|
PLATE NCB PP PROX FEM L 324MM
|
Facility
|
OP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem Medicaid |
$3,798.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Humana KY Medicaid |
$3,798.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,837.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,874.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE NCB PP PROX FEM L 324MM
|
Facility
|
IP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE NCB PP PROX FEM L 363MM
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE NCB PP PROX FEM L 363MM
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE NCB PP PROX FEM R L 285M
|
Facility
|
OP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem Medicaid |
$3,471.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Humana KY Medicaid |
$3,471.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,507.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,541.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE NCB PP PROX FEM R L 285M
|
Facility
|
IP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE NCB PP PROX FEM R L 324
|
Facility
|
IP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE NCB PP PROX FEM R L 324
|
Facility
|
OP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem Medicaid |
$3,798.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Humana KY Medicaid |
$3,798.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,837.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,874.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE NCB PP PROX FEM R L 363M
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE NCB PP PROX FEM R L 363M
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE OLECRANON 3H R
|
Facility
|
IP
|
$4,713.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$3,629.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.59
|
| Rate for Payer: Cash Price |
$2,356.79
|
| Rate for Payer: Cigna Commercial |
$3,912.27
|
| Rate for Payer: First Health Commercial |
$4,477.90
|
| Rate for Payer: Humana Commercial |
$4,006.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.37
|
| Rate for Payer: PHCS Commercial |
$4,525.04
|
| Rate for Payer: United Healthcare All Payer |
$4,147.95
|
|
|
PLATE OLECRANON 3H R
|
Facility
|
OP
|
$4,713.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$3,629.46
|
| Rate for Payer: Anthem Medicaid |
$1,621.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.59
|
| Rate for Payer: Cash Price |
$2,356.79
|
| Rate for Payer: Cigna Commercial |
$3,912.27
|
| Rate for Payer: First Health Commercial |
$4,477.90
|
| Rate for Payer: Humana Commercial |
$4,006.54
|
| Rate for Payer: Humana KY Medicaid |
$1,621.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,653.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.37
|
| Rate for Payer: PHCS Commercial |
$4,525.04
|
| Rate for Payer: United Healthcare All Payer |
$4,147.95
|
|
|
PLATE OLECRANON 4H R
|
Facility
|
OP
|
$7,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,272.14 |
| Max. Negotiated Rate |
$7,270.86 |
| Rate for Payer: Aetna Commercial |
$5,831.83
|
| Rate for Payer: Anthem Medicaid |
$2,604.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.57
|
| Rate for Payer: Cash Price |
$3,786.91
|
| Rate for Payer: Cigna Commercial |
$6,286.26
|
| Rate for Payer: First Health Commercial |
$7,195.12
|
| Rate for Payer: Humana Commercial |
$6,437.74
|
| Rate for Payer: Humana KY Medicaid |
$2,604.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,631.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,656.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,664.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,059.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,589.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,225.93
|
| Rate for Payer: PHCS Commercial |
$7,270.86
|
| Rate for Payer: United Healthcare All Payer |
$6,664.95
|
|
|
PLATE OLECRANON 4H R
|
Facility
|
IP
|
$7,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,272.14 |
| Max. Negotiated Rate |
$7,270.86 |
| Rate for Payer: Aetna Commercial |
$5,831.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.57
|
| Rate for Payer: Cash Price |
$3,786.91
|
| Rate for Payer: Cigna Commercial |
$6,286.26
|
| Rate for Payer: First Health Commercial |
$7,195.12
|
| Rate for Payer: Humana Commercial |
$6,437.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,664.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,059.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,589.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,225.93
|
| Rate for Payer: PHCS Commercial |
$7,270.86
|
| Rate for Payer: United Healthcare All Payer |
$6,664.95
|
|
|
PLATE OLECRANON 7H 110MM L
|
Facility
|
OP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem Medicaid |
$2,374.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Humana KY Medicaid |
$2,374.80
|
| Rate for Payer: Kentucky WC Medicaid |
$2,398.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,422.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
PLATE OLECRANON 7H 110MM L
|
Facility
|
IP
|
$6,905.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,071.65 |
| Max. Negotiated Rate |
$6,629.28 |
| Rate for Payer: Aetna Commercial |
$5,317.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,386.29
|
| Rate for Payer: Cash Price |
$3,452.75
|
| Rate for Payer: Cigna Commercial |
$5,731.56
|
| Rate for Payer: First Health Commercial |
$6,560.23
|
| Rate for Payer: Humana Commercial |
$5,869.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,662.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,096.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,071.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,076.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,179.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,524.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,007.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,764.80
|
| Rate for Payer: PHCS Commercial |
$6,629.28
|
| Rate for Payer: United Healthcare All Payer |
$6,076.84
|
|
|
PLATE OLECRANON 8H LEFT
|
Facility
|
IP
|
$12,249.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,674.78 |
| Max. Negotiated Rate |
$11,759.31 |
| Rate for Payer: Aetna Commercial |
$9,431.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,554.44
|
| Rate for Payer: Cash Price |
$6,124.64
|
| Rate for Payer: Cigna Commercial |
$10,166.90
|
| Rate for Payer: First Health Commercial |
$11,636.82
|
| Rate for Payer: Humana Commercial |
$10,411.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,044.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,039.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,779.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,186.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,799.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,656.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.00
|
| Rate for Payer: PHCS Commercial |
$11,759.31
|
| Rate for Payer: United Healthcare All Payer |
$10,779.37
|
|
|
