|
PLATE 4.5 TI LC-DCP 9H 160MM
|
Facility
|
IP
|
$1,851.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.39 |
| Max. Negotiated Rate |
$1,777.25 |
| Rate for Payer: Aetna Commercial |
$1,425.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,444.01
|
| Rate for Payer: Cash Price |
$925.65
|
| Rate for Payer: Cigna Commercial |
$1,536.58
|
| Rate for Payer: First Health Commercial |
$1,758.73
|
| Rate for Payer: Humana Commercial |
$1,573.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,518.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,366.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,629.14
|
| Rate for Payer: Ohio Health Group HMO |
$1,388.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,481.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,610.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,277.40
|
| Rate for Payer: PHCS Commercial |
$1,777.25
|
| Rate for Payer: United Healthcare All Payer |
$1,629.14
|
|
|
PLATE 4H DIST MED TIBIA
|
Facility
|
IP
|
$8,020.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.13 |
| Max. Negotiated Rate |
$7,699.61 |
| Rate for Payer: Aetna Commercial |
$6,175.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.94
|
| Rate for Payer: Cash Price |
$4,010.21
|
| Rate for Payer: Cigna Commercial |
$6,656.96
|
| Rate for Payer: First Health Commercial |
$7,619.41
|
| Rate for Payer: Humana Commercial |
$6,817.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,576.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,919.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,015.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,416.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,977.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,534.10
|
| Rate for Payer: PHCS Commercial |
$7,699.61
|
| Rate for Payer: United Healthcare All Payer |
$7,057.98
|
|
|
PLATE 4H DIST MED TIBIA
|
Facility
|
OP
|
$8,020.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,406.13 |
| Max. Negotiated Rate |
$7,699.61 |
| Rate for Payer: Aetna Commercial |
$6,175.73
|
| Rate for Payer: Anthem Medicaid |
$2,758.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,255.94
|
| Rate for Payer: Cash Price |
$4,010.21
|
| Rate for Payer: Cigna Commercial |
$6,656.96
|
| Rate for Payer: First Health Commercial |
$7,619.41
|
| Rate for Payer: Humana Commercial |
$6,817.37
|
| Rate for Payer: Humana KY Medicaid |
$2,758.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,786.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,576.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,919.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,406.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,813.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,057.98
|
| Rate for Payer: Ohio Health Group HMO |
$6,015.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,416.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,977.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,534.10
|
| Rate for Payer: PHCS Commercial |
$7,699.61
|
| Rate for Payer: United Healthcare All Payer |
$7,057.98
|
|
|
PLATE 4 HOLE TUBULAR STRAIGHT
|
Facility
|
IP
|
$1,521.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.42 |
| Max. Negotiated Rate |
$1,460.54 |
| Rate for Payer: Aetna Commercial |
$1,171.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,186.69
|
| Rate for Payer: Cash Price |
$760.70
|
| Rate for Payer: Cigna Commercial |
$1,262.76
|
| Rate for Payer: First Health Commercial |
$1,445.33
|
| Rate for Payer: Humana Commercial |
$1,293.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,247.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,122.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,338.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,141.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,217.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,323.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.77
|
| Rate for Payer: PHCS Commercial |
$1,460.54
|
| Rate for Payer: United Healthcare All Payer |
$1,338.83
|
|
|
PLATE 4 HOLE TUBULAR STRAIGHT
|
Facility
|
OP
|
$1,521.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.42 |
| Max. Negotiated Rate |
$1,460.54 |
| Rate for Payer: Aetna Commercial |
$1,171.48
|
| Rate for Payer: Anthem Medicaid |
$523.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,186.69
|
| Rate for Payer: Cash Price |
$760.70
|
| Rate for Payer: Cigna Commercial |
$1,262.76
|
| Rate for Payer: First Health Commercial |
$1,445.33
|
| Rate for Payer: Humana Commercial |
$1,293.19
|
| Rate for Payer: Humana KY Medicaid |
$523.21
|
| Rate for Payer: Kentucky WC Medicaid |
