|
PLATE PROX RADIUS LARGE
|
Facility
|
IP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
|
PLATE PROX RADIUS SMALL
|
Facility
|
OP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem Medicaid |
$1,771.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Humana KY Medicaid |
$1,771.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
|
PLATE PROX RADIUS SMALL
|
Facility
|
IP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
|
PLATE PROX TIB 3.5 6H 107MM R
|
Facility
|
OP
|
$8,821.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.81 |
| Max. Negotiated Rate |
$8,468.73 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.84
|
| Rate for Payer: Cash Price |
$4,410.79
|
| Rate for Payer: Cigna Commercial |
$7,321.92
|
| Rate for Payer: First Health Commercial |
$8,380.51
|
| Rate for Payer: Humana Commercial |
$7,498.35
|
| Rate for Payer: Humana KY Medicaid |
$3,033.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,064.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,094.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.69
|
| Rate for Payer: PHCS Commercial |
$8,468.73
|
| Rate for Payer: United Healthcare All Payer |
$7,763.00
|
| Rate for Payer: Aetna Commercial |
$6,792.62
|
| Rate for Payer: Anthem Medicaid |
$3,033.74
|
|
|
PLATE PROX TIB 3.5 6H 107MM R
|
Facility
|
IP
|
$8,821.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,146.81 |
| Max. Negotiated Rate |
$8,468.73 |
| Rate for Payer: Aetna Commercial |
$6,792.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,880.84
|
| Rate for Payer: Cash Price |
$4,410.79
|
| Rate for Payer: Cigna Commercial |
$7,321.92
|
| Rate for Payer: First Health Commercial |
$8,380.51
|
| Rate for Payer: Humana Commercial |
$7,498.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,233.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,510.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,646.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,763.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,616.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,764.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,146.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,734.69
|
| Rate for Payer: PHCS Commercial |
$8,468.73
|
| Rate for Payer: United Healthcare All Payer |
$7,763.00
|
|
|
PLATE PROX TIBIAL LOCKNG 10H L
|
Facility
|
IP
|
$8,272.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.41 |
| Max. Negotiated Rate |
$7,941.48 |
| Rate for Payer: Aetna Commercial |
$6,369.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,452.45
|
| Rate for Payer: Cash Price |
$4,136.19
|
| Rate for Payer: Cigna Commercial |
$6,866.07
|
| Rate for Payer: First Health Commercial |
$7,858.75
|
| Rate for Payer: Humana Commercial |
$7,031.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,783.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,105.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,279.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,204.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.43
|
| Rate for Payer: PHCS Commercial |
$7,941.48
|
| Rate for Payer: United Healthcare All Payer |
$7,279.69
|
|
|
PLATE PROX TIBIAL LOCKNG 10H L
|
Facility
|
OP
|
$8,272.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,075.41 |
| Max. Negotiated Rate |
$7,941.48 |
| Rate for Payer: Aetna Commercial |
$6,369.72
|
| Rate for Payer: Anthem Medicaid |
$2,844.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,452.45
|
| Rate for Payer: Cash Price |
$4,136.19
|
| Rate for Payer: Cigna Commercial |
$6,866.07
|
| Rate for Payer: First Health Commercial |
$7,858.75
|
| Rate for Payer: Humana Commercial |
$7,031.51
|
| Rate for Payer: Humana KY Medicaid |
$2,844.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,873.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,783.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,105.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,481.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,901.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,279.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,204.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,654.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,075.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,564.43
|
| Rate for Payer: PHCS Commercial |
$7,941.48
|
| Rate for Payer: United Healthcare All Payer |
$7,279.69
|
|
|
PLATE PROX TIBIAL LOCKNG 10H R
|
Facility
|
IP
|
$6,903.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.52 |
| Max. Negotiated Rate |
$6,627.83 |
| Rate for Payer: Aetna Commercial |
$5,316.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,385.11
|
| Rate for Payer: Cash Price |
$3,451.99
|
| Rate for Payer: Cigna Commercial |
$5,730.31
|
| Rate for Payer: First Health Commercial |
$6,558.79
|
| Rate for Payer: Humana Commercial |
$5,868.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,661.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,095.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,075.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,177.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.24
|
| Rate for Payer: PHCS Commercial |
$6,627.83
|
| Rate for Payer: United Healthcare All Payer |
$6,075.51
|
|
|
PLATE PROX TIBIAL LOCKNG 10H R
|
Facility
|
OP
|
$6,903.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$897.52 |
| Max. Negotiated Rate |
$6,627.83 |
| Rate for Payer: Aetna Commercial |
$5,316.07
|
| Rate for Payer: Anthem Medicaid |
$2,374.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,385.11
|
| Rate for Payer: Cash Price |
$3,451.99
|
| Rate for Payer: Cigna Commercial |
$5,730.31
|
| Rate for Payer: First Health Commercial |
$6,558.79
|
| Rate for Payer: Humana Commercial |
$5,868.39
|
| Rate for Payer: Humana KY Medicaid |
