|
PLATE MEDIAL EPICONDYAL 10H
|
Facility
|
OP
|
$4,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.47 |
| Max. Negotiated Rate |
$4,242.24 |
| Rate for Payer: Aetna Commercial |
$3,402.63
|
| Rate for Payer: Anthem Medicaid |
$1,519.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,446.82
|
| Rate for Payer: Cash Price |
$2,209.50
|
| Rate for Payer: Cigna Commercial |
$3,667.77
|
| Rate for Payer: First Health Commercial |
$4,198.05
|
| Rate for Payer: Humana Commercial |
$3,756.15
|
| Rate for Payer: Humana KY Medicaid |
$1,519.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,535.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,623.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,261.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,550.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,888.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,314.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.89
|
| Rate for Payer: PHCS Commercial |
$4,242.24
|
| Rate for Payer: United Healthcare All Payer |
$3,888.72
|
|
|
PLATE MEDIAL EPICONDYAL 10H
|
Facility
|
IP
|
$4,419.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.47 |
| Max. Negotiated Rate |
$4,242.24 |
| Rate for Payer: Aetna Commercial |
$3,402.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,446.82
|
| Rate for Payer: Cash Price |
$2,209.50
|
| Rate for Payer: Cigna Commercial |
$3,667.77
|
| Rate for Payer: First Health Commercial |
$4,198.05
|
| Rate for Payer: Humana Commercial |
$3,756.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,623.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,261.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,888.72
|
| Rate for Payer: Ohio Health Group HMO |
$3,314.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.89
|
| Rate for Payer: PHCS Commercial |
$4,242.24
|
| Rate for Payer: United Healthcare All Payer |
$3,888.72
|
|
|
PLATE MEDIAL EPICONDYAL LONG
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
|
|
PLATE MEDIAL EPICONDYAL LONG
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE MEDIAL EPICONDYAL MED
|
Facility
|
OP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem Medicaid |
$1,749.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Humana KY Medicaid |
$1,749.59
|
| Rate for Payer: Kentucky WC Medicaid |
$1,767.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,784.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE MEDIAL EPICONDYAL MED
|
Facility
|
IP
|
$5,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.38 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$3,917.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,968.25
|
| Rate for Payer: Cash Price |
$2,543.75
|
| Rate for Payer: Cigna Commercial |
$4,222.62
|
| Rate for Payer: First Health Commercial |
$4,833.12
|
| Rate for Payer: Humana Commercial |
$4,324.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,171.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,754.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,526.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,477.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,815.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,017.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$661.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,577.12
|
| Rate for Payer: PHCS Commercial |
$4,884.00
|
| Rate for Payer: United Healthcare All Payer |
$4,477.00
|
|
|
PLATE MEDIAL EPICONDYAL SM
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE MEDIAL EPICONDYAL SM
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE MEDIAL EPICONDYAL XLG
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE MEDIAL EPICONDYAL XLG
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE MEDIAL MALLEOLAR
|
Facility
|
OP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem Medicaid |
$1,171.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Humana KY Medicaid |
$1,171.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE MEDIAL MALLEOLAR
|
Facility
|
IP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE MEDIAL PILON 3H
|
Facility
|
OP
|
$3,420.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.68 |
| Max. Negotiated Rate |
$3,283.77 |
| Rate for Payer: Aetna Commercial |
$2,633.85
|
| Rate for Payer: Anthem Medicaid |
$1,176.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,668.06
|
| Rate for Payer: Cash Price |
$1,710.30
|
| Rate for Payer: Cigna Commercial |
$2,839.09
|
| Rate for Payer: First Health Commercial |
$3,249.56
|
| Rate for Payer: Humana Commercial |
$2,907.50
|
| Rate for Payer: Humana KY Medicaid |
$1,176.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,188.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,804.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,524.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,199.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,010.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,565.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$684.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,060.38
|
| Rate for Payer: PHCS Commercial |
$3,283.77
|
| Rate for Payer: United Healthcare All Payer |
$3,010.12
|
|
|
PLATE MEDIAL PILON 3H
|
Facility
|
IP
|
$3,420.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$444.68 |
| Max. Negotiated Rate |
$3,283.77 |
| Rate for Payer: Aetna Commercial |
$2,633.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,668.06
|
| Rate for Payer: Cash Price |
$1,710.30
|
| Rate for Payer: Cigna Commercial |
$2,839.09
|
| Rate for Payer: First Health Commercial |
$3,249.56
|
| Rate for Payer: Humana Commercial |
$2,907.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,804.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,524.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,026.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,010.12
|
| Rate for Payer: Ohio Health Group HMO |
$2,565.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$684.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$444.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,060.38
|
| Rate for Payer: PHCS Commercial |
$3,283.77
|
| Rate for Payer: United Healthcare All Payer |
$3,010.12
|
|
|
PLATE MEDIAL PILON 5H
|
Facility
|
OP
|
$2,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.79 |
| Max. Negotiated Rate |
$2,095.68 |
| Rate for Payer: Aetna Commercial |
$1,680.91
|
| Rate for Payer: Anthem Medicaid |
$750.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,702.74
|
| Rate for Payer: Cash Price |
$1,091.50
|
| Rate for Payer: Cigna Commercial |
$1,811.89
|
| Rate for Payer: First Health Commercial |
$2,073.85
|
| Rate for Payer: Humana Commercial |
$1,855.55
|
| Rate for Payer: Humana KY Medicaid |
$750.73
|
| Rate for Payer: Kentucky WC Medicaid |
$758.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$765.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,637.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.73
|
| Rate for Payer: PHCS Commercial |
$2,095.68
|
| Rate for Payer: United Healthcare All Payer |
$1,921.04
|
|
|
PLATE MEDIAL PILON 5H
|
Facility
|
IP
|
$2,183.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$283.79 |
| Max. Negotiated Rate |
$2,095.68 |
| Rate for Payer: Aetna Commercial |
$1,680.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,702.74
|