$528.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,247.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,122.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$456.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$533.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,338.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,141.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,217.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,323.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,049.77
|
| Rate for Payer: PHCS Commercial |
$1,460.54
|
| Rate for Payer: United Healthcare All Payer |
$1,338.83
|
|
|
PLATE 4H STR
|
Facility
|
OP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem Medicaid |
$1,616.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Humana KY Medicaid |
$1,616.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
PLATE 4H STR
|
Facility
|
IP
|
$4,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.00 |
| Max. Negotiated Rate |
$4,512.00 |
| Rate for Payer: Aetna Commercial |
$3,619.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,666.00
|
| Rate for Payer: Cash Price |
$2,350.00
|
| Rate for Payer: Cigna Commercial |
$3,901.00
|
| Rate for Payer: First Health Commercial |
$4,465.00
|
| Rate for Payer: Humana Commercial |
$3,995.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,854.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,468.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,410.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,136.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,525.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,760.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,089.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,243.00
|
| Rate for Payer: PHCS Commercial |
$4,512.00
|
| Rate for Payer: United Healthcare All Payer |
$4,136.00
|
|
|
PLATE 5H 1/3 TUB W/COLLAR 57MM
|
Facility
|
OP
|
$2,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.66 |
| Max. Negotiated Rate |
$1,963.70 |
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Anthem Medicaid |
$703.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,595.51
|
| Rate for Payer: Cash Price |
$1,022.76
|
| Rate for Payer: Cigna Commercial |
$1,697.78
|
| Rate for Payer: First Health Commercial |
$1,943.24
|
| Rate for Payer: Humana Commercial |
$1,738.69
|
| Rate for Payer: Humana KY Medicaid |
$703.45
|
| Rate for Payer: Kentucky WC Medicaid |
$710.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,677.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,509.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,636.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,411.41
|
| Rate for Payer: PHCS Commercial |
$1,963.70
|
| Rate for Payer: United Healthcare All Payer |
$1,800.06
|
|
|
PLATE 5H 1/3 TUB W/COLLAR 57MM
|
Facility
|
IP
|
$2,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.66 |
| Max. Negotiated Rate |
$1,963.70 |
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,595.51
|
| Rate for Payer: Cash Price |
$1,022.76
|
| Rate for Payer: Cigna Commercial |
$1,697.78
|
| Rate for Payer: First Health Commercial |
$1,943.24
|
| Rate for Payer: Humana Commercial |
$1,738.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,677.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,509.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,636.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,411.41
|
| Rate for Payer: PHCS Commercial |
$1,963.70
|
| Rate for Payer: United Healthcare All Payer |
$1,800.06
|
|
|
PLATE 5H 3.5*72MM SM FRAG
|
Facility
|
OP
|
$4,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.00 |
| Max. Negotiated Rate |
$4,022.40 |
| Rate for Payer: Aetna Commercial |
$3,226.30
|
| Rate for Payer: Anthem Medicaid |
$1,440.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.20
|
| Rate for Payer: Cash Price |
$2,095.00
|
| Rate for Payer: Cigna Commercial |
$3,477.70
|
| Rate for Payer: First Health Commercial |
$3,980.50
|
| Rate for Payer: Humana Commercial |
$3,561.50
|
| Rate for Payer: Humana KY Medicaid |
$1,440.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,455.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,435.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,469.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,645.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.10
|
| Rate for Payer: PHCS Commercial |
$4,022.40
|
| Rate for Payer: United Healthcare All Payer |
$3,687.20
|
|
|
PLATE 5H 3.5*72MM SM FRAG
|
Facility
|
IP
|
$4,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.00 |
| Max. Negotiated Rate |
$4,022.40 |
| Rate for Payer: Aetna Commercial |
$3,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.20
|
| Rate for Payer: Cash Price |
$2,095.00
