|
PLATE OLECRANON LK 6 81MM R
|
Facility
|
IP
|
$7,692.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,307.90 |
| Max. Negotiated Rate |
$7,385.27 |
| Rate for Payer: Aetna Commercial |
$5,923.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,000.53
|
| Rate for Payer: Cash Price |
$3,846.49
|
| Rate for Payer: Cigna Commercial |
$6,385.18
|
| Rate for Payer: First Health Commercial |
$7,308.34
|
| Rate for Payer: Humana Commercial |
$6,539.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,308.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,677.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,769.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,769.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,154.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,692.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,308.16
|
| Rate for Payer: PHCS Commercial |
$7,385.27
|
| Rate for Payer: United Healthcare All Payer |
$6,769.83
|
|
|
PLATE OLECRANON LK 6 81MM R
|
Facility
|
OP
|
$7,692.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,307.90 |
| Max. Negotiated Rate |
$7,385.27 |
| Rate for Payer: Aetna Commercial |
$5,923.60
|
| Rate for Payer: Anthem Medicaid |
$2,645.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,000.53
|
| Rate for Payer: Cash Price |
$3,846.49
|
| Rate for Payer: Cigna Commercial |
$6,385.18
|
| Rate for Payer: First Health Commercial |
$7,308.34
|
| Rate for Payer: Humana Commercial |
$6,539.04
|
| Rate for Payer: Humana KY Medicaid |
$2,645.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,672.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,308.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,677.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,698.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,769.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,769.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,154.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,692.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,308.16
|
| Rate for Payer: PHCS Commercial |
$7,385.27
|
| Rate for Payer: United Healthcare All Payer |
$6,769.83
|
|
|
PLATE OLECRANON LK 6H 81MM L
|
Facility
|
IP
|
$7,692.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,307.90 |
| Max. Negotiated Rate |
$7,385.27 |
| Rate for Payer: Aetna Commercial |
$5,923.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,000.53
|
| Rate for Payer: Cash Price |
$3,846.49
|
| Rate for Payer: Cigna Commercial |
$6,385.18
|
| Rate for Payer: First Health Commercial |
$7,308.34
|
| Rate for Payer: Humana Commercial |
$6,539.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,308.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,677.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,769.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,769.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,154.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,692.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,308.16
|
| Rate for Payer: PHCS Commercial |
$7,385.27
|
| Rate for Payer: United Healthcare All Payer |
$6,769.83
|
|
|
PLATE OLECRANON LK 6H 81MM L
|
Facility
|
OP
|
$7,692.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,307.90 |
| Max. Negotiated Rate |
$7,385.27 |
| Rate for Payer: Aetna Commercial |
$5,923.60
|
| Rate for Payer: Anthem Medicaid |
$2,645.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,000.53
|
| Rate for Payer: Cash Price |
$3,846.49
|
| Rate for Payer: Cigna Commercial |
$6,385.18
|
| Rate for Payer: First Health Commercial |
$7,308.34
|
| Rate for Payer: Humana Commercial |
$6,539.04
|
| Rate for Payer: Humana KY Medicaid |
$2,645.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,672.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,308.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,677.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,698.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,769.83
|
| Rate for Payer: Ohio Health Group HMO |
$5,769.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,154.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,692.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,308.16
|
| Rate for Payer: PHCS Commercial |
$7,385.27
|
| Rate for Payer: United Healthcare All Payer |
$6,769.83
|
|
|
PLATE OLECRANON LK 8 107MM L
|
Facility
|
IP
|
$8,057.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.29 |
| Max. Negotiated Rate |
$7,735.32 |
| Rate for Payer: Aetna Commercial |
$6,204.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,284.94
|
| Rate for Payer: Cash Price |
$4,028.81
|
| Rate for Payer: Cigna Commercial |
$6,687.82
|
| Rate for Payer: First Health Commercial |
$7,654.74
|
| Rate for Payer: Humana Commercial |
$6,848.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,946.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,090.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,559.76
|
