|
PLATE H 5 HOLE 2.7MM
|
Facility
|
IP
|
$5,103.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$663.40 |
| Max. Negotiated Rate |
$4,898.96 |
| Rate for Payer: Aetna Commercial |
$3,929.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,980.40
|
| Rate for Payer: Cash Price |
$2,551.54
|
| Rate for Payer: Cigna Commercial |
$4,235.56
|
| Rate for Payer: First Health Commercial |
$4,847.93
|
| Rate for Payer: Humana Commercial |
$4,337.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,184.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,766.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,530.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,490.71
|
| Rate for Payer: Ohio Health Group HMO |
$3,827.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,020.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$663.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,581.95
|
| Rate for Payer: PHCS Commercial |
$4,898.96
|
| Rate for Payer: United Healthcare All Payer |
$4,490.71
|
|
|
PLATE H 8 HOLE 2.7MM
|
Facility
|
OP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem Medicaid |
$1,480.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Humana KY Medicaid |
$1,480.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,509.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE H 8 HOLE 2.7MM
|
Facility
|
IP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE HIGH STRENGTH Y
|
Facility
|
OP
|
$4,433.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.29 |
| Max. Negotiated Rate |
$4,255.68 |
| Rate for Payer: Aetna Commercial |
$3,413.41
|
| Rate for Payer: Anthem Medicaid |
$1,524.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,457.74
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna Commercial |
$3,679.39
|
| Rate for Payer: First Health Commercial |
$4,211.35
|
| Rate for Payer: Humana Commercial |
$3,768.05
|
| Rate for Payer: Humana KY Medicaid |
$1,524.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,540.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,271.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,555.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,324.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$576.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.23
|
| Rate for Payer: PHCS Commercial |
$4,255.68
|
| Rate for Payer: United Healthcare All Payer |
$3,901.04
|
|
|
PLATE HIGH STRENGTH Y
|
Facility
|
IP
|
$4,433.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.29 |
| Max. Negotiated Rate |
$4,255.68 |
| Rate for Payer: Aetna Commercial |
$3,413.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,457.74
|
| Rate for Payer: Cash Price |
$2,216.50
|
| Rate for Payer: Cigna Commercial |
$3,679.39
|
| Rate for Payer: First Health Commercial |
$4,211.35
|
| Rate for Payer: Humana Commercial |
$3,768.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,635.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,271.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,901.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,324.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$886.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$576.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,374.23
|
| Rate for Payer: PHCS Commercial |
$4,255.68
|
| Rate for Payer: United Healthcare All Payer |
$3,901.04
|
|
|
PLATE HOCKEY STICK LEFT
|
Facility
|
IP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
|
|
PLATE HOCKEY STICK LEFT
|
Facility
|
OP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
PLATE HOCKEY STICK RIGHT
|
Facility
|
IP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
PLATE HOCKEY STICK RIGHT
|
Facility
|
OP
|
$3,932.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$511.22 |
| Max. Negotiated Rate |
$3,775.20 |
| Rate for Payer: Aetna Commercial |
$3,028.02
|
| Rate for Payer: Anthem Medicaid |
$1,352.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,067.35
|
| Rate for Payer: Cash Price |
$1,966.25
|
| Rate for Payer: Cigna Commercial |
$3,263.98
|
| Rate for Payer: First Health Commercial |
$3,735.88
|
| Rate for Payer: Humana Commercial |
$3,342.62
|
| Rate for Payer: Humana KY Medicaid |
$1,352.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,366.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,224.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,902.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,179.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,379.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,460.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,949.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$786.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$511.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,219.08
|
| Rate for Payer: PHCS Commercial |
$3,775.20
|
| Rate for Payer: United Healthcare All Payer |
$3,460.60
|
|
|
PLATE HOOK 2H
|
Facility
|
IP
|
$3,883.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.86 |
| Max. Negotiated Rate |
$3,728.16 |
| Rate for Payer: Aetna Commercial |
$2,990.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.13
|
| Rate for Payer: Cash Price |
$1,941.75
|
| Rate for Payer: Cigna Commercial |
$3,223.30
|
| Rate for Payer: First Health Commercial |
$3,689.32
|
| Rate for Payer: Humana Commercial |
$3,300.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,866.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.88
|
| Rate for Payer: PHCS Commercial |
$3,728.16
|
| Rate for Payer: United Healthcare All Payer |
$3,417.48
|
|
|
PLATE HOOK 2H
|
Facility
|
OP
|
$3,883.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.86 |
