|
PLATE LK MD CLV SP 10H 121M R
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK MD CLV SP 10H 121M R
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK OLECRANON 10H 132MM R
|
Facility
|
IP
|
$8,233.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.96 |
| Max. Negotiated Rate |
$7,903.86 |
| Rate for Payer: Aetna Commercial |
$6,339.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,421.89
|
| Rate for Payer: Cash Price |
$4,116.59
|
| Rate for Payer: Cigna Commercial |
$6,833.55
|
| Rate for Payer: First Health Commercial |
$7,821.53
|
| Rate for Payer: Humana Commercial |
$6,998.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,751.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,076.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,245.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,174.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,586.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,162.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,680.90
|
| Rate for Payer: PHCS Commercial |
$7,903.86
|
| Rate for Payer: United Healthcare All Payer |
$7,245.21
|
|
|
PLATE LK OLECRANON 10H 132MM R
|
Facility
|
OP
|
$8,233.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.96 |
| Max. Negotiated Rate |
$7,903.86 |
| Rate for Payer: Aetna Commercial |
$6,339.56
|
| Rate for Payer: Anthem Medicaid |
$2,831.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,421.89
|
| Rate for Payer: Cash Price |
$4,116.59
|
| Rate for Payer: Cigna Commercial |
$6,833.55
|
| Rate for Payer: First Health Commercial |
$7,821.53
|
| Rate for Payer: Humana Commercial |
$6,998.21
|
| Rate for Payer: Humana KY Medicaid |
$2,831.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,860.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,751.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,076.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,469.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,888.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,245.21
|
| Rate for Payer: Ohio Health Group HMO |
$6,174.89
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,586.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,162.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,680.90
|
| Rate for Payer: PHCS Commercial |
$7,903.86
|
| Rate for Payer: United Healthcare All Payer |
$7,245.21
|
|
|
PLATE LK OLECRANON 12H 157MM R
|
Facility
|
OP
|
$8,300.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,490.21 |
| Max. Negotiated Rate |
$7,968.68 |
| Rate for Payer: Aetna Commercial |
$6,391.55
|
| Rate for Payer: Anthem Medicaid |
$2,854.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,474.55
|
| Rate for Payer: Cash Price |
$4,150.36
|
| Rate for Payer: Cigna Commercial |
$6,889.59
|
| Rate for Payer: First Health Commercial |
$7,885.67
|
| Rate for Payer: Humana Commercial |
$7,055.60
|
| Rate for Payer: Humana KY Medicaid |
$2,854.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,883.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,806.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,125.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,490.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,911.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,304.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,225.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,640.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,221.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,727.49
|
| Rate for Payer: PHCS Commercial |
$7,968.68
|
| Rate for Payer: United Healthcare All Payer |
$7,304.62
|
|
|
PLATE LK OLECRANON 12H 157MM R
|
Facility
|
IP
|
$8,300.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,490.21 |
| Max. Negotiated Rate |
$7,968.68 |
| Rate for Payer: Aetna Commercial |
$6,391.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,474.55
|
| Rate for Payer: Cash Price |
$4,150.36
|
| Rate for Payer: Cigna Commercial |
$6,889.59
|
| Rate for Payer: First Health Commercial |
$7,885.67
|
| Rate for Payer: Humana Commercial |
$7,055.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,806.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,125.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,490.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,304.62
|
| Rate for Payer: Ohio Health Group HMO |
$6,225.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,640.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,221.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,727.49
|
| Rate for Payer: PHCS Commercial |
$7,968.68
|
| Rate for Payer: United Healthcare All Payer |
$7,304.62
|
|
|
PLATE LK OLECRANON 4H 56MM R
|
Facility
|
IP
|
$7,301.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,190.40 |
| Max. Negotiated Rate |
$7,009.29 |
| Rate for Payer: Aetna Commercial |
$5,622.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,695.05
|
| Rate for Payer: Cash Price |
$3,650.67
|
| Rate for Payer: Cigna Commercial |
$6,060.11
|
| Rate for Payer: First Health Commercial |
$6,936.27
|
| Rate for Payer: Humana Commercial |
$6,206.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,987.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,388.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,190.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,425.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,476.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,841.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,352.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,037.92
|
| Rate for Payer: PHCS Commercial |
$7,009.29
|
| Rate for Payer: United Healthcare All Payer |
$6,425.18
|
|
|
PLATE LK OLECRANON 4H 56MM R
|
Facility
|
OP
|
$7,301.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,190.40 |