|
| Rate for Payer: Cigna Commercial |
$3,477.70
|
| Rate for Payer: First Health Commercial |
$3,980.50
|
| Rate for Payer: Humana Commercial |
$3,561.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,435.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,645.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.10
|
| Rate for Payer: PHCS Commercial |
$4,022.40
|
| Rate for Payer: United Healthcare All Payer |
$3,687.20
|
|
|
PLATE 5 HOLE LATERAL MALLEOLAR
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE 5 HOLE LATERAL MALLEOLAR
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE 5 HOLE TUBULAR STRAIGHT
|
Facility
|
IP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
PLATE 5 HOLE TUBULAR STRAIGHT
|
Facility
|
OP
|
$1,120.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$336.00 |
| Max. Negotiated Rate |
$1,075.20 |
| Rate for Payer: Aetna Commercial |
$862.40
|
| Rate for Payer: Anthem Medicaid |
$385.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$873.60
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cigna Commercial |
$929.60
|
| Rate for Payer: First Health Commercial |
$1,064.00
|
| Rate for Payer: Humana Commercial |
$952.00
|
| Rate for Payer: Humana KY Medicaid |
$385.17
|
| Rate for Payer: Kentucky WC Medicaid |
$389.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$918.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$826.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$336.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$392.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$985.60
|
| Rate for Payer: Ohio Health Group HMO |
$840.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$896.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$772.80
|
| Rate for Payer: PHCS Commercial |
$1,075.20
|
| Rate for Payer: United Healthcare All Payer |
$985.60
|
|
|
PLATE 5H RECON 3.5*70MM
|
Facility
|
IP
|
$3,727.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.36 |
| Max. Negotiated Rate |
$3,578.74 |
| Rate for Payer: Aetna Commercial |
$2,870.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,907.72
|
| Rate for Payer: Cash Price |
$1,863.92
|
| Rate for Payer: Cigna Commercial |
$3,094.12
|
| Rate for Payer: First Health Commercial |
$3,541.46
|
| Rate for Payer: Humana Commercial |
$3,168.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,280.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,982.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,243.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.22
|
| Rate for Payer: PHCS Commercial |
$3,578.74
|
| Rate for Payer: United Healthcare All Payer |
$3,280.51
|
|
|
PLATE 5H RECON 3.5*70MM
|
Facility
|
OP
|
$3,727.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,118.36 |
| Max. Negotiated Rate |
$3,578.74 |
| Rate for Payer: Aetna Commercial |
$2,870.44
|
| Rate for Payer: Anthem Medicaid |
$1,282.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,907.72
|
| Rate for Payer: Cash Price |
$1,863.92
|
| Rate for Payer: Cigna Commercial |
$3,094.12
|
| Rate for Payer: First Health Commercial |
$3,541.46
|
| Rate for Payer: Humana Commercial |
$3,168.67
|
| Rate for Payer: Humana KY Medicaid |
$1,282.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,295.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,056.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,751.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,118.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,307.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,280.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,795.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,982.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,243.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,572.22
|
| Rate for Payer: PHCS Commercial |
$3,578.74
|
| Rate for Payer: United Healthcare All Payer |
$3,280.51
|
|
|
PLATE 5 MET HOOK STD R
|
Facility
|
OP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem Medicaid |
$2,531.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Humana KY Medicaid |
$2,531.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE 5 MET HOOK STD R
|
Facility
|
IP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE 5TH MET HOOK
|
Facility
|
OP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem Medicaid |
$3,065.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Humana KY Medicaid |
$3,065.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,096.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,126.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PLATE 5TH MET HOOK
|
Facility
|
IP
|
$8,913.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,673.90 |
| Max. Negotiated Rate |
$8,556.48 |
