|
PLATE OLECRANON 3H R
|
Facility
|
OP
|
$6,575.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$854.75 |
| Max. Negotiated Rate |
$6,312.01 |
| Rate for Payer: Anthem Medicaid |
$2,261.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,128.51
|
| Rate for Payer: Cash Price |
$3,287.51
|
| Rate for Payer: Cigna Commercial |
$5,457.26
|
| Rate for Payer: First Health Commercial |
$6,246.26
|
| Rate for Payer: Humana Commercial |
$5,588.76
|
| Rate for Payer: Humana KY Medicaid |
$2,261.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,284.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,391.51
|
| Rate for Payer: Aetna Commercial |
$5,062.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,852.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,972.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,306.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,786.01
|
| Rate for Payer: Ohio Health Group HMO |
$4,931.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,315.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,038.25
|
| Rate for Payer: PHCS Commercial |
$6,312.01
|
| Rate for Payer: United Healthcare All Payer |
$5,786.01
|
|
|
PLATE OLECRANON 3H R
|
Facility
|
IP
|
$6,575.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$854.75 |
| Max. Negotiated Rate |
$6,312.01 |
| Rate for Payer: Aetna Commercial |
$5,062.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,128.51
|
| Rate for Payer: Cash Price |
$3,287.51
|
| Rate for Payer: Cigna Commercial |
$5,457.26
|
| Rate for Payer: First Health Commercial |
$6,246.26
|
| Rate for Payer: Humana Commercial |
$5,588.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,391.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,852.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,972.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,786.01
|
| Rate for Payer: Ohio Health Group HMO |
$4,931.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,315.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$854.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,038.25
|
| Rate for Payer: PHCS Commercial |
$6,312.01
|
| Rate for Payer: United Healthcare All Payer |
$5,786.01
|
|
|
PLATE OLECRANON 4H R
|
Facility
|
OP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem Medicaid |
$2,535.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Humana KY Medicaid |
$2,535.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,561.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,586.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE OLECRANON 4H R
|
Facility
|
IP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE OLECRANON 7H 110MM L
|
Facility
|
OP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem Medicaid |
$2,306.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Humana KY Medicaid |
$2,306.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
PLATE OLECRANON 7H 110MM L
|
Facility
|
IP
|
$6,705.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$871.72 |
| Max. Negotiated Rate |
$6,437.28 |
| Rate for Payer: Aetna Commercial |
$5,163.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,230.29
|
| Rate for Payer: Cash Price |
$3,352.75
|
| Rate for Payer: Cigna Commercial |
$5,565.56
|
| Rate for Payer: First Health Commercial |
$6,370.22
|
| Rate for Payer: Humana Commercial |
$5,699.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,498.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,948.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,011.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,900.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,029.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,341.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$871.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,078.70
|
| Rate for Payer: PHCS Commercial |
$6,437.28
|
| Rate for Payer: United Healthcare All Payer |
$5,900.84
|
|
|
PLATE OLECRANON 8H LEFT
|
Facility
|
OP
|
$12,001.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.21 |
| Max. Negotiated Rate |
$11,521.54 |
| Rate for Payer: Aetna Commercial |
$9,241.23
|
| Rate for Payer: Anthem Medicaid |
$4,127.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,361.25
|
| Rate for Payer: Cash Price |
$6,000.80
|
| Rate for Payer: Cigna Commercial |
$9,961.33
|
| Rate for Payer: First Health Commercial |
$11,401.52
|
| Rate for Payer: Humana Commercial |
$10,201.36
|
| Rate for Payer: Humana KY Medicaid |
$4,127.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,169.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,841.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,210.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,561.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,001.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.50
|
| Rate for Payer: PHCS Commercial |
$11,521.54
|
| Rate for Payer: United Healthcare All Payer |
$10,561.41
|
|
|
PLATE OLECRANON 8H LEFT
|
Facility
|
IP
|
$12,001.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.21 |
| Max. Negotiated Rate |
$11,521.54 |
| Rate for Payer: Aetna Commercial |
$9,241.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,361.25
|
| Rate for Payer: Cash Price |
$6,000.80
|
| Rate for Payer: Cigna Commercial |
$9,961.33
|
| Rate for Payer: First Health Commercial |