$2,374.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,661.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,095.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,421.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,075.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,177.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,380.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$897.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,140.24
|
| Rate for Payer: PHCS Commercial |
$6,627.83
|
| Rate for Payer: United Healthcare All Payer |
$6,075.51
|
|
|
PLATE PROX TIBIAL LOCKNG 12H L
|
Facility
|
IP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
|
|
PLATE PROX TIBIAL LOCKNG 12H L
|
Facility
|
OP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem Medicaid |
$2,405.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Humana KY Medicaid |
$2,405.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
|
|
PLATE PROX TIBIAL LOCKNG 12H R
|
Facility
|
IP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
|
|
PLATE PROX TIBIAL LOCKNG 12H R
|
Facility
|
OP
|
$6,995.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$909.43 |
| Max. Negotiated Rate |
$6,715.78 |
| Rate for Payer: Aetna Commercial |
$5,386.61
|
| Rate for Payer: Anthem Medicaid |
$2,405.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,456.57
|
| Rate for Payer: Cash Price |
$3,497.80
|
| Rate for Payer: Cigna Commercial |
$5,806.35
|
| Rate for Payer: First Health Commercial |
$6,645.82
|
| Rate for Payer: Humana Commercial |
$5,946.26
|
| Rate for Payer: Humana KY Medicaid |
$2,405.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,430.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,736.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,162.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,098.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,454.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,156.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,246.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,399.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$909.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,168.64
|
| Rate for Payer: PHCS Commercial |
$6,715.78
|
| Rate for Payer: United Healthcare All Payer |
$6,156.13
|
|
|
PLATE PROX TIBIAL LOCKNG 14H L
|
Facility
|
OP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem Medicaid |
$2,422.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Humana KY Medicaid |
$2,422.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE PROX TIBIAL LOCKNG 14H L
|
Facility
|
IP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE PROX TIBIAL LOCKNG 14H R
|
Facility
|
OP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem Medicaid |
$2,422.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Humana KY Medicaid |
$2,422.13
|
| Rate for Payer: Kentucky WC Medicaid |
$2,446.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,470.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE PROX TIBIAL LOCKNG 14H R
|
Facility
|
IP
|
$7,043.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$915.61 |
| Max. Negotiated Rate |
$6,761.40 |
| Rate for Payer: Aetna Commercial |
$5,423.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,493.63
|
| Rate for Payer: Cash Price |
$3,521.56
|
| Rate for Payer: Cigna Commercial |
$5,845.79
|
| Rate for Payer: First Health Commercial |
$6,690.96
|
| Rate for Payer: Humana Commercial |
$5,986.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,775.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,197.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,112.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,197.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,282.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,408.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$915.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,183.37
|
| Rate for Payer: PHCS Commercial |
$6,761.40
|
| Rate for Payer: United Healthcare All Payer |
$6,197.95
|
|
|
PLATE PROX TIBIAL LOCKNG 4H LT
|
Facility
|
IP
|
$6,805.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.72 |
| Max. Negotiated Rate |
$6,533.29 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,104.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.71
|
| Rate for Payer: PHCS Commercial |
$6,533.29
|
| Rate for Payer: United Healthcare All Payer |
$5,988.85
|
| Rate for Payer: Aetna Commercial |
$5,240.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,308.30
|
| Rate for Payer: Cash Price |
$3,402.76
|
| Rate for Payer: Cigna Commercial |
$5,648.57
|
| Rate for Payer: First Health Commercial |
$6,465.23
|
| Rate for Payer: Humana Commercial |
$5,784.68
|
|
|
PLATE PROX TIBIAL LOCKNG 4H LT
|
Facility
|
OP
|
$6,805.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.72 |
| Max. Negotiated Rate |
$6,533.29 |
| Rate for Payer: Aetna Commercial |
$5,240.24
|
| Rate for Payer: Anthem Medicaid |
$2,340.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,308.30
|
| Rate for Payer: Cash Price |
$3,402.76
|
| Rate for Payer: Cigna Commercial |
$5,648.57
|
| Rate for Payer: First Health Commercial |
$6,465.23
|
| Rate for Payer: Humana Commercial |
$5,784.68
|
| Rate for Payer: Humana KY Medicaid |
$2,340.41
|
| Rate for Payer: Kentucky WC Medicaid |
$2,364.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,580.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,022.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,041.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,387.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,988.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,104.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,361.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$884.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,109.71
|
| Rate for Payer: PHCS Commercial |
$6,533.29
|
| Rate for Payer: United Healthcare All Payer |
$5,988.85
|
|
|
PLATE PROX TIBIAL LOCKNG 4H RT
|
Facility
|
OP
|
$6,506.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.88 |
| Max. Negotiated Rate |
$6,246.52 |
| Rate for Payer: Aetna Commercial |
$5,010.23
|
| Rate for Payer: Anthem Medicaid |
$2,237.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,075.30
|