| Rate for Payer: Aetna Commercial |
$6,863.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,952.14
|
| Rate for Payer: Cash Price |
$4,456.50
|
| Rate for Payer: Cigna Commercial |
$7,397.79
|
| Rate for Payer: First Health Commercial |
$8,467.35
|
| Rate for Payer: Humana Commercial |
$7,576.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,308.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,577.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,673.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,843.44
|
| Rate for Payer: Ohio Health Group HMO |
$6,684.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,130.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,754.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,149.97
|
| Rate for Payer: PHCS Commercial |
$8,556.48
|
| Rate for Payer: United Healthcare All Payer |
$7,843.44
|
|
|
PLATE 6H 1/3 TUB W/COLLAR 69MM
|
Facility
|
OP
|
$2,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.66 |
| Max. Negotiated Rate |
$1,963.70 |
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Anthem Medicaid |
$703.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,595.51
|
| Rate for Payer: Cash Price |
$1,022.76
|
| Rate for Payer: Cigna Commercial |
$1,697.78
|
| Rate for Payer: First Health Commercial |
$1,943.24
|
| Rate for Payer: Humana Commercial |
$1,738.69
|
| Rate for Payer: Humana KY Medicaid |
$703.45
|
| Rate for Payer: Kentucky WC Medicaid |
$710.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,677.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,509.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$717.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,636.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,411.41
|
| Rate for Payer: PHCS Commercial |
$1,963.70
|
| Rate for Payer: United Healthcare All Payer |
$1,800.06
|
|
|
PLATE 6H 1/3 TUB W/COLLAR 69MM
|
Facility
|
IP
|
$2,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$613.66 |
| Max. Negotiated Rate |
$1,963.70 |
| Rate for Payer: Aetna Commercial |
$1,575.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,595.51
|
| Rate for Payer: Cash Price |
$1,022.76
|
| Rate for Payer: Cigna Commercial |
$1,697.78
|
| Rate for Payer: First Health Commercial |
$1,943.24
|
| Rate for Payer: Humana Commercial |
$1,738.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,677.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,509.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$613.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,800.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,534.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,636.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,779.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,411.41
|
| Rate for Payer: PHCS Commercial |
$1,963.70
|
| Rate for Payer: United Healthcare All Payer |
$1,800.06
|
|
|
PLATE 6H 3.5*85MM SM FRAG
|
Facility
|
OP
|
$3,368.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.59 |
| Max. Negotiated Rate |
$3,233.89 |
| Rate for Payer: Aetna Commercial |
$2,593.85
|
| Rate for Payer: Anthem Medicaid |
$1,158.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.54
|
| Rate for Payer: Cash Price |
$1,684.32
|
| Rate for Payer: Cigna Commercial |
$2,795.97
|
| Rate for Payer: First Health Commercial |
$3,200.21
|
| Rate for Payer: Humana Commercial |
$2,863.34
|
| Rate for Payer: Humana KY Medicaid |
$1,158.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,170.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,181.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.36
|
| Rate for Payer: PHCS Commercial |
$3,233.89
|
| Rate for Payer: United Healthcare All Payer |
$2,964.40
|
|
|
PLATE 6H 3.5*85MM SM FRAG
|
Facility
|
IP
|
$3,368.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,010.59 |
| Max. Negotiated Rate |
$3,233.89 |
| Rate for Payer: Aetna Commercial |
$2,593.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,627.54
|
| Rate for Payer: Cash Price |
$1,684.32
|
| Rate for Payer: Cigna Commercial |
$2,795.97
|
| Rate for Payer: First Health Commercial |
$3,200.21
|
| Rate for Payer: Humana Commercial |
$2,863.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,762.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,486.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,010.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,964.40
|
| Rate for Payer: Ohio Health Group HMO |
$2,526.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,694.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,930.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,324.36
|
| Rate for Payer: PHCS Commercial |
$3,233.89
|
| Rate for Payer: United Healthcare All Payer |
$2,964.40
|
|