$11,401.52
|
| Rate for Payer: Humana Commercial |
$10,201.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,841.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,561.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,001.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.50
|
| Rate for Payer: PHCS Commercial |
$11,521.54
|
| Rate for Payer: United Healthcare All Payer |
$10,561.41
|
|
|
PLATE OLECRANON 9H LOCKING
|
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 OLECRANON 9H LOCKING
|
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 OLECRANON EXTENDED 5H L
|
Facility
|
IP
|
$15,262.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.16 |
| Max. Negotiated Rate |
$14,652.29 |
| Rate for Payer: Aetna Commercial |
$11,752.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,904.98
|
| Rate for Payer: Cash Price |
$7,631.40
|
| Rate for Payer: Cigna Commercial |
$12,668.12
|
| Rate for Payer: First Health Commercial |
$14,499.66
|
| Rate for Payer: Humana Commercial |
$12,973.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,515.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,263.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,578.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,431.26
|
| Rate for Payer: Ohio Health Group HMO |
$11,447.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,052.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,984.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,731.47
|
| Rate for Payer: PHCS Commercial |
$14,652.29
|
| Rate for Payer: United Healthcare All Payer |
$13,431.26
|
|
|
PLATE OLECRANON EXTENDED 5H L
|
Facility
|
OP
|
$15,262.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,984.16 |
| Max. Negotiated Rate |
$14,652.29 |
| Rate for Payer: Aetna Commercial |
$11,752.36
|
| Rate for Payer: Anthem Medicaid |
$5,248.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,904.98
|
| Rate for Payer: Cash Price |
$7,631.40
|
| Rate for Payer: Cigna Commercial |
$12,668.12
|
| Rate for Payer: First Health Commercial |
$14,499.66
|
| Rate for Payer: Humana Commercial |
$12,973.38
|
| Rate for Payer: Humana KY Medicaid |
$5,248.88
|
| Rate for Payer: Kentucky WC Medicaid |
$5,302.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,515.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,263.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,578.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,354.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,431.26
|
| Rate for Payer: Ohio Health Group HMO |
$11,447.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,052.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,984.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,731.47
|
| Rate for Payer: PHCS Commercial |
$14,652.29
|
| Rate for Payer: United Healthcare All Payer |
$13,431.26
|
|
|
PLATE OLECRANON EXTENDED 5H R
|
Facility
|
OP
|
$13,782.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,791.76 |
| Max. Negotiated Rate |
$13,231.49 |
| Rate for Payer: Aetna Commercial |
$10,612.76
|
| Rate for Payer: Anthem Medicaid |
$4,739.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,750.58
|
| Rate for Payer: Cash Price |
$6,891.40
|
| Rate for Payer: Cigna Commercial |
$11,439.72
|
| Rate for Payer: First Health Commercial |
$13,093.66
|
| Rate for Payer: Humana Commercial |
$11,715.38
|
| Rate for Payer: Humana KY Medicaid |
$4,739.90
|
| Rate for Payer: Kentucky WC Medicaid |
$4,788.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,301.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,171.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,134.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,835.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,128.86
|
| Rate for Payer: Ohio Health Group HMO |
$10,337.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,756.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,791.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,272.67
|
| Rate for Payer: PHCS Commercial |
$13,231.49
|
| Rate for Payer: United Healthcare All Payer |
$12,128.86
|
|
|
PLATE OLECRANON EXTENDED 5H R
|
Facility
|
IP
|
$13,782.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,791.76 |
| Max. Negotiated Rate |
$13,231.49 |
| Rate for Payer: Aetna Commercial |
$10,612.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,750.58
|
| Rate for Payer: Cash Price |
$6,891.40
|
| Rate for Payer: Cigna Commercial |
$11,439.72
|
| Rate for Payer: First Health Commercial |
$13,093.66
|
| Rate for Payer: Humana Commercial |
$11,715.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,301.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,171.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,134.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,128.86
|
| Rate for Payer: Ohio Health Group HMO |
$10,337.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,756.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,791.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,272.67
|
| Rate for Payer: PHCS Commercial |
$13,231.49
|
| Rate for Payer: United Healthcare All Payer |
$12,128.86
|
|
|
PLATE OLECRANON EXT LOCK 13H
|
Facility
|
OP
|
$5,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$677.30 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem Medicaid |
