|
PLATE T 6 HOLE
|
Facility
|
OP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem Medicaid |
$1,057.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Humana KY Medicaid |
$1,057.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,068.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,078.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
PLATE T 6 HOLE
|
Facility
|
IP
|
$3,075.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.75 |
| Max. Negotiated Rate |
$2,952.00 |
| Rate for Payer: Aetna Commercial |
$2,367.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,398.50
|
| Rate for Payer: Cash Price |
$1,537.50
|
| Rate for Payer: Cigna Commercial |
$2,552.25
|
| Rate for Payer: First Health Commercial |
$2,921.25
|
| Rate for Payer: Humana Commercial |
$2,613.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,521.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,269.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$922.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,706.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,306.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$399.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$953.25
|
| Rate for Payer: PHCS Commercial |
$2,952.00
|
| Rate for Payer: United Healthcare All Payer |
$2,706.00
|
|
|
PLATE T 6 HOLE 116MM
|
Facility
|
OP
|
$3,319.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.51 |
| Max. Negotiated Rate |
$3,186.53 |
| Rate for Payer: Aetna Commercial |
$2,555.86
|
| Rate for Payer: Anthem Medicaid |
$1,141.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.05
|
| Rate for Payer: Cash Price |
$1,659.65
|
| Rate for Payer: Cigna Commercial |
$2,755.02
|
| Rate for Payer: First Health Commercial |
$3,153.34
|
| Rate for Payer: Humana Commercial |
$2,821.40
|
| Rate for Payer: Humana KY Medicaid |
$1,141.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,721.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,449.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,920.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,489.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.98
|
| Rate for Payer: PHCS Commercial |
$3,186.53
|
| Rate for Payer: United Healthcare All Payer |
$2,920.98
|
|
|
PLATE T 6 HOLE 116MM
|
Facility
|
IP
|
$3,319.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.51 |
| Max. Negotiated Rate |
$3,186.53 |
| Rate for Payer: Aetna Commercial |
$2,555.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.05
|
| Rate for Payer: Cash Price |
$1,659.65
|
| Rate for Payer: Cigna Commercial |
$2,755.02
|
| Rate for Payer: First Health Commercial |
$3,153.34
|
| Rate for Payer: Humana Commercial |
$2,821.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,721.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,449.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$995.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,920.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,489.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$663.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,028.98
|
| Rate for Payer: PHCS Commercial |
$3,186.53
|
| Rate for Payer: United Healthcare All Payer |
$2,920.98
|
|
|
PLATE T 8H 4.5MM
|
Facility
|
OP
|
$3,404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.52 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$2,621.08
|
| Rate for Payer: Anthem Medicaid |
$1,170.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.12
|
| Rate for Payer: Cash Price |
$1,702.00
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: First Health Commercial |
$3,233.80
|
| Rate for Payer: Humana Commercial |
$2,893.40
|
| Rate for Payer: Humana KY Medicaid |
$1,170.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,182.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,194.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.24
|
| Rate for Payer: PHCS Commercial |
$3,267.84
|
| Rate for Payer: United Healthcare All Payer |
$2,995.52
|
|
|
PLATE T 8H 4.5MM
|
Facility
|
IP
|
$3,404.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.52 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$2,621.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,655.12
|
| Rate for Payer: Cash Price |
$1,702.00
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: First Health Commercial |
$3,233.80
|
| Rate for Payer: Humana Commercial |
$2,893.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,791.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,512.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,021.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,995.52
|
| Rate for Payer: Ohio Health Group HMO |
$2,553.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$680.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,055.24
|
| Rate for Payer: PHCS Commercial |
$3,267.84
|
| Rate for Payer: United Healthcare All Payer |
$2,995.52
|
|
|
PLATE T 8 HOLE
|
Facility
|
IP
|
$3,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.05 |
| Max. Negotiated Rate |
$3,153.60 |
| Rate for Payer: Aetna Commercial |
$2,529.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,562.30
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cigna Commercial |
$2,726.55
|
| Rate for Payer: First Health Commercial |
$3,120.75
|
| Rate for Payer: Humana Commercial |
$2,792.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,693.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,424.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.35
|
| Rate for Payer: PHCS Commercial |
$3,153.60
|
| Rate for Payer: United Healthcare All Payer |
$2,890.80
|
|
|
PLATE T 8 HOLE
|
Facility
|
OP
|
$3,285.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$427.05 |
| Max. Negotiated Rate |
$3,153.60 |
| Rate for Payer: Aetna Commercial |
$2,529.45
|
| Rate for Payer: Anthem Medicaid |
$1,129.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,562.30
|
| Rate for Payer: Cash Price |
