|
PLATE LP TIB LK 3.5M 8H 123M R
|
Facility
|
IP
|
$8,586.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.30 |
| Max. Negotiated Rate |
$8,243.41 |
| Rate for Payer: Aetna Commercial |
$6,611.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,697.77
|
| Rate for Payer: Cash Price |
$4,293.45
|
| Rate for Payer: Cigna Commercial |
$7,127.12
|
| Rate for Payer: First Health Commercial |
$8,157.55
|
| Rate for Payer: Humana Commercial |
$7,298.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,041.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,337.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,576.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,556.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,440.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,717.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,116.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,661.94
|
| Rate for Payer: PHCS Commercial |
$8,243.41
|
| Rate for Payer: United Healthcare All Payer |
$7,556.46
|
|
|
PLATE LP TIB LK 4.5M 4H 94M L
|
Facility
|
OP
|
$7,614.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.89 |
| Max. Negotiated Rate |
$7,309.95 |
| Rate for Payer: Aetna Commercial |
$5,863.19
|
| Rate for Payer: Anthem Medicaid |
$2,618.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,939.33
|
| Rate for Payer: Cash Price |
$3,807.27
|
| Rate for Payer: Cigna Commercial |
$6,320.06
|
| Rate for Payer: First Health Commercial |
$7,233.80
|
| Rate for Payer: Humana Commercial |
$6,472.35
|
| Rate for Payer: Humana KY Medicaid |
$2,618.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,645.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,619.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,671.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,700.79
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,360.50
|
| Rate for Payer: PHCS Commercial |
$7,309.95
|
| Rate for Payer: United Healthcare All Payer |
$6,700.79
|
|
|
PLATE LP TIB LK 4.5M 4H 94M L
|
Facility
|
IP
|
$7,614.53
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$989.89 |
| Max. Negotiated Rate |
$7,309.95 |
| Rate for Payer: Aetna Commercial |
$5,863.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,939.33
|
| Rate for Payer: Cash Price |
$3,807.27
|
| Rate for Payer: Cigna Commercial |
$6,320.06
|
| Rate for Payer: First Health Commercial |
$7,233.80
|
| Rate for Payer: Humana Commercial |
$6,472.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,243.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,619.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,284.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,700.79
|
| Rate for Payer: Ohio Health Group HMO |
$5,710.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,522.91
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,360.50
|
| Rate for Payer: PHCS Commercial |
$7,309.95
|
| Rate for Payer: United Healthcare All Payer |
$6,700.79
|
|
|
PLATE LP TIB LK 4.5M 6H 130M L
|
Facility
|
IP
|
$7,722.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.93 |
| Max. Negotiated Rate |
$7,413.67 |
| Rate for Payer: Aetna Commercial |
$5,946.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,023.60
|
| Rate for Payer: Cash Price |
$3,861.29
|
| Rate for Payer: Cigna Commercial |
$6,409.73
|
| Rate for Payer: First Health Commercial |
$7,336.44
|
| Rate for Payer: Humana Commercial |
$6,564.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,332.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,699.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.00
|
| Rate for Payer: PHCS Commercial |
$7,413.67
|
| Rate for Payer: United Healthcare All Payer |
$6,795.86
|
|
|
PLATE LP TIB LK 4.5M 6H 130M L
|
Facility
|
OP
|
$7,722.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.93 |
| Max. Negotiated Rate |
$7,413.67 |
| Rate for Payer: Aetna Commercial |
$5,946.38
|
| Rate for Payer: Anthem Medicaid |
$2,655.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,023.60
|
| Rate for Payer: Cash Price |
$3,861.29
|
| Rate for Payer: Cigna Commercial |
$6,409.73
|
| Rate for Payer: First Health Commercial |
$7,336.44
|
| Rate for Payer: Humana Commercial |
$6,564.18
|
| Rate for Payer: Humana KY Medicaid |
$2,655.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,682.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,332.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,699.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,709.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.00
|
| Rate for Payer: PHCS Commercial |
$7,413.67
|
| Rate for Payer: United Healthcare All Payer |
$6,795.86
|
|
|
PLATE LP TIB LK 4.5M 8H 130M L
|
Facility
|
OP
|
$7,722.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.93 |
| Max. Negotiated Rate |
$7,413.67 |
| Rate for Payer: Aetna Commercial |
$5,946.38
|
| Rate for Payer: Anthem Medicaid |
$2,655.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,023.60
|
| Rate for Payer: Cash Price |
$3,861.29
|
| Rate for Payer: Cigna Commercial |
$6,409.73
|
| Rate for Payer: First Health Commercial |
$7,336.44
|
| Rate for Payer: Humana Commercial |
$6,564.18
|
| Rate for Payer: Humana KY Medicaid |
$2,655.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,682.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,332.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,699.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,709.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.00
|
| Rate for Payer: PHCS Commercial |
$7,413.67
|
| Rate for Payer: United Healthcare All Payer |
$6,795.86
|
|
|
PLATE LP TIB LK 4.5M 8H 130M L
|
Facility
|
IP
|
$7,722.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.93 |
| Max. Negotiated Rate |
$7,413.67 |
| Rate for Payer: Aetna Commercial |
$5,946.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,023.60
|
| Rate for Payer: Cash Price |