| Rate for Payer: Cash Price |
$1,091.50
|
| Rate for Payer: Cigna Commercial |
$1,811.89
|
| Rate for Payer: First Health Commercial |
$2,073.85
|
| Rate for Payer: Humana Commercial |
$1,855.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,790.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,611.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$654.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,921.04
|
| Rate for Payer: Ohio Health Group HMO |
$1,637.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$436.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$283.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$676.73
|
| Rate for Payer: PHCS Commercial |
$2,095.68
|
| Rate for Payer: United Healthcare All Payer |
$1,921.04
|
|
|
PLATE MEDIAL PILON 7H
|
Facility
|
OP
|
$3,610.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.36 |
| Max. Negotiated Rate |
$3,466.08 |
| Rate for Payer: Aetna Commercial |
$2,780.08
|
| Rate for Payer: Anthem Medicaid |
$1,241.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.19
|
| Rate for Payer: Cash Price |
$1,805.25
|
| Rate for Payer: Cigna Commercial |
$2,996.72
|
| Rate for Payer: First Health Commercial |
$3,429.98
|
| Rate for Payer: Humana Commercial |
$3,068.92
|
| Rate for Payer: Humana KY Medicaid |
$1,241.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,254.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,960.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,266.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,177.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,707.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$722.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,119.26
|
| Rate for Payer: PHCS Commercial |
$3,466.08
|
| Rate for Payer: United Healthcare All Payer |
$3,177.24
|
|
|
PLATE MEDIAL PILON 7H
|
Facility
|
IP
|
$3,610.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$469.36 |
| Max. Negotiated Rate |
$3,466.08 |
| Rate for Payer: Aetna Commercial |
$2,780.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,816.19
|
| Rate for Payer: Cash Price |
$1,805.25
|
| Rate for Payer: Cigna Commercial |
$2,996.72
|
| Rate for Payer: First Health Commercial |
$3,429.98
|
| Rate for Payer: Humana Commercial |
$3,068.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,960.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,664.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,083.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,177.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,707.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$722.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$469.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,119.26
|
| Rate for Payer: PHCS Commercial |
$3,466.08
|
| Rate for Payer: United Healthcare All Payer |
$3,177.24
|
|
|
PLATE MEDIAL PILON 9H
|
Facility
|
IP
|
$3,194.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.22 |
| Max. Negotiated Rate |
$3,066.24 |
| Rate for Payer: Aetna Commercial |
$2,459.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,491.32
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cigna Commercial |
$2,651.02
|
| Rate for Payer: First Health Commercial |
$3,034.30
|
| Rate for Payer: Humana Commercial |
$2,714.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,619.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,357.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,810.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,395.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$990.14
|
| Rate for Payer: PHCS Commercial |
$3,066.24
|
| Rate for Payer: United Healthcare All Payer |
$2,810.72
|
|
|
PLATE MEDIAL PILON 9H
|
Facility
|
OP
|
$3,194.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$415.22 |
| Max. Negotiated Rate |
$3,066.24 |
| Rate for Payer: Aetna Commercial |
$2,459.38
|
| Rate for Payer: Anthem Medicaid |
$1,098.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,491.32
|
| Rate for Payer: Cash Price |
$1,597.00
|
| Rate for Payer: Cigna Commercial |
$2,651.02
|
| Rate for Payer: First Health Commercial |
$3,034.30
|
| Rate for Payer: Humana Commercial |
$2,714.90
|
| Rate for Payer: Humana KY Medicaid |
$1,098.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,109.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,619.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,357.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$958.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,120.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,810.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,395.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$638.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$415.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$990.14
|
| Rate for Payer: PHCS Commercial |
$3,066.24
|
| Rate for Payer: United Healthcare All Payer |
$2,810.72
|
|
|
PLATE MEDL DIS TIB 3.5*246 14H
|
Facility
|
OP
|
$10,798.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.78 |
| Max. Negotiated Rate |
$10,366.37 |
| Rate for Payer: Anthem Medicaid |
$3,713.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,422.67
|
| Rate for Payer: Cash Price |
$5,399.15
|
| Rate for Payer: Cigna Commercial |
$8,962.59
|
| Rate for Payer: First Health Commercial |
$10,258.38
|
| Rate for Payer: Humana Commercial |
$9,178.56
|
| Rate for Payer: Humana KY Medicaid |
$3,713.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,751.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,854.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,969.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,239.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,788.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,502.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,098.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,159.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,347.47
|
| Rate for Payer: PHCS Commercial |
$10,366.37
|
| Rate for Payer: United Healthcare All Payer |
$9,502.50
|
| Rate for Payer: Aetna Commercial |
$8,314.69
|
|
|
PLATE MEDL DIS TIB 3.5*246 14H
|
Facility
|
IP
|
$10,798.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,403.78 |
| Max. Negotiated Rate |
$10,366.37 |
| Rate for Payer: Aetna Commercial |
$8,314.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,422.67
|
| Rate for Payer: Cash Price |
$5,399.15
|
| Rate for Payer: Cigna Commercial |
$8,962.59
|
| Rate for Payer: First Health Commercial |
$10,258.38
|
| Rate for Payer: Humana Commercial |
$9,178.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,854.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,969.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,239.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,502.50
|
| Rate for Payer: Ohio Health Group HMO |
$8,098.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,159.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,403.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,347.47
|
| Rate for Payer: PHCS Commercial |
$10,366.37
|
| Rate for Payer: United Healthcare All Payer |
$9,502.50
|
|
|
PLATE MED PROX TIB 10H R
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 10H R
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 12H L
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