| Max. Negotiated Rate |
$7,009.29 |
| Rate for Payer: Aetna Commercial |
$5,622.03
|
| Rate for Payer: Anthem Medicaid |
$2,510.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,695.05
|
| Rate for Payer: Cash Price |
$3,650.67
|
| Rate for Payer: Cigna Commercial |
$6,060.11
|
| Rate for Payer: First Health Commercial |
$6,936.27
|
| Rate for Payer: Humana Commercial |
$6,206.14
|
| Rate for Payer: Humana KY Medicaid |
$2,510.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,536.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,987.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,388.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,190.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,561.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,425.18
|
| Rate for Payer: Ohio Health Group HMO |
$5,476.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,841.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,352.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,037.92
|
| Rate for Payer: PHCS Commercial |
$7,009.29
|
| Rate for Payer: United Healthcare All Payer |
$6,425.18
|
|
|
PLATE LK OLECRANON 6H 81MM R
|
Facility
|
IP
|
$7,692.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,307.90 |
| Max. Negotiated Rate |
$7,385.27 |
| Rate for Payer: Aetna Commercial |
$5,923.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,000.53
|
| Rate for Payer: Cash Price |
$3,846.49
|
| Rate for Payer: Cigna Commercial |
$6,385.18
|
| Rate for Payer: First Health Commercial |
$7,308.34
|
| Rate for Payer: Humana Commercial |
$6,539.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,308.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,677.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,769.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,769.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,154.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,692.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,308.16
|
| Rate for Payer: PHCS Commercial |
$7,385.27
|
| Rate for Payer: United Healthcare All Payer |
$6,769.83
|
|
|
PLATE LK OLECRANON 6H 81MM R
|
Facility
|
OP
|
$7,692.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,307.90 |
| Max. Negotiated Rate |
$7,385.27 |
| Rate for Payer: Aetna Commercial |
$5,923.60
|
| Rate for Payer: Anthem Medicaid |
$2,645.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,000.53
|
| Rate for Payer: Cash Price |
$3,846.49
|
| Rate for Payer: Cigna Commercial |
$6,385.18
|
| Rate for Payer: First Health Commercial |
$7,308.34
|
| Rate for Payer: Humana Commercial |
$6,539.04
|
| Rate for Payer: Humana KY Medicaid |
$2,645.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,672.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,308.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,677.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,698.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,769.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,769.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,154.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,692.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,308.16
|
| Rate for Payer: PHCS Commercial |
$7,385.27
|
| Rate for Payer: United Healthcare All Payer |
$6,769.83
|
|
|
PLATE LK OLECRANON 8H 107MM R
|
Facility
|
IP
|
$8,057.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.29 |
| Max. Negotiated Rate |
$7,735.32 |
| Rate for Payer: Aetna Commercial |
$6,204.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,284.94
|
| Rate for Payer: Cash Price |
$4,028.81
|
| Rate for Payer: Cigna Commercial |
$6,687.82
|
| Rate for Payer: First Health Commercial |
$7,654.74
|
| Rate for Payer: Humana Commercial |
$6,848.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,946.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,090.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,559.76
|
| Rate for Payer: PHCS Commercial |
$7,735.32
|
| Rate for Payer: United Healthcare All Payer |
$7,090.71
|
|
|
PLATE LK OLECRANON 8H 107MM R
|
Facility
|
OP
|
$8,057.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.29 |
| Max. Negotiated Rate |
$7,735.32 |
| Rate for Payer: Aetna Commercial |
$6,204.37
|
| Rate for Payer: Anthem Medicaid |
$2,771.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,284.94
|
| Rate for Payer: Cash Price |
$4,028.81
|
| Rate for Payer: Cigna Commercial |
$6,687.82
|
| Rate for Payer: First Health Commercial |
$7,654.74
|
| Rate for Payer: Humana Commercial |
$6,848.98
|
| Rate for Payer: Humana KY Medicaid |
$2,771.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,799.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,946.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,090.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,559.76
|
| Rate for Payer: PHCS Commercial |
$7,735.32
|
| Rate for Payer: United Healthcare All Payer |
$7,090.71
|
|
|
PLATE L LT 2.7MM
|
Facility
|
IP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE L LT 2.7MM
|
Facility
|
OP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem Medicaid |
$398.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Humana KY Medicaid |
$398.06
|
| Rate for Payer: Kentucky WC Medicaid |
$402.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE L OBLIQUE LT 2.0MM
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE L OBLIQUE LT 2.0MM
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem Medicaid |
$391.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Humana KY Medicaid |
$391.01
|
| Rate for Payer: Kentucky WC Medicaid |
$394.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE L OBLIQUE LT 2.7MM
|
Facility
|
IP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE L OBLIQUE LT 2.7MM
|
Facility
|