$1,791.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Humana KY Medicaid |
$1,791.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,809.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,827.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.10
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
|
|
PLATE OLECRANON EXT LOCK 13H
|
Facility
|
IP
|
$5,210.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$677.30 |
| Max. Negotiated Rate |
$5,001.60 |
| Rate for Payer: Aetna Commercial |
$4,011.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,063.80
|
| Rate for Payer: Cash Price |
$2,605.00
|
| Rate for Payer: Cigna Commercial |
$4,324.30
|
| Rate for Payer: First Health Commercial |
$4,949.50
|
| Rate for Payer: Humana Commercial |
$4,428.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,272.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,844.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,563.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,584.80
|
| Rate for Payer: Ohio Health Group HMO |
$3,907.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,042.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$677.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,615.10
|
| Rate for Payer: PHCS Commercial |
$5,001.60
|
| Rate for Payer: United Healthcare All Payer |
$4,584.80
|
|
|
PLATE OLECRANON LARGE
|
Facility
|
OP
|
$5,329.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.77 |
| Max. Negotiated Rate |
$5,115.84 |
| Rate for Payer: Aetna Commercial |
$4,103.33
|
| Rate for Payer: Anthem Medicaid |
$1,832.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,156.62
|
| Rate for Payer: Cash Price |
$2,664.50
|
| Rate for Payer: Cigna Commercial |
$4,423.07
|
| Rate for Payer: First Health Commercial |
$5,062.55
|
| Rate for Payer: Humana Commercial |
$4,529.65
|
| Rate for Payer: Humana KY Medicaid |
$1,832.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,851.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,369.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,598.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,869.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,689.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,996.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.99
|
| Rate for Payer: PHCS Commercial |
$5,115.84
|
| Rate for Payer: United Healthcare All Payer |
$4,689.52
|
|
|
PLATE OLECRANON LARGE
|
Facility
|
IP
|
$5,329.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.77 |
| Max. Negotiated Rate |
$5,115.84 |
| Rate for Payer: Aetna Commercial |
$4,103.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,156.62
|
| Rate for Payer: Cash Price |
$2,664.50
|
| Rate for Payer: Cigna Commercial |
$4,423.07
|
| Rate for Payer: First Health Commercial |
$5,062.55
|
| Rate for Payer: Humana Commercial |
$4,529.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,369.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,932.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,598.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,689.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,996.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,065.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$692.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,651.99
|
| Rate for Payer: PHCS Commercial |
$5,115.84
|
| Rate for Payer: United Healthcare All Payer |
$4,689.52
|
|
|
PLATE OLECRANON LCK 12H 157M L
|
Facility
|
IP
|
$7,234.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.52 |
| Max. Negotiated Rate |
$6,945.36 |
| Rate for Payer: Aetna Commercial |
$5,570.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,643.10
|
| Rate for Payer: Cash Price |
$3,617.38
|
| Rate for Payer: Cigna Commercial |
$6,004.84
|
| Rate for Payer: First Health Commercial |
$6,873.01
|
| Rate for Payer: Humana Commercial |
$6,149.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,932.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,339.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,366.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,426.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,446.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$940.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,242.77
|
| Rate for Payer: PHCS Commercial |
$6,945.36
|
| Rate for Payer: United Healthcare All Payer |
$6,366.58
|
|
|
PLATE OLECRANON LCK 12H 157M L
|
Facility
|
OP
|
$7,234.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$940.52 |
| Max. Negotiated Rate |
$6,945.36 |
| Rate for Payer: Aetna Commercial |
$5,570.76
|
| Rate for Payer: Anthem Medicaid |
$2,488.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,643.10
|
| Rate for Payer: Cash Price |
$3,617.38
|
| Rate for Payer: Cigna Commercial |
$6,004.84
|
| Rate for Payer: First Health Commercial |
$6,873.01
|
| Rate for Payer: Humana Commercial |
$6,149.54
|
| Rate for Payer: Humana KY Medicaid |
$2,488.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,513.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,932.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,339.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,170.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,537.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,366.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,426.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,446.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$940.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,242.77