$3,861.29
|
| Rate for Payer: Cigna Commercial |
$6,409.73
|
| Rate for Payer: First Health Commercial |
$7,336.44
|
| Rate for Payer: Humana Commercial |
$6,564.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,332.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,699.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,316.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,795.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,791.93
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.00
|
| Rate for Payer: PHCS Commercial |
$7,413.67
|
| Rate for Payer: United Healthcare All Payer |
$6,795.86
|
|
|
PLATE L RT 2.7MM
|
Facility
|
OP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem Medicaid |
$383.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Humana KY Medicaid |
$383.26
|
| Rate for Payer: Kentucky WC Medicaid |
$387.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$390.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE L RT 2.7MM
|
Facility
|
IP
|
$1,114.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$144.88 |
| Max. Negotiated Rate |
$1,069.87 |
| Rate for Payer: Aetna Commercial |
$858.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$869.27
|
| Rate for Payer: Cash Price |
$557.22
|
| Rate for Payer: Cigna Commercial |
$924.99
|
| Rate for Payer: First Health Commercial |
$1,058.73
|
| Rate for Payer: Humana Commercial |
$947.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$913.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$822.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$980.72
|
| Rate for Payer: Ohio Health Group HMO |
$835.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$222.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$144.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$345.48
|
| Rate for Payer: PHCS Commercial |
$1,069.87
|
| Rate for Payer: United Healthcare All Payer |
$980.72
|
|
|
PLATE L TI BUTTRESS 4H 86MM LT
|
Facility
|
OP
|
$3,619.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.59 |
| Max. Negotiated Rate |
$3,475.15 |
| Rate for Payer: Aetna Commercial |
$2,787.36
|
| Rate for Payer: Anthem Medicaid |
$1,244.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,823.56
|
| Rate for Payer: Cash Price |
$1,809.97
|
| Rate for Payer: Cigna Commercial |
$3,004.56
|
| Rate for Payer: First Health Commercial |
$3,438.95
|
| Rate for Payer: Humana Commercial |
$3,076.96
|
| Rate for Payer: Humana KY Medicaid |
$1,244.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,257.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,968.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,671.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,269.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,185.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,714.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,122.18
|
| Rate for Payer: PHCS Commercial |
$3,475.15
|
| Rate for Payer: United Healthcare All Payer |
$3,185.56
|
|
|
PLATE L TI BUTTRESS 4H 86MM LT
|
Facility
|
IP
|
$3,619.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$470.59 |
| Max. Negotiated Rate |
$3,475.15 |
| Rate for Payer: Aetna Commercial |
$2,787.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,823.56
|
| Rate for Payer: Cash Price |
$1,809.97
|
| Rate for Payer: Cigna Commercial |
$3,004.56
|
| Rate for Payer: First Health Commercial |
$3,438.95
|
| Rate for Payer: Humana Commercial |
$3,076.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,968.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,671.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,085.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,185.56
|
| Rate for Payer: Ohio Health Group HMO |
$2,714.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$723.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$470.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,122.18
|
| Rate for Payer: PHCS Commercial |
$3,475.15
|
| Rate for Payer: United Healthcare All Payer |
$3,185.56
|
|
|
PLATE L TI BUTTRESS 4 H 86MM R
|
Facility
|
OP
|
$9,913.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.73 |
| Max. Negotiated Rate |
$9,516.81 |
| Rate for Payer: Aetna Commercial |
$7,633.27
|
| Rate for Payer: Anthem Medicaid |
$3,409.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,732.41
|
| Rate for Payer: Cash Price |
$4,956.67
|
| Rate for Payer: Cigna Commercial |
$8,228.07
|
| Rate for Payer: First Health Commercial |
$9,417.67
|
| Rate for Payer: Humana Commercial |
$8,426.34
|
| Rate for Payer: Humana KY Medicaid |
$3,409.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,443.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,128.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,316.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,974.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,477.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,723.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,982.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,288.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,073.14
|
| Rate for Payer: PHCS Commercial |
$9,516.81
|
| Rate for Payer: United Healthcare All Payer |
$8,723.74
|
|
|
PLATE L TI BUTTRESS 4 H 86MM R
|
Facility
|
IP
|
$9,913.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,288.73 |
| Max. Negotiated Rate |
$9,516.81 |
| Rate for Payer: Aetna Commercial |
$7,633.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,732.41
|
| Rate for Payer: Cash Price |
$4,956.67
|
| Rate for Payer: Cigna Commercial |
$8,228.07
|
| Rate for Payer: First Health Commercial |
$9,417.67
|
| Rate for Payer: Humana Commercial |
$8,426.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,128.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,316.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,974.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,723.74
