|
PLATE T BUTTRESS 5X96MM
|
Facility
|
IP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
|
|
PLATE T BUTTRESS 5X96MM
|
Facility
|
OP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem Medicaid |
$1,235.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Humana KY Medicaid |
$1,235.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
|
|
PLATE T BUTTRESS 6X112MM
|
Facility
|
IP
|
$4,087.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.31 |
| Max. Negotiated Rate |
$3,923.54 |
| Rate for Payer: Aetna Commercial |
$3,147.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,187.88
|
| Rate for Payer: Cash Price |
$2,043.51
|
| Rate for Payer: Cigna Commercial |
$3,392.23
|
| Rate for Payer: First Health Commercial |
$3,882.67
|
| Rate for Payer: Humana Commercial |
$3,473.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,351.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,596.58
|
| Rate for Payer: Ohio Health Group HMO |
$3,065.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$817.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,266.98
|
| Rate for Payer: PHCS Commercial |
$3,923.54
|
| Rate for Payer: United Healthcare All Payer |
$3,596.58
|
|
|
PLATE T BUTTRESS 6X112MM
|
Facility
|
OP
|
$4,087.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$531.31 |
| Max. Negotiated Rate |
$3,923.54 |
| Rate for Payer: Aetna Commercial |
$3,147.01
|
| Rate for Payer: Anthem Medicaid |
$1,405.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,187.88
|
| Rate for Payer: Cash Price |
$2,043.51
|
| Rate for Payer: Cigna Commercial |
$3,392.23
|
| Rate for Payer: First Health Commercial |
$3,882.67
|
| Rate for Payer: Humana Commercial |
$3,473.97
|
| Rate for Payer: Humana KY Medicaid |
$1,405.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,419.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,351.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,016.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,226.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,433.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,596.58
|
| Rate for Payer: Ohio Health Group HMO |
$3,065.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$817.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$531.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,266.98
|
| Rate for Payer: PHCS Commercial |
$3,923.54
|
| Rate for Payer: United Healthcare All Payer |
$3,596.58
|
|
|
PLATE T FRAGMENT 2.7*61
|
Facility
|
IP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
PLATE T FRAGMENT 2.7*61
|
Facility
|
OP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem Medicaid |
$1,124.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Humana KY Medicaid |
$1,124.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
PLATE TI 3.5 10H 129MM
|
Facility
|
OP
|
$3,453.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$3,315.69 |
| Rate for Payer: Humana Commercial |
$2,935.76
|
| Rate for Payer: Humana KY Medicaid |
$1,187.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,199.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,832.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,548.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,036.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,211.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,039.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.69
|
| Rate for Payer: PHCS Commercial |
$3,315.69
|
| Rate for Payer: United Healthcare All Payer |
$3,039.38
|
| Rate for Payer: Aetna Commercial |
$2,659.46
|
| Rate for Payer: Anthem Medicaid |
$1,187.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,694.00
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna Commercial |
$2,866.69
|
| Rate for Payer: First Health Commercial |
$3,281.15
|
|
|
PLATE TI 3.5 10H 129MM
|
Facility
|
IP
|
$3,453.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$449.00 |
| Max. Negotiated Rate |
$3,315.69 |
| Rate for Payer: Aetna Commercial |
$2,659.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,694.00
|
| Rate for Payer: Cash Price |
$1,726.92
|
| Rate for Payer: Cigna Commercial |
$2,866.69
|
| Rate for Payer: First Health Commercial |
$3,281.15
|
| Rate for Payer: Humana Commercial |
$2,935.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,832.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,548.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,036.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,039.38
|
| Rate for Payer: Ohio Health Group HMO |
$2,590.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$690.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$449.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,070.69
|
| Rate for Payer: PHCS Commercial |
$3,315.69
|
| Rate for Payer: United Healthcare All Payer |
$3,039.38
|
|
|
PLATE TI 3.5 6H 77MM
|
Facility
|
OP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem Medicaid |
$638.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Humana KY Medicaid |
$638.89
|
| Rate for Payer: Kentucky WC Medicaid |
$645.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$651.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE TI 3.5 6H 77MM
|
Facility
|
IP
|
$1,857.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.51 |
| Max. Negotiated Rate |
$1,783.47 |
| Rate for Payer: Aetna Commercial |
$1,430.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,449.07
|
| Rate for Payer: Cash Price |
$928.89
|
| Rate for Payer: Cigna Commercial |
$1,541.96
|
| Rate for Payer: First Health Commercial |
$1,764.89
|
| Rate for Payer: Humana Commercial |
$1,579.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,523.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,371.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$557.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,634.85
|
| Rate for Payer: Ohio Health Group HMO |
$1,393.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$371.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$241.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$575.91
|
| Rate for Payer: PHCS Commercial |
$1,783.47
|
| Rate for Payer: United Healthcare All Payer |
$1,634.85
|
|
|
PLATE TI 3.5 7H 103MM
|
Facility
|
OP
|
$1,747.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.12 |
| Max. Negotiated Rate |
$1,677.23 |
| Rate for Payer: Aetna Commercial |
$1,345.27
|
| Rate for Payer: Anthem Medicaid |
$600.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.75
|
| Rate for Payer: Cash Price |
$873.56
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,659.75
|
| Rate for Payer: Humana Commercial |
