|
PLATE LATERAL FIBULA 6H L
|
Facility
|
IP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE LATERAL FIBULA 6H L
|
Facility
|
OP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem Medicaid |
$1,660.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Humana KY Medicaid |
$1,660.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,677.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,693.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE LATERAL FIBULA 6H R
|
Facility
|
IP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE LATERAL FIBULA 6H R
|
Facility
|
OP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem Medicaid |
$1,660.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Humana KY Medicaid |
$1,660.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,677.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,693.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE LATERAL FIBULA 7H L
|
Facility
|
IP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE LATERAL FIBULA 7H L
|
Facility
|
OP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem Medicaid |
$1,676.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Humana KY Medicaid |
$1,676.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,710.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE LATERAL FIBULA 7H R
|
Facility
|
IP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE LATERAL FIBULA 7H R
|
Facility
|
OP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem Medicaid |
$1,676.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Humana KY Medicaid |
$1,676.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,710.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE LATERAL FIBULA 9H L
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE LATERAL FIBULA 9H L
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE LATERAL FIBULA 9H R
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE LATERAL FIBULA 9H R
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE LATERAL FIBULA RT 77MM
|
Facility
|
OP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem Medicaid |
$2,537.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Humana KY Medicaid |
$2,537.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,563.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,588.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
PLATE LATERAL FIBULA RT 77MM
|
Facility
|
IP
|
$7,380.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,214.00 |
| Max. Negotiated Rate |
$7,084.80 |
| Rate for Payer: Aetna Commercial |
$5,682.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,756.40
|
| Rate for Payer: Cash Price |
$3,690.00
|
| Rate for Payer: Cigna Commercial |
$6,125.40
|
| Rate for Payer: First Health Commercial |
$7,011.00
|
| Rate for Payer: Humana Commercial |
$6,273.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,051.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,446.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,494.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,535.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,904.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,420.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,092.20
|
| Rate for Payer: PHCS Commercial |
$7,084.80
|
| Rate for Payer: United Healthcare All Payer |
$6,494.40
|
|
|
PLATE LATL TTC 4.5MM 120MM L
|
Facility
|
IP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE LATL TTC 4.5MM 120MM L
|
Facility
|
OP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem Medicaid |
$2,465.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Humana KY Medicaid |
$2,465.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,490.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,514.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE LATL TTC 4.5MM 120MM R
|
Facility
|
IP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE LATL TTC 4.5MM 120MM R
|
Facility
|
OP
|
$7,168.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.66 |
| Max. Negotiated Rate |
$6,882.10 |
| Rate for Payer: Aetna Commercial |
$5,520.01
|
| Rate for Payer: Anthem Medicaid |
$2,465.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,591.70
|
| Rate for Payer: Cash Price |
$3,584.42
|
| Rate for Payer: Cigna Commercial |
$5,950.15
|
| Rate for Payer: First Health Commercial |
$6,810.41
|
| Rate for Payer: Humana Commercial |
$6,093.52
|
| Rate for Payer: Humana KY Medicaid |
$2,465.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,490.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,878.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,290.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,150.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,514.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,308.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,376.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,735.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,236.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,946.51
|
| Rate for Payer: PHCS Commercial |
$6,882.10
|
| Rate for Payer: United Healthcare All Payer |
$6,308.59
|
|
|
PLATE L-BUTTRESS 4 HOLE
|
Facility
|
OP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem Medicaid |
$630.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Humana KY Medicaid |
$630.02
|
| Rate for Payer: Kentucky WC Medicaid |
$636.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$642.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
PLATE L-BUTTRESS 4 HOLE
|
Facility
|
IP
|
$1,832.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$549.60 |
| Max. Negotiated Rate |
$1,758.72 |
| Rate for Payer: Aetna Commercial |
$1,410.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,428.96
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cigna Commercial |
$1,520.56
|
| Rate for Payer: First Health Commercial |
$1,740.40
|
| Rate for Payer: Humana Commercial |
$1,557.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,502.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,352.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$549.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,374.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,465.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,593.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,264.08
|
| Rate for Payer: PHCS Commercial |
$1,758.72
|
| Rate for Payer: United Healthcare All Payer |
$1,612.16
|
|
|
PLATE L-BUTTRESS W/PF LT
|
Facility
|
OP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem Medicaid |
$1,200.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Humana KY Medicaid |
$1,200.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,212.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,224.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE L-BUTTRESS W/PF LT
|
Facility
|
IP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE L-BUTTRESS W/PF RT
|
Facility
|
IP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE L-BUTTRESS W/PF RT
|
Facility
|
OP
|
$3,491.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,047.41 |
| Max. Negotiated Rate |
$3,351.72 |
| Rate for Payer: Aetna Commercial |
$2,688.36
|
| Rate for Payer: Anthem Medicaid |
$1,200.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,723.28
|
| Rate for Payer: Cash Price |
$1,745.69
|
| Rate for Payer: Cigna Commercial |
$2,897.85
|
| Rate for Payer: First Health Commercial |
$3,316.81
|
| Rate for Payer: Humana Commercial |
$2,967.67
|
| Rate for Payer: Humana KY Medicaid |
$1,200.69
|
| Rate for Payer: Kentucky WC Medicaid |
$1,212.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,862.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,576.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,047.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,224.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,072.41
|
| Rate for Payer: Ohio Health Group HMO |
$2,618.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,793.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,037.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,409.05
|
| Rate for Payer: PHCS Commercial |
$3,351.72
|
| Rate for Payer: United Healthcare All Payer |
$3,072.41
|
|
|
PLATE LCK 1/3 TUB 4H L50MM
|
Facility
|
IP
|
$2,129.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.98 |
| Max. Negotiated Rate |
$2,044.72 |
| Rate for Payer: Aetna Commercial |
$1,640.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,661.34
|
| Rate for Payer: Cash Price |
$1,064.96
|
| Rate for Payer: Cigna Commercial |
$1,767.83
|
| Rate for Payer: First Health Commercial |
$2,023.42
|
| Rate for Payer: Humana Commercial |
$1,810.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,746.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,571.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$638.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,874.33
|
| Rate for Payer: Ohio Health Group HMO |
$1,597.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,703.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,853.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,469.64
|
| Rate for Payer: PHCS Commercial |
$2,044.72
|
| Rate for Payer: United Healthcare All Payer |
$1,874.33
|
|