OP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem Medicaid |
$398.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Humana KY Medicaid |
$398.06
|
| Rate for Payer: Kentucky WC Medicaid |
$402.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE L OBLIQUE RT 2.0MM
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem Medicaid |
$391.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Humana KY Medicaid |
$391.01
|
| Rate for Payer: Kentucky WC Medicaid |
$394.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$398.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE L OBLIQUE RT 2.0MM
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$341.10 |
| Max. Negotiated Rate |
$1,091.52 |
| Rate for Payer: Aetna Commercial |
$875.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$886.86
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$943.71
|
| Rate for Payer: First Health Commercial |
$1,080.15
|
| Rate for Payer: Humana Commercial |
$966.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$932.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$839.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$341.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,000.56
|
| Rate for Payer: Ohio Health Group HMO |
$852.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$989.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$784.53
|
| Rate for Payer: PHCS Commercial |
$1,091.52
|
| Rate for Payer: United Healthcare All Payer |
$1,000.56
|
|
|
PLATE L OBLIQUE RT 2.7MM
|
Facility
|
OP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem Medicaid |
$398.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Humana KY Medicaid |
$398.06
|
| Rate for Payer: Kentucky WC Medicaid |
$402.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE L OBLIQUE RT 2.7MM
|
Facility
|
IP
|
$1,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$347.25 |
| Max. Negotiated Rate |
$1,111.20 |
| Rate for Payer: Aetna Commercial |
$891.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$902.85
|
| Rate for Payer: Cash Price |
$578.75
|
| Rate for Payer: Cigna Commercial |
$960.73
|
| Rate for Payer: First Health Commercial |
$1,099.62
|
| Rate for Payer: Humana Commercial |
$983.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$949.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$854.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$347.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,018.60
|
| Rate for Payer: Ohio Health Group HMO |
$868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,007.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$798.67
|
| Rate for Payer: PHCS Commercial |
$1,111.20
|
| Rate for Payer: United Healthcare All Payer |
$1,018.60
|
|
|
PLATE LOCK 1/3 TUB 7H 89MM
|
Facility
|
IP
|
$1,853.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.98 |
| Max. Negotiated Rate |
$1,779.15 |
| Rate for Payer: Aetna Commercial |
$1,427.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,445.56
|
| Rate for Payer: Cash Price |
$926.64
|
| Rate for Payer: Cigna Commercial |
$1,538.22
|
| Rate for Payer: First Health Commercial |
$1,760.62
|
| Rate for Payer: Humana Commercial |
$1,575.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,519.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,367.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,630.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.76
|
| Rate for Payer: PHCS Commercial |
$1,779.15
|
| Rate for Payer: United Healthcare All Payer |
$1,630.89
|
|
|
PLATE LOCK 1/3 TUB 7H 89MM
|
Facility
|
OP
|
$1,853.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$555.98 |
| Max. Negotiated Rate |
$1,779.15 |
| Rate for Payer: Aetna Commercial |
$1,427.03
|
| Rate for Payer: Anthem Medicaid |
$637.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,445.56
|
| Rate for Payer: Cash Price |
$926.64
|
| Rate for Payer: Cigna Commercial |
$1,538.22
|
| Rate for Payer: First Health Commercial |
$1,760.62
|
| Rate for Payer: Humana Commercial |
$1,575.29
|
| Rate for Payer: Humana KY Medicaid |
$637.34
|
| Rate for Payer: Kentucky WC Medicaid |
$643.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,519.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,367.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$555.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$650.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,630.89
|
| Rate for Payer: Ohio Health Group HMO |
$1,389.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,482.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,612.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,278.76
|
| Rate for Payer: PHCS Commercial |
$1,779.15
|
| Rate for Payer: United Healthcare All Payer |
$1,630.89
|
|
|
PLATE LOCK DIST FIB LEFT 10H
|
Facility
|
OP
|
$5,445.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.59 |
| Max. Negotiated Rate |
$5,227.50 |
| Rate for Payer: Aetna Commercial |
$4,192.89
|
| Rate for Payer: Anthem Medicaid |
$1,872.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.34
|
| Rate for Payer: Cash Price |
$2,722.66
|
| Rate for Payer: Cigna Commercial |
$4,519.61
|
| Rate for Payer: First Health Commercial |
$5,173.04
|
| Rate for Payer: Humana Commercial |
$4,628.51
|
| Rate for Payer: Humana KY Medicaid |
$1,872.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,891.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,465.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,910.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.87
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,356.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,737.42
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,757.26
|
| Rate for Payer: PHCS Commercial |
$5,227.50
|
| Rate for Payer: United Healthcare All Payer |
$4,791.87
|
|