|
| Rate for Payer: Ohio Health Group HMO |
$7,435.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,982.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,288.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,073.14
|
| Rate for Payer: PHCS Commercial |
$9,516.81
|
| Rate for Payer: United Healthcare All Payer |
$8,723.74
|
|
|
PLATE MALLEOLAR 3 HOLE
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MALLEOLAR 3 HOLE
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MALLEOLAR 5 HOLE
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
| Rate for Payer: Aetna Commercial |
$1,486.87
|
|
|
PLATE MALLEOLAR 5 HOLE
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MALLEOLAR 7 HOLE
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MALLEOLAR 7 HOLE
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MD PR0X LCP 4.5 8H 178 L
|
Facility
|
OP
|
$6,903.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.51 |
| Max. Negotiated Rate |
$6,627.79 |
| Rate for Payer: Aetna Commercial |
$5,316.04
|
| Rate for Payer: Anthem Medicaid |
$2,374.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,385.08
|
| Rate for Payer: Cash Price |
$3,451.98
|
| Rate for Payer: Cigna Commercial |
$5,730.28
|
| Rate for Payer: First Health Commercial |
$6,558.75
|
| Rate for Payer: Humana Commercial |
$5,868.36
|
| Rate for Payer: Humana KY Medicaid |
$2,374.27
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,661.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,095.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,421.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,075.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,177.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.22
|
| Rate for Payer: PHCS Commercial |
$6,627.79
|
| Rate for Payer: United Healthcare All Payer |
$6,075.48
|
|
|
PLATE MD PR0X LCP 4.5 8H 178 L
|
Facility
|
IP
|
$6,903.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.51 |
| Max. Negotiated Rate |
$6,627.79 |
| Rate for Payer: Aetna Commercial |
$5,316.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,385.08
|
| Rate for Payer: Cash Price |
$3,451.98
|
| Rate for Payer: Cigna Commercial |
$5,730.28
|
| Rate for Payer: First Health Commercial |
$6,558.75
|
| Rate for Payer: Humana Commercial |
$5,868.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,661.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,095.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,075.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,177.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.79
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.22
|
| Rate for Payer: PHCS Commercial |
$6,627.79
|
| Rate for Payer: United Healthcare All Payer |
$6,075.48
|
|
|
PLATE MD PROX LCP 4.5 4H 106 L
|
Facility
|
OP
|
$6,805.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.72 |
| Max. Negotiated Rate |
$6,533.29 |
| Rate for Payer: Aetna Commercial |
$5,240.24
|
| Rate for Payer: Anthem Medicaid |
$2,340.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,308.30
|
| Rate for Payer: Cash Price |
$3,402.76
|
| Rate for Payer: Cigna Commercial |
$5,648.57
|
| Rate for Payer: First Health Commercial |
$6,465.23
|
| Rate for Payer: Humana Commercial |
$5,784.68
|
| Rate for Payer: Humana KY Medicaid |
$2,340.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,364.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,387.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,104.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.71
|
| Rate for Payer: PHCS Commercial |
$6,533.29
|
| Rate for Payer: United Healthcare All Payer |
$5,988.85
|
|
|
PLATE MD PROX LCP 4.5 4H 106 L
|
Facility
|
IP
|
$6,805.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.72 |
| Max. Negotiated Rate |
$6,533.29 |
| Rate for Payer: Aetna Commercial |
$5,240.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,308.30
|
| Rate for Payer: Cash Price |
$3,402.76
|
| Rate for Payer: Cigna Commercial |
$5,648.57
|
| Rate for Payer: First Health Commercial |
$6,465.23
|
| Rate for Payer: Humana Commercial |
$5,784.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,104.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.71
|
| Rate for Payer: PHCS Commercial |
$6,533.29
|
| Rate for Payer: United Healthcare All Payer |
$5,988.85
|
|
|
PLATE MD PROX LCP 4.5 4H 106 R
|
Facility
|
OP
|
$6,805.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.72 |
| Max. Negotiated Rate |
$6,533.29 |
| Rate for Payer: Aetna Commercial |
$5,240.24
|
| Rate for Payer: Anthem Medicaid |
$2,340.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,308.30
|
| Rate for Payer: Cash Price |
$3,402.76
|
| Rate for Payer: Cigna Commercial |
$5,648.57
|
| Rate for Payer: First Health Commercial |
$6,465.23
|
| Rate for Payer: Humana Commercial |
$5,784.68
|
| Rate for Payer: Humana KY Medicaid |
$2,340.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,364.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,387.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,104.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.71
|
| Rate for Payer: PHCS Commercial |
$6,533.29
|
| Rate for Payer: United Healthcare All Payer |
$5,988.85
|
|
|
PLATE MD PROX LCP 4.5 4H 106 R
|
Facility
|
IP
|
$6,805.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.72 |
| Max. Negotiated Rate |
$6,533.29 |
| Rate for Payer: Aetna Commercial |
$5,240.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,308.30
|
| Rate for Payer: Cash Price |
$3,402.76
|
| Rate for Payer: Cigna Commercial |
$5,648.57
|
| Rate for Payer: First Health Commercial |
$6,465.23
|
| Rate for Payer: Humana Commercial |
$5,784.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,104.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.71
|
| Rate for Payer: PHCS Commercial |
$6,533.29
|
| Rate for Payer: United Healthcare All Payer |
$5,988.85
|
|