| Rate for Payer: PHCS Commercial |
$7,735.32
|
| Rate for Payer: United Healthcare All Payer |
$7,090.71
|
|
|
PLATE OLECRANON LK 8 107MM L
|
Facility
|
OP
|
$8,057.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.29 |
| Max. Negotiated Rate |
$7,735.32 |
| Rate for Payer: Aetna Commercial |
$6,204.37
|
| Rate for Payer: Anthem Medicaid |
$2,771.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,284.94
|
| Rate for Payer: Cash Price |
$4,028.81
|
| Rate for Payer: Cigna Commercial |
$6,687.82
|
| Rate for Payer: First Health Commercial |
$7,654.74
|
| Rate for Payer: Humana Commercial |
$6,848.98
|
| Rate for Payer: Humana KY Medicaid |
$2,771.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,799.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,946.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,090.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,559.76
|
| Rate for Payer: PHCS Commercial |
$7,735.32
|
| Rate for Payer: United Healthcare All Payer |
$7,090.71
|
|
|
PLATE OLECRANON LK 8 107MM R
|
Facility
|
IP
|
$8,057.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.29 |
| Max. Negotiated Rate |
$7,735.32 |
| Rate for Payer: Aetna Commercial |
$6,204.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,284.94
|
| Rate for Payer: Cash Price |
$4,028.81
|
| Rate for Payer: Cigna Commercial |
$6,687.82
|
| Rate for Payer: First Health Commercial |
$7,654.74
|
| Rate for Payer: Humana Commercial |
$6,848.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,946.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,090.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,559.76
|
| Rate for Payer: PHCS Commercial |
$7,735.32
|
| Rate for Payer: United Healthcare All Payer |
$7,090.71
|
|
|
PLATE OLECRANON LK 8 107MM R
|
Facility
|
OP
|
$8,057.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,417.29 |
| Max. Negotiated Rate |
$7,735.32 |
| Rate for Payer: Aetna Commercial |
$6,204.37
|
| Rate for Payer: Anthem Medicaid |
$2,771.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,284.94
|
| Rate for Payer: Cash Price |
$4,028.81
|
| Rate for Payer: Cigna Commercial |
$6,687.82
|
| Rate for Payer: First Health Commercial |
$7,654.74
|
| Rate for Payer: Humana Commercial |
$6,848.98
|
| Rate for Payer: Humana KY Medicaid |
$2,771.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,799.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,607.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,946.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,417.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,826.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,090.71
|
| Rate for Payer: Ohio Health Group HMO |
$6,043.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,446.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,010.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,559.76
|
| Rate for Payer: PHCS Commercial |
$7,735.32
|
| Rate for Payer: United Healthcare All Payer |
$7,090.71
|
|
|
PLATE OLECRANON MEDIUM
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE OLECRANON MEDIUM
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE OLECRANON TI 3H 65MM L
|
Facility
|
OP
|
$5,112.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.75 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$3,936.62
|
| Rate for Payer: Anthem Medicaid |
$1,758.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.75
|
| Rate for Payer: Cash Price |
$2,556.25
|
| Rate for Payer: Cigna Commercial |
$4,243.38
|
| Rate for Payer: First Health Commercial |
$4,856.88
|
| Rate for Payer: Humana Commercial |
$4,345.62
|
| Rate for Payer: Humana KY Medicaid |
$1,758.19
|
| Rate for Payer: Kentucky WC Medicaid |
$1,776.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,793.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,447.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,527.62
|
| Rate for Payer: PHCS Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare All Payer |
$4,499.00
|
|
|
PLATE OLECRANON TI 3H 65MM L
|
Facility
|
IP
|
$5,112.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,533.75 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$3,936.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,987.75
|
| Rate for Payer: Cash Price |
$2,556.25
|
| Rate for Payer: Cigna Commercial |
$4,243.38
|
| Rate for Payer: First Health Commercial |
$4,856.88
|
| Rate for Payer: Humana Commercial |
$4,345.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,192.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,773.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,533.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,499.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,834.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,090.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,447.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,527.62
|
| Rate for Payer: PHCS Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare All Payer |