$1,642.50
|
| Rate for Payer: Cigna Commercial |
$2,726.55
|
| Rate for Payer: First Health Commercial |
$3,120.75
|
| Rate for Payer: Humana Commercial |
$2,792.25
|
| Rate for Payer: Humana KY Medicaid |
$1,129.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,141.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,693.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,424.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$985.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,152.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,890.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,463.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$657.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$427.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,018.35
|
| Rate for Payer: PHCS Commercial |
$3,153.60
|
| Rate for Payer: United Healthcare All Payer |
$2,890.80
|
|
|
PLATE T 8 HOLE 148MM
|
Facility
|
IP
|
$3,742.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.54 |
| Max. Negotiated Rate |
$3,592.92 |
| Rate for Payer: Humana Commercial |
$3,181.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,068.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,293.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,806.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.21
|
| Rate for Payer: PHCS Commercial |
$3,592.92
|
| Rate for Payer: United Healthcare All Payer |
$3,293.51
|
| Rate for Payer: Aetna Commercial |
$2,881.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.24
|
| Rate for Payer: Cash Price |
$1,871.31
|
| Rate for Payer: Cigna Commercial |
$3,106.37
|
| Rate for Payer: First Health Commercial |
$3,555.49
|
|
|
PLATE T 8 HOLE 148MM
|
Facility
|
OP
|
$3,742.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.54 |
| Max. Negotiated Rate |
$3,592.92 |
| Rate for Payer: Aetna Commercial |
$2,881.82
|
| Rate for Payer: Anthem Medicaid |
$1,287.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,919.24
|
| Rate for Payer: Cash Price |
$1,871.31
|
| Rate for Payer: Cigna Commercial |
$3,106.37
|
| Rate for Payer: First Health Commercial |
$3,555.49
|
| Rate for Payer: Humana Commercial |
$3,181.23
|
| Rate for Payer: Humana KY Medicaid |
$1,287.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,300.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,068.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,762.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,122.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,312.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,293.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,806.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$748.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$486.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,160.21
|
| Rate for Payer: PHCS Commercial |
$3,592.92
|
| Rate for Payer: United Healthcare All Payer |
$3,293.51
|
|
|
PLATE TALS MDL 2.5M 17X20M T L
|
Facility
|
OP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem Medicaid |
$2,296.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Humana KY Medicaid |
$2,296.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,320.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,342.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALS MDL 2.5M 17X20M T L
|
Facility
|
IP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALS MDL 2.5M 17X20M T R
|
Facility
|
OP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem Medicaid |
$2,296.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Humana KY Medicaid |
$2,296.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,320.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,342.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALS MDL 2.5M 17X20M T R
|
Facility
|
IP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALUS LTL 3H 16X22MM LT
|
Facility
|
OP
|
$5,576.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.89 |
| Max. Negotiated Rate |
$5,353.06 |
| Rate for Payer: Aetna Commercial |
$4,293.60
|
| Rate for Payer: Anthem Medicaid |
$1,917.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.36
|
| Rate for Payer: Cash Price |
$2,788.05
|
| Rate for Payer: Cigna Commercial |
$4,628.16
|
| Rate for Payer: First Health Commercial |
$5,297.30
|
| Rate for Payer: Humana Commercial |
$4,739.68
|
| Rate for Payer: Humana KY Medicaid |
$1,917.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,937.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,956.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,906.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.59
|
| Rate for Payer: PHCS Commercial |
$5,353.06
|
| Rate for Payer: United Healthcare All Payer |
$4,906.97
|
|
|
PLATE TALUS LTL 3H 16X22MM LT
|
Facility
|
IP
|
$5,576.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.89 |
| Max. Negotiated Rate |
$5,353.06 |
| Rate for Payer: Aetna Commercial |
$4,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.36
|
| Rate for Payer: Cash Price |
$2,788.05
|
| Rate for Payer: Cigna Commercial |
$4,628.16
|
| Rate for Payer: First Health Commercial |
$5,297.30
|
| Rate for Payer: Humana Commercial |
$4,739.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,906.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.59
|
| Rate for Payer: PHCS Commercial |
$5,353.06
|
| Rate for Payer: United Healthcare All Payer |
$4,906.97
|
|
|
PLATE TALUS LTL 3H 16X22MM RT
|
Facility
|
IP
|
$5,576.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.89 |
| Max. Negotiated Rate |
$5,353.06 |
| Rate for Payer: Aetna Commercial |
$4,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.36
|
| Rate for Payer: Cash Price |
$2,788.05
|
| Rate for Payer: Cigna Commercial |
$4,628.16
|
| Rate for Payer: First Health Commercial |
$5,297.30
|
| Rate for Payer: Humana Commercial |
$4,739.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,906.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.59
