|
PLATE OLECRANON LK 10 132MM L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE OLECRANON LK 10 132MM R
|
Facility
|
IP
|
$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: 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: Medical Mutual Of Ohio HMO |
$6,587.22
|
| Rate for Payer: Aetna Commercial |
$6,185.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,265.89
|
| 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: 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
|
|
|
PLATE OLECRANON LK 10 132MM R
|
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
|
|
|
PLATE OLECRANON LK 12 157MM L
|
Facility
|
OP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Anthem Medicaid |
$2,785.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Humana KY Medicaid |
$2,785.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,814.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE OLECRANON LK 12 157MM L
|
Facility
|
IP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE OLECRANON LK 12 157MM R
|
Facility
|
OP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Anthem Medicaid |
$2,785.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Humana KY Medicaid |
$2,785.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,814.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE OLECRANON LK 12 157MM R
|
Facility
|
IP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE OLECRANON LK 12H 157MM L
|
Facility
|
OP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Anthem Medicaid |
$2,785.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Humana KY Medicaid |
$2,785.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,814.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,841.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE OLECRANON LK 12H 157MM L
|
Facility
|
IP
|
$8,100.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.09 |
| Max. Negotiated Rate |
$7,776.68 |
| Rate for Payer: Aetna Commercial |
$6,237.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,318.55
|
| Rate for Payer: Cash Price |
$4,050.36
|
| Rate for Payer: Cigna Commercial |
$6,723.59
|
| Rate for Payer: First Health Commercial |
$7,695.67
|
| Rate for Payer: Humana Commercial |
$6,885.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,642.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,978.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,430.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,128.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,075.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,053.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,511.22
|
| Rate for Payer: PHCS Commercial |
$7,776.68
|
| Rate for Payer: United Healthcare All Payer |
$7,128.62
|
|
|
PLATE OLECRANON LK 4 56MM L
|
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: Aetna Commercial |
$5,468.03
|
| 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: 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 LK 4 56MM L
|
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 LK 4H 56MM L
|
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 LK 4H 56MM L
|
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: Aetna Commercial |
$5,468.03
|
| 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: 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 LK 6 81MM L
|
Facility
|
OP
|
$7,857.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.54 |
| Max. Negotiated Rate |
$7,543.67 |
| Rate for Payer: Aetna Commercial |
$6,050.65
|
| Rate for Payer: Anthem Medicaid |
$2,702.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.23
|
| Rate for Payer: Cash Price |
$3,928.99
|
| Rate for Payer: Cigna Commercial |
$6,522.13
|
| Rate for Payer: First Health Commercial |
$7,465.09
|
| Rate for Payer: Humana Commercial |
$6,679.29
|
| Rate for Payer: Humana KY Medicaid |
$2,702.36
|
| Rate for Payer: Kentucky WC Medicaid |
$2,729.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,756.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.98
|
| Rate for Payer: PHCS Commercial |
$7,543.67
|
| Rate for Payer: United Healthcare All Payer |
$6,915.03
|
|
|
PLATE OLECRANON LK 6 81MM L
|
Facility
|
IP
|
$7,857.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,021.54 |
| Max. Negotiated Rate |
$7,543.67 |
| Rate for Payer: Aetna Commercial |
$6,050.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,129.23
|
| Rate for Payer: Cash Price |
$3,928.99
|
| Rate for Payer: Cigna Commercial |
$6,522.13
|
| Rate for Payer: First Health Commercial |
$7,465.09
|
| Rate for Payer: Humana Commercial |
$6,679.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,443.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,799.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,357.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,915.03
|
| Rate for Payer: Ohio Health Group HMO |
$5,893.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,571.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,021.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,435.98
|
| Rate for Payer: PHCS Commercial |
$7,543.67
|
| Rate for Payer: United Healthcare All Payer |
$6,915.03
|
|
|
PLATE OLECRANON LK 6 81MM R
|
Facility
|
IP
|
$7,492.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.09 |
| Max. Negotiated Rate |
$7,193.27 |
| Rate for Payer: Aetna Commercial |
$5,769.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.53
|
| Rate for Payer: Cash Price |
$3,746.49
|
| Rate for Payer: Cigna Commercial |
$6,219.18
|
| Rate for Payer: First Health Commercial |
$7,118.34
|
| Rate for Payer: Humana Commercial |
$6,369.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.83
|
| Rate for Payer: PHCS Commercial |
$7,193.27
|
| Rate for Payer: United Healthcare All Payer |
$6,593.83
|
|
|
PLATE OLECRANON LK 6 81MM R
|
Facility
|
OP
|
$7,492.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.09 |
| Max. Negotiated Rate |
$7,193.27 |
| Rate for Payer: Anthem Medicaid |
$2,576.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.53
|
| Rate for Payer: Cash Price |
$3,746.49
|
| Rate for Payer: Cigna Commercial |
$6,219.18
|
| Rate for Payer: First Health Commercial |
$7,118.34
|
| Rate for Payer: Humana Commercial |
$6,369.04
|
| Rate for Payer: Humana KY Medicaid |
$2,576.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,603.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.25
|
| Rate for Payer: Aetna Commercial |
$5,769.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.83
|
| Rate for Payer: PHCS Commercial |
$7,193.27
|
| Rate for Payer: United Healthcare All Payer |
$6,593.83
|
|
|
PLATE OLECRANON LK 6H 81MM L
|
Facility
|
IP
|
$7,492.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.09 |
| Max. Negotiated Rate |
$7,193.27 |
| Rate for Payer: Aetna Commercial |
$5,769.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.53
|
| Rate for Payer: Cash Price |
$3,746.49
|
| Rate for Payer: Cigna Commercial |
$6,219.18
|
| Rate for Payer: First Health Commercial |
$7,118.34
|
| Rate for Payer: Humana Commercial |
$6,369.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.83
|
| Rate for Payer: PHCS Commercial |
$7,193.27
|
| Rate for Payer: United Healthcare All Payer |
$6,593.83
|
|
|
PLATE OLECRANON LK 6H 81MM L
|
Facility
|
OP
|
$7,492.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$974.09 |
| Max. Negotiated Rate |
$7,193.27 |
| Rate for Payer: Aetna Commercial |
$5,769.60
|
| Rate for Payer: Anthem Medicaid |
$2,576.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,844.53
|
| Rate for Payer: Cash Price |
$3,746.49
|
| Rate for Payer: Cigna Commercial |
$6,219.18
|
| Rate for Payer: First Health Commercial |
$7,118.34
|
| Rate for Payer: Humana Commercial |
$6,369.04
|
| Rate for Payer: Humana KY Medicaid |
$2,576.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,603.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,144.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,529.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,247.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,628.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,593.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,619.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,498.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$974.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,322.83
|
| Rate for Payer: PHCS Commercial |
$7,193.27
|
| Rate for Payer: United Healthcare All Payer |
$6,593.83
|
|
|
PLATE OLECRANON LK 8 107MM 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 8 107MM 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 LK 8 107MM R
|
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 LK 8 107MM R
|
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 MEDIUM
|
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 OLECRANON MEDIUM
|
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
|
|