| Max. Negotiated Rate |
$3,728.16 |
| Rate for Payer: Aetna Commercial |
$2,990.30
|
| Rate for Payer: Anthem Medicaid |
$1,335.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.13
|
| Rate for Payer: Cash Price |
$1,941.75
|
| Rate for Payer: Cigna Commercial |
$3,223.30
|
| Rate for Payer: First Health Commercial |
$3,689.32
|
| Rate for Payer: Humana Commercial |
$3,300.98
|
| Rate for Payer: Humana KY Medicaid |
$1,335.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,866.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.88
|
| Rate for Payer: PHCS Commercial |
$3,728.16
|
| Rate for Payer: United Healthcare All Payer |
$3,417.48
|
|
|
PLATE HOOK 3H
|
Facility
|
OP
|
$3,974.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.68 |
| Max. Negotiated Rate |
$3,815.52 |
| Rate for Payer: Aetna Commercial |
$3,060.36
|
| Rate for Payer: Anthem Medicaid |
$1,366.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.11
|
| Rate for Payer: Cash Price |
$1,987.25
|
| Rate for Payer: Cigna Commercial |
$3,298.84
|
| Rate for Payer: First Health Commercial |
$3,775.78
|
| Rate for Payer: Humana Commercial |
$3,378.32
|
| Rate for Payer: Humana KY Medicaid |
$1,366.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,380.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,497.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,980.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.10
|
| Rate for Payer: PHCS Commercial |
$3,815.52
|
| Rate for Payer: United Healthcare All Payer |
$3,497.56
|
|
|
PLATE HOOK 3H
|
Facility
|
IP
|
$3,974.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.68 |
| Max. Negotiated Rate |
$3,815.52 |
| Rate for Payer: Aetna Commercial |
$3,060.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.11
|
| Rate for Payer: Cash Price |
$1,987.25
|
| Rate for Payer: Cigna Commercial |
$3,298.84
|
| Rate for Payer: First Health Commercial |
$3,775.78
|
| Rate for Payer: Humana Commercial |
$3,378.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,497.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,980.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.10
|
| Rate for Payer: PHCS Commercial |
$3,815.52
|
| Rate for Payer: United Healthcare All Payer |
$3,497.56
|
|
|
PLATE HOOK LOCKING PEG 2H
|
Facility
|
IP
|
$3,883.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.86 |
| Max. Negotiated Rate |
$3,728.16 |
| Rate for Payer: Aetna Commercial |
$2,990.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.13
|
| Rate for Payer: Cash Price |
$1,941.75
|
| Rate for Payer: Cigna Commercial |
$3,223.30
|
| Rate for Payer: First Health Commercial |
$3,689.32
|
| Rate for Payer: Humana Commercial |
$3,300.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,866.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.88
|
| Rate for Payer: PHCS Commercial |
$3,728.16
|
| Rate for Payer: United Healthcare All Payer |
$3,417.48
|
|
|
PLATE HOOK LOCKING PEG 2H
|
Facility
|
OP
|
$3,883.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.86 |
| Max. Negotiated Rate |
$3,728.16 |
| Rate for Payer: Kentucky WC Medicaid |
$1,349.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,866.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,165.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$776.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$504.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,203.88
|
| Rate for Payer: PHCS Commercial |
$3,728.16
|
| Rate for Payer: United Healthcare All Payer |
$3,417.48
|
| Rate for Payer: Aetna Commercial |
$2,990.30
|
| Rate for Payer: Anthem Medicaid |
$1,335.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,029.13
|
| Rate for Payer: Cash Price |
$1,941.75
|
| Rate for Payer: Cigna Commercial |
$3,223.30
|
| Rate for Payer: First Health Commercial |
$3,689.32
|
| Rate for Payer: Humana Commercial |
$3,300.98
|
| Rate for Payer: Humana KY Medicaid |
$1,335.54
|
|
|
PLATE HOOK LOCKING PEG 3H
|
Facility
|
OP
|
$3,974.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.68 |
| Max. Negotiated Rate |
$3,815.52 |
| Rate for Payer: Aetna Commercial |
$3,060.36
|
| Rate for Payer: Anthem Medicaid |
$1,366.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.11
|
| Rate for Payer: Cash Price |
$1,987.25
|
| Rate for Payer: Cigna Commercial |
$3,298.84
|
| Rate for Payer: First Health Commercial |
$3,775.78
|
| Rate for Payer: Humana Commercial |
$3,378.32
|
| Rate for Payer: Humana KY Medicaid |
$1,366.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,380.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,394.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,497.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,980.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.10
|
| Rate for Payer: PHCS Commercial |
$3,815.52
|
| Rate for Payer: United Healthcare All Payer |
$3,497.56
|
|
|
PLATE HOOK LOCKING PEG 3H
|
Facility
|
IP
|
$3,974.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$516.68 |
| Max. Negotiated Rate |
$3,815.52 |
| Rate for Payer: Aetna Commercial |
$3,060.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,100.11
|
| Rate for Payer: Cash Price |
$1,987.25
|
| Rate for Payer: Cigna Commercial |
$3,298.84
|
| Rate for Payer: First Health Commercial |
$3,775.78
|
| Rate for Payer: Humana Commercial |
$3,378.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,259.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,933.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,192.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,497.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,980.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$794.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$516.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,232.10