|
| Rate for Payer: PHCS Commercial |
$5,353.06
|
| Rate for Payer: United Healthcare All Payer |
$4,906.97
|
|
|
PLATE TALUS LTL 3H 16X22MM RT
|
Facility
|
OP
|
$5,576.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.89 |
| Max. Negotiated Rate |
$5,353.06 |
| Rate for Payer: Humana Commercial |
$4,739.68
|
| Rate for Payer: Humana KY Medicaid |
$1,917.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,937.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,956.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,906.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.59
|
| Rate for Payer: PHCS Commercial |
$5,353.06
|
| Rate for Payer: United Healthcare All Payer |
$4,906.97
|
| Rate for Payer: Aetna Commercial |
$4,293.60
|
| Rate for Payer: Anthem Medicaid |
$1,917.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.36
|
| Rate for Payer: Cash Price |
$2,788.05
|
| Rate for Payer: Cigna Commercial |
$4,628.16
|
| Rate for Payer: First Health Commercial |
$5,297.30
|
|
|
PLATE TALUS LTL 4H 16X25MM LT
|
Facility
|
OP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem Medicaid |
$2,296.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Humana KY Medicaid |
$2,296.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,320.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,342.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALUS LTL 4H 16X25MM LT
|
Facility
|
IP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALUS LTL 4H 16X25MM RT
|
Facility
|
OP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem Medicaid |
$2,296.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Humana KY Medicaid |
$2,296.79
|
| Rate for Payer: Kentucky WC Medicaid |
$2,320.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,342.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALUS LTL 4H 16X25MM RT
|
Facility
|
IP
|
$6,678.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$868.23 |
| Max. Negotiated Rate |
$6,411.52 |
| Rate for Payer: Aetna Commercial |
$5,142.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,209.36
|
| Rate for Payer: Cash Price |
$3,339.34
|
| Rate for Payer: Cigna Commercial |
$5,543.30
|
| Rate for Payer: First Health Commercial |
$6,344.74
|
| Rate for Payer: Humana Commercial |
$5,676.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,476.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,928.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,003.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,877.23
|
| Rate for Payer: Ohio Health Group HMO |
$5,009.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,335.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$868.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,070.39
|
| Rate for Payer: PHCS Commercial |
$6,411.52
|
| Rate for Payer: United Healthcare All Payer |
$5,877.23
|
|
|
PLATE TALUS MDL 2.5 11X20M L L
|
Facility
|
OP
|
$5,576.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.89 |
| Max. Negotiated Rate |
$5,353.06 |
| Rate for Payer: Aetna Commercial |
$4,293.60
|
| Rate for Payer: Anthem Medicaid |
$1,917.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.36
|
| Rate for Payer: Cash Price |
$2,788.05
|
| Rate for Payer: Cigna Commercial |
$4,628.16
|
| Rate for Payer: First Health Commercial |
$5,297.30
|
| Rate for Payer: Humana Commercial |
$4,739.68
|
| Rate for Payer: Humana KY Medicaid |
$1,917.62
|
| Rate for Payer: Kentucky WC Medicaid |
$1,937.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,956.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,906.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.59
|
| Rate for Payer: PHCS Commercial |
$5,353.06
|
| Rate for Payer: United Healthcare All Payer |
$4,906.97
|
|
|
PLATE TALUS MDL 2.5 11X20M L L
|
Facility
|
IP
|
$5,576.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$724.89 |
| Max. Negotiated Rate |
$5,353.06 |
| Rate for Payer: Aetna Commercial |
$4,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,349.36
|
| Rate for Payer: Cash Price |
$2,788.05
|
| Rate for Payer: Cigna Commercial |
$4,628.16
|
| Rate for Payer: First Health Commercial |
$5,297.30
|
| Rate for Payer: Humana Commercial |
$4,739.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,572.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,115.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,906.97
|
| Rate for Payer: Ohio Health Group HMO |
$4,182.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,115.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$724.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,728.59
|
| Rate for Payer: PHCS Commercial |
$5,353.06
|
| Rate for Payer: United Healthcare All Payer |
$4,906.97
|
|
|
PLATE TALUS MDL 2.5 11X20M L R
|
Facility
|
OP
|
$5,098.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$662.74 |
| Max. Negotiated Rate |
$4,894.08 |
| Rate for Payer: Aetna Commercial |
$3,925.46
|
| Rate for Payer: Anthem Medicaid |
$1,753.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,976.44
|
| Rate for Payer: Cash Price |
$2,549.00
|
| Rate for Payer: Cigna Commercial |
$4,231.34
|
| Rate for Payer: First Health Commercial |
$4,843.10
|
| Rate for Payer: Humana Commercial |
$4,333.30
|
| Rate for Payer: Humana KY Medicaid |
$1,753.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,771.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,180.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,762.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,529.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,788.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,486.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,823.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,019.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$662.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,580.38
|
| Rate for Payer: PHCS Commercial |
$4,894.08
|
| Rate for Payer: United Healthcare All Payer |
$4,486.24
|
|