| Rate for Payer: Cash Price |
$3,253.40
|
| Rate for Payer: Cigna Commercial |
$5,400.64
|
| Rate for Payer: First Health Commercial |
$6,181.45
|
| Rate for Payer: Humana Commercial |
$5,530.77
|
| Rate for Payer: Humana KY Medicaid |
$2,237.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,260.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,335.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,802.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,952.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,282.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,725.98
|
| Rate for Payer: Ohio Health Group HMO |
$4,880.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,017.10
|
| Rate for Payer: PHCS Commercial |
$6,246.52
|
| Rate for Payer: United Healthcare All Payer |
$5,725.98
|
|
|
PLATE PROX TIBIAL LOCKNG 4H RT
|
Facility
|
IP
|
$6,506.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$845.88 |
| Max. Negotiated Rate |
$6,246.52 |
| Rate for Payer: Aetna Commercial |
$5,010.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,075.30
|
| Rate for Payer: Cash Price |
$3,253.40
|
| Rate for Payer: Cigna Commercial |
$5,400.64
|
| Rate for Payer: First Health Commercial |
$6,181.45
|
| Rate for Payer: Humana Commercial |
$5,530.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,335.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,802.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,952.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,725.98
|
| Rate for Payer: Ohio Health Group HMO |
$4,880.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,301.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$845.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,017.10
|
| Rate for Payer: PHCS Commercial |
$6,246.52
|
| Rate for Payer: United Healthcare All Payer |
$5,725.98
|
|
|
PLATE PROX TIBIAL LOCKNG 6H LT
|
Facility
|
IP
|
$8,261.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.97 |
| Max. Negotiated Rate |
$7,930.83 |
| Rate for Payer: Aetna Commercial |
$6,361.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,443.80
|
| Rate for Payer: Cash Price |
$4,130.64
|
| Rate for Payer: Cigna Commercial |
$6,856.86
|
| Rate for Payer: First Health Commercial |
$7,848.22
|
| Rate for Payer: Humana Commercial |
$7,022.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,774.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,096.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,269.93
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,561.00
|
| Rate for Payer: PHCS Commercial |
$7,930.83
|
| Rate for Payer: United Healthcare All Payer |
$7,269.93
|
|
|
PLATE PROX TIBIAL LOCKNG 6H LT
|
Facility
|
OP
|
$8,261.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,073.97 |
| Max. Negotiated Rate |
$7,930.83 |
| Rate for Payer: Aetna Commercial |
$6,361.19
|
| Rate for Payer: Anthem Medicaid |
$2,841.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,443.80
|
| Rate for Payer: Cash Price |
$4,130.64
|
| Rate for Payer: Cigna Commercial |
$6,856.86
|
| Rate for Payer: First Health Commercial |
$7,848.22
|
| Rate for Payer: Humana Commercial |
$7,022.09
|
| Rate for Payer: Humana KY Medicaid |
$2,841.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,869.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,774.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,096.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,478.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,898.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,269.93
|
| Rate for Payer: Ohio Health Group HMO |
$6,195.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,652.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,073.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,561.00
|
| Rate for Payer: PHCS Commercial |
$7,930.83
|
| Rate for Payer: United Healthcare All Payer |
$7,269.93
|
|
|
PLATE PROX TIBIAL LOCKNG 6H RT
|
Facility
|
IP
|
$6,554.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.06 |
| Max. Negotiated Rate |
$6,292.15 |
| Rate for Payer: Aetna Commercial |
$5,046.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,112.37
|
| Rate for Payer: Cash Price |
$3,277.16
|
| Rate for Payer: Cigna Commercial |
$5,440.09
|
| Rate for Payer: First Health Commercial |
$6,226.60
|
| Rate for Payer: Humana Commercial |
$5,571.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,374.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,837.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,966.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,767.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,915.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.84
|
| Rate for Payer: PHCS Commercial |
$6,292.15
|
| Rate for Payer: United Healthcare All Payer |
$5,767.80
|
|
|
PLATE PROX TIBIAL LOCKNG 6H RT
|
Facility
|
OP
|
$6,554.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$852.06 |
| Max. Negotiated Rate |
$6,292.15 |
| Rate for Payer: Aetna Commercial |
$5,046.83
|
| Rate for Payer: Anthem Medicaid |
$2,254.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,112.37
|
| Rate for Payer: Cash Price |
$3,277.16
|
| Rate for Payer: Cigna Commercial |
$5,440.09
|
| Rate for Payer: First Health Commercial |
$6,226.60
|
| Rate for Payer: Humana Commercial |
$5,571.17
|
| Rate for Payer: Humana KY Medicaid |
$2,254.03
|
| Rate for Payer: Kentucky WC Medicaid |
$2,276.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,374.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,837.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,966.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,299.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,767.80
|
| Rate for Payer: Ohio Health Group HMO |
$4,915.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,310.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$852.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,031.84
|
| Rate for Payer: PHCS Commercial |
$6,292.15
|
| Rate for Payer: United Healthcare All Payer |
$5,767.80
|
|