|
| Rate for Payer: PHCS Commercial |
$3,815.52
|
| Rate for Payer: United Healthcare All Payer |
$3,497.56
|
|
|
PLATE HTO ST WDGE 15MM L
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE HTO ST WDGE 15MM L
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE HUB CAP WRIST FUSION
|
Facility
|
OP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem Medicaid |
$1,733.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Humana KY Medicaid |
$1,733.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,751.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,768.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
PLATE HUB CAP WRIST FUSION
|
Facility
|
IP
|
$5,042.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$655.46 |
| Max. Negotiated Rate |
$4,840.32 |
| Rate for Payer: Aetna Commercial |
$3,882.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,932.76
|
| Rate for Payer: Cash Price |
$2,521.00
|
| Rate for Payer: Cigna Commercial |
$4,184.86
|
| Rate for Payer: First Health Commercial |
$4,789.90
|
| Rate for Payer: Humana Commercial |
$4,285.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,134.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,721.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,512.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,436.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,781.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,008.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$655.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,563.02
|
| Rate for Payer: PHCS Commercial |
$4,840.32
|
| Rate for Payer: United Healthcare All Payer |
$4,436.96
|
|
|
PLATE HUB CAP WRST FUSION POST
|
Facility
|
IP
|
$1,714.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$1,645.44 |
| Rate for Payer: Aetna Commercial |
$1,319.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.92
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cigna Commercial |
$1,422.62
|
| Rate for Payer: First Health Commercial |
$1,628.30
|
| Rate for Payer: Humana Commercial |
$1,456.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,508.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.34
|
| Rate for Payer: PHCS Commercial |
$1,645.44
|
| Rate for Payer: United Healthcare All Payer |
$1,508.32
|
|
|
PLATE HUB CAP WRST FUSION POST
|
Facility
|
OP
|
$1,714.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.82 |
| Max. Negotiated Rate |
$1,645.44 |
| Rate for Payer: Aetna Commercial |
$1,319.78
|
| Rate for Payer: Anthem Medicaid |
$589.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,336.92
|
| Rate for Payer: Cash Price |
$857.00
|
| Rate for Payer: Cigna Commercial |
$1,422.62
|
| Rate for Payer: First Health Commercial |
$1,628.30
|
| Rate for Payer: Humana Commercial |
$1,456.90
|
| Rate for Payer: Humana KY Medicaid |
$589.44
|
| Rate for Payer: Kentucky WC Medicaid |
$595.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,405.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,264.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$514.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$601.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,508.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,285.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$342.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$222.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$531.34
|
| Rate for Payer: PHCS Commercial |
$1,645.44
|
| Rate for Payer: United Healthcare All Payer |
$1,508.32
|
|
|
PLATE HUM LK PRX 11H L 3.5*191
|
Facility
|
IP
|
$8,330.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.94 |
| Max. Negotiated Rate |
$7,997.09 |
| Rate for Payer: Humana Commercial |
$7,080.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,082.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,582.39
|
| Rate for Payer: PHCS Commercial |
$7,997.09
|
| Rate for Payer: United Healthcare All Payer |
$7,330.66
|
| Rate for Payer: Aetna Commercial |
$6,414.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.63
|
| Rate for Payer: Cash Price |
$4,165.15
|
| Rate for Payer: Cigna Commercial |
$6,914.15
|
| Rate for Payer: First Health Commercial |
$7,913.78
|
|
|
PLATE HUM LK PRX 11H L 3.5*191
|
Facility
|
OP
|
$8,330.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,082.94 |
| Max. Negotiated Rate |
$7,997.09 |
| Rate for Payer: Aetna Commercial |
$6,414.33
|
| Rate for Payer: Anthem Medicaid |
$2,864.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,497.63
|
| Rate for Payer: Cash Price |
$4,165.15
|
| Rate for Payer: Cigna Commercial |
$6,914.15
|
| Rate for Payer: First Health Commercial |
$7,913.78
|
| Rate for Payer: Humana Commercial |
$7,080.76
|
| Rate for Payer: Humana KY Medicaid |
$2,864.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,893.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,830.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,147.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,499.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,922.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,330.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,247.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,666.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,082.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,582.39
|
| Rate for Payer: PHCS Commercial |
$7,997.09
|
| Rate for Payer: United Healthcare All Payer |
$7,330.66
|
|