PLATE OLECRANON 8H LEFT
|
Facility
|
OP
|
$12,249.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,674.78 |
| Max. Negotiated Rate |
$11,759.31 |
| Rate for Payer: Aetna Commercial |
$9,431.95
|
| Rate for Payer: Anthem Medicaid |
$4,212.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,554.44
|
| Rate for Payer: Cash Price |
$6,124.64
|
| Rate for Payer: Cigna Commercial |
$10,166.90
|
| Rate for Payer: First Health Commercial |
$11,636.82
|
| Rate for Payer: Humana Commercial |
$10,411.89
|
| Rate for Payer: Humana KY Medicaid |
$4,212.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,255.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,044.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,039.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,297.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,779.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,186.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,799.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,656.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.00
|
| Rate for Payer: PHCS Commercial |
$11,759.31
|
| Rate for Payer: United Healthcare All Payer |
$10,779.37
|
|
|
PLATE OLECRANON 9H LOCKING
|
Facility
|
OP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem Medicaid |
$1,751.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Humana KY Medicaid |
$1,751.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,769.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,786.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE OLECRANON 9H LOCKING
|
Facility
|
IP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE OLECRANON EXTENDED 5H L
|
Facility
|
IP
|
$15,770.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.03 |
| Max. Negotiated Rate |
$15,139.30 |
| Rate for Payer: Aetna Commercial |
$12,142.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,300.68
|
| Rate for Payer: Cash Price |
$7,885.05
|
| Rate for Payer: Cigna Commercial |
$13,089.18
|
| Rate for Payer: First Health Commercial |
$14,981.59
|
| Rate for Payer: Humana Commercial |
$13,404.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,931.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,638.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,731.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,877.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,827.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,616.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,719.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,881.37
|
| Rate for Payer: PHCS Commercial |
$15,139.30
|
| Rate for Payer: United Healthcare All Payer |
$13,877.69
|
|
|
PLATE OLECRANON EXTENDED 5H L
|
Facility
|
OP
|
$15,770.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,731.03 |
| Max. Negotiated Rate |
$15,139.30 |
| Rate for Payer: Aetna Commercial |
$12,142.98
|
| Rate for Payer: Anthem Medicaid |
$5,423.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,300.68
|
| Rate for Payer: Cash Price |
$7,885.05
|
| Rate for Payer: Cigna Commercial |
$13,089.18
|
| Rate for Payer: First Health Commercial |
$14,981.59
|
| Rate for Payer: Humana Commercial |
$13,404.58
|
| Rate for Payer: Humana KY Medicaid |
$5,423.34
|
| Rate for Payer: Kentucky WC Medicaid |
$5,478.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,931.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,638.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,731.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,532.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,877.69
|
| Rate for Payer: Ohio Health Group HMO |
$11,827.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,616.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,719.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,881.37
|
| Rate for Payer: PHCS Commercial |
$15,139.30
|
| Rate for Payer: United Healthcare All Payer |
$13,877.69
|
|
|
PLATE OLECRANON EXTENDED 5H R
|
Facility
|
IP
|
$14,040.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,212.07 |
| Max. Negotiated Rate |
$13,478.63 |
| Rate for Payer: Aetna Commercial |
$10,810.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,951.39
|
| Rate for Payer: Cash Price |
$7,020.12
|
| Rate for Payer: Cigna Commercial |
$11,653.40
|
| Rate for Payer: First Health Commercial |
$13,338.23
|
| Rate for Payer: Humana Commercial |
$11,934.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,513.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,361.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,212.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,355.41
|
| Rate for Payer: Ohio Health Group HMO |
$10,530.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,232.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,215.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,687.77
|
| Rate for Payer: PHCS Commercial |
$13,478.63
|
| Rate for Payer: United Healthcare All Payer |
$12,355.41
|
|
|
PLATE OLECRANON EXTENDED 5H R
|
Facility
|
OP
|
$14,040.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,212.07 |
| Max. Negotiated Rate |
$13,478.63 |
| Rate for Payer: Aetna Commercial |
$10,810.98
|
| Rate for Payer: Anthem Medicaid |
$4,828.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,951.39
|
| Rate for Payer: Cash Price |
$7,020.12
|
| Rate for Payer: Cigna Commercial |
$11,653.40
|
| Rate for Payer: First Health Commercial |
$13,338.23
|
| Rate for Payer: Humana Commercial |
$11,934.20
|
| Rate for Payer: Humana KY Medicaid |
$4,828.44
|
| Rate for Payer: Kentucky WC Medicaid |
$4,877.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,513.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,361.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,212.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,925.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,355.41
|
| Rate for Payer: Ohio Health Group HMO |
$10,530.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,232.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,215.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,687.77
|
| Rate for Payer: PHCS Commercial |
$13,478.63
|
| Rate for Payer: United Healthcare All Payer |
$12,355.41
|
|
|
PLATE OLECRANON EXT LOCK 13H
|
Facility
|
OP
|
$5,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$5,016.00 |
| Rate for Payer: Aetna Commercial |
$4,023.25
|
| Rate for Payer: Anthem Medicaid |
$1,796.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.50
|
| Rate for Payer: Cash Price |
$2,612.50
|
| Rate for Payer: Cigna Commercial |
$4,336.75
|
| Rate for Payer: First Health Commercial |
$4,963.75
|
| Rate for Payer: Humana Commercial |
$4,441.25
|
| Rate for Payer: Humana KY Medicaid |
$1,796.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,815.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,598.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,545.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,605.25
|
| Rate for Payer: PHCS Commercial |
$5,016.00
|
| Rate for Payer: United Healthcare All Payer |
$4,598.00
|
|
