana Commercial |
$3,485.42
|
| Rate for Payer: Humana KY Medicaid |
$1,410.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,424.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,362.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,026.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,438.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,608.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,075.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.16
|
| Rate for Payer: PHCS Commercial |
$3,936.48
|
| Rate for Payer: United Healthcare All Payer |
$3,608.44
|
|