$1,485.04
|
| Rate for Payer: Humana KY Medicaid |
$600.83
|
| Rate for Payer: Kentucky WC Medicaid |
$606.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.60
|
| Rate for Payer: PHCS Commercial |
$1,677.23
|
| Rate for Payer: United Healthcare All Payer |
$1,537.46
|
|
|
PLATE TI 3.5 7H 103MM
|
Facility
|
IP
|
$1,747.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.12 |
| Max. Negotiated Rate |
$1,677.23 |
| Rate for Payer: Aetna Commercial |
$1,345.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.75
|
| Rate for Payer: Cash Price |
$873.56
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,659.75
|
| Rate for Payer: Humana Commercial |
$1,485.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.60
|
| Rate for Payer: PHCS Commercial |
$1,677.23
|
| Rate for Payer: United Healthcare All Payer |
$1,537.46
|
|
|
PLATE TI 3.5 7H 90MM
|
Facility
|
OP
|
$1,747.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.12 |
| Max. Negotiated Rate |
$1,677.23 |
| Rate for Payer: Aetna Commercial |
$1,345.27
|
| Rate for Payer: Anthem Medicaid |
$600.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.75
|
| Rate for Payer: Cash Price |
$873.56
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,659.75
|
| Rate for Payer: Humana Commercial |
$1,485.04
|
| Rate for Payer: Humana KY Medicaid |
$600.83
|
| Rate for Payer: Kentucky WC Medicaid |
$606.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.60
|
| Rate for Payer: PHCS Commercial |
$1,677.23
|
| Rate for Payer: United Healthcare All Payer |
$1,537.46
|
|
|
PLATE TI 3.5 7H 90MM
|
Facility
|
IP
|
$1,747.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.12 |
| Max. Negotiated Rate |
$1,677.23 |
| Rate for Payer: Aetna Commercial |
$1,345.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.75
|
| Rate for Payer: Cash Price |
$873.56
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,659.75
|
| Rate for Payer: Humana Commercial |
$1,485.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.60
|
| Rate for Payer: PHCS Commercial |
$1,677.23
|
| Rate for Payer: United Healthcare All Payer |
$1,537.46
|
|
|
PLATE TI 3.5 9H 116MM
|
Facility
|
OP
|
$1,747.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.12 |
| Max. Negotiated Rate |
$1,677.23 |
| Rate for Payer: Aetna Commercial |
$1,345.27
|
| Rate for Payer: Anthem Medicaid |
$600.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.75
|
| Rate for Payer: Cash Price |
$873.56
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,659.75
|
| Rate for Payer: Humana Commercial |
$1,485.04
|
| Rate for Payer: Humana KY Medicaid |
$600.83
|
| Rate for Payer: Kentucky WC Medicaid |
$606.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$612.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.60
|
| Rate for Payer: PHCS Commercial |
$1,677.23
|
| Rate for Payer: United Healthcare All Payer |
$1,537.46
|
|
|
PLATE TI 3.5 9H 116MM
|
Facility
|
IP
|
$1,747.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$227.12 |
| Max. Negotiated Rate |
$1,677.23 |
| Rate for Payer: Aetna Commercial |
$1,345.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,362.75
|
| Rate for Payer: Cash Price |
$873.56
|
| Rate for Payer: Cigna Commercial |
$1,450.10
|
| Rate for Payer: First Health Commercial |
$1,659.75
|
| Rate for Payer: Humana Commercial |
$1,485.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,432.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,289.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$524.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,537.46
|
| Rate for Payer: Ohio Health Group HMO |
$1,310.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$349.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$227.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$541.60
|
| Rate for Payer: PHCS Commercial |
$1,677.23
|
| Rate for Payer: United Healthcare All Payer |
$1,537.46
|
|
|
PLATE TIBIA DISTAL LT 10H
|
Facility
|
OP
|
$10,024.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.14 |
| Max. Negotiated Rate |
$9,623.16 |
| Rate for Payer: Aetna Commercial |
$7,718.57
|
| Rate for Payer: Anthem Medicaid |
$3,447.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,818.81
|
| Rate for Payer: Cash Price |
$5,012.06
|
| Rate for Payer: Cigna Commercial |
$8,320.02
|
| Rate for Payer: First Health Commercial |
$9,522.91
|
| Rate for Payer: Humana Commercial |
$8,520.50
|
| Rate for Payer: Humana KY Medicaid |
$3,447.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,482.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,219.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,397.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,516.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,821.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,518.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,004.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,107.48
|
| Rate for Payer: PHCS Commercial |
$9,623.16
|
| Rate for Payer: United Healthcare All Payer |
$8,821.23
|
|
|
PLATE TIBIA DISTAL LT 10H
|
Facility
|
IP
|
$10,024.12
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,303.14 |
| Max. Negotiated Rate |
$9,623.16 |
| Rate for Payer: Aetna Commercial |
$7,718.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,818.81
|
| Rate for Payer: Cash Price |
$5,012.06
|
| Rate for Payer: Cigna Commercial |
$8,320.02
|
| Rate for Payer: First Health Commercial |
$9,522.91
|
| Rate for Payer: Humana Commercial |
$8,520.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,219.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,397.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,007.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,821.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,518.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,004.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,303.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,107.48
|
| Rate for Payer: PHCS Commercial |
$9,623.16
|
| Rate for Payer: United Healthcare All Payer |
$8,821.23
|
|
|
PLATE TIB LAT PROX L 10H 194M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB LAT PROX L 10H 194M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB LAT PROX L 12H 226M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB LAT PROX L 12H 226M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB LAT PROX L 14H 258M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB LAT PROX L 14H 258M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB LAT PROXMAL L 2H 66M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