|
| Rate for Payer: PHCS Commercial |
$6,945.36
|
| Rate for Payer: United Healthcare All Payer |
$6,366.58
|
|
|
PLATE OLECRANON LCK 4 56M R
|
Facility
|
OP
|
$7,101.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.17 |
| Max. Negotiated Rate |
$6,817.29 |
| Rate for Payer: Anthem Medicaid |
$2,442.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,539.05
|
| Rate for Payer: Cash Price |
$3,550.67
|
| Rate for Payer: Cigna Commercial |
$5,894.11
|
| Rate for Payer: First Health Commercial |
$6,746.27
|
| Rate for Payer: Humana Commercial |
$6,036.14
|
| Rate for Payer: Humana KY Medicaid |
$2,442.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,823.10
|
| Rate for Payer: Aetna Commercial |
$5,468.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,240.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,130.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,491.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,249.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,326.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.42
|
| Rate for Payer: PHCS Commercial |
$6,817.29
|
| Rate for Payer: United Healthcare All Payer |
$6,249.18
|
|
|
PLATE OLECRANON LCK 4 56M R
|
Facility
|
IP
|
$7,101.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.17 |
| Max. Negotiated Rate |
$6,817.29 |
| Rate for Payer: Aetna Commercial |
$5,468.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,539.05
|
| Rate for Payer: Cash Price |
$3,550.67
|
| Rate for Payer: Cigna Commercial |
$5,894.11
|
| Rate for Payer: First Health Commercial |
$6,746.27
|
| Rate for Payer: Humana Commercial |
$6,036.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,823.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,240.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,130.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,249.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,326.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,420.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$923.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,201.42
|
| Rate for Payer: PHCS Commercial |
$6,817.29
|
| Rate for Payer: United Healthcare All Payer |
$6,249.18
|
|
|
PLATE OLECRANON LCK 8H 107M L
|
Facility
|
OP
|
$7,857.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.49 |
| Max. Negotiated Rate |
$7,543.32 |
| Rate for Payer: Aetna Commercial |
$6,050.37
|
| Rate for Payer: Anthem Medicaid |
$2,702.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,128.94
|
| Rate for Payer: Cash Price |
$3,928.81
|
| Rate for Payer: Cigna Commercial |
$6,521.82
|
| Rate for Payer: First Health Commercial |
$7,464.74
|
| Rate for Payer: Humana Commercial |
$6,678.98
|
| Rate for Payer: Humana KY Medicaid |
$2,702.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,729.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,798.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,914.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.86
|
| Rate for Payer: PHCS Commercial |
$7,543.32
|
| Rate for Payer: United Healthcare All Payer |
$6,914.71
|
|
|
PLATE OLECRANON LCK 8H 107M L
|
Facility
|
IP
|
$7,857.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.49 |
| Max. Negotiated Rate |
$7,543.32 |
| Rate for Payer: Aetna Commercial |
$6,050.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,128.94
|
| Rate for Payer: Cash Price |
$3,928.81
|
| Rate for Payer: Cigna Commercial |
$6,521.82
|
| Rate for Payer: First Health Commercial |
$7,464.74
|
| Rate for Payer: Humana Commercial |
$6,678.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,798.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,914.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.86
|
| Rate for Payer: PHCS Commercial |
$7,543.32
|
| Rate for Payer: United Healthcare All Payer |
$6,914.71
|
|
|
PLATE OLECRANON LK 10 132MM L
|
Facility
|
OP
|
$8,033.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.31 |
| Max. Negotiated Rate |
$7,711.86 |
| Rate for Payer: Aetna Commercial |
$6,185.56
|
| Rate for Payer: Anthem Medicaid |
$2,762.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,265.89
|
| Rate for Payer: Cash Price |
$4,016.59
|
| Rate for Payer: Cigna Commercial |
$6,667.55
|
| Rate for Payer: First Health Commercial |
$7,631.53
|
| Rate for Payer: Humana Commercial |
$6,828.21
|
| Rate for Payer: Humana KY Medicaid |
$2,762.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,790.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,587.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,928.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,409.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,818.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,069.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,024.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,606.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,044.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,490.29
|
| Rate for Payer: PHCS Commercial |
$7,711.86
|
| Rate for Payer: United Healthcare All Payer |
$7,069.21
|
|