$4,499.00
|
|
|
PLATE OLECRANON TI 4H 89MM L
|
Facility
|
OP
|
$4,990.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.01 |
| Max. Negotiated Rate |
$4,790.42 |
| Rate for Payer: Aetna Commercial |
$3,842.32
|
| Rate for Payer: Anthem Medicaid |
$1,716.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,892.22
|
| Rate for Payer: Cash Price |
$2,495.01
|
| Rate for Payer: Cigna Commercial |
$4,141.72
|
| Rate for Payer: First Health Commercial |
$4,740.52
|
| Rate for Payer: Humana Commercial |
$4,241.52
|
| Rate for Payer: Humana KY Medicaid |
$1,716.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,733.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,497.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,750.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,391.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,992.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,341.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,443.11
|
| Rate for Payer: PHCS Commercial |
$4,790.42
|
| Rate for Payer: United Healthcare All Payer |
$4,391.22
|
|
|
PLATE OLECRANON TI 4H 89MM L
|
Facility
|
IP
|
$4,990.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.01 |
| Max. Negotiated Rate |
$4,790.42 |
| Rate for Payer: Aetna Commercial |
$3,842.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,892.22
|
| Rate for Payer: Cash Price |
$2,495.01
|
| Rate for Payer: Cigna Commercial |
$4,141.72
|
| Rate for Payer: First Health Commercial |
$4,740.52
|
| Rate for Payer: Humana Commercial |
$4,241.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,091.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,682.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,497.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,391.22
|
| Rate for Payer: Ohio Health Group HMO |
$3,742.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,992.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,341.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,443.11
|
| Rate for Payer: PHCS Commercial |
$4,790.42
|
| Rate for Payer: United Healthcare All Payer |
$4,391.22
|
|
|
PLATE OLECRANON TI 6H 113MM L
|
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 TI 6H 113MM L
|
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 XLG LEFT
|
Facility
|
IP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
PLATE OLECRANON XLG LEFT
|
Facility
|
OP
|
$6,923.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,077.12 |
| Max. Negotiated Rate |
$6,646.80 |
| Rate for Payer: Aetna Commercial |
$5,331.29
|
| Rate for Payer: Anthem Medicaid |
$2,381.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,400.52
|
| Rate for Payer: Cash Price |
$3,461.88
|
| Rate for Payer: Cigna Commercial |
$5,746.71
|
| Rate for Payer: First Health Commercial |
$6,577.56
|
| Rate for Payer: Humana Commercial |
$5,885.19
|
| Rate for Payer: Humana KY Medicaid |
$2,381.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,405.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,677.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,109.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,077.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,428.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,092.90
|
| Rate for Payer: Ohio Health Group HMO |
$5,192.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,539.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,023.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,777.39
|
| Rate for Payer: PHCS Commercial |
$6,646.80
|
| Rate for Payer: United Healthcare All Payer |
$6,092.90
|
|
|
PLATE ONE-THIRD TUBULAR 10H
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
PLATE ONE-THIRD TUBULAR 10H
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
PLATE ONE-THIRD TUBULAR 12H
|
Facility
|
IP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
PLATE ONE-THIRD TUBULAR 12H
|
Facility
|
OP
|
$1,699.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$509.70 |
| Max. Negotiated Rate |
$1,631.04 |
| Rate for Payer: Aetna Commercial |
$1,308.23
|
| Rate for Payer: Anthem Medicaid |
$584.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,325.22
|
| Rate for Payer: Cash Price |
$849.50
|
| Rate for Payer: Cigna Commercial |
$1,410.17
|
| Rate for Payer: First Health Commercial |
$1,614.05
|
| Rate for Payer: Humana Commercial |
$1,444.15
|
| Rate for Payer: Humana KY Medicaid |
$584.29
|
| Rate for Payer: Kentucky WC Medicaid |
$590.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,393.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,253.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$509.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,495.12
|
| Rate for Payer: Ohio Health Group HMO |
$1,274.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,359.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,478.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,172.31
|
| Rate for Payer: PHCS Commercial |
$1,631.04
|
| Rate for Payer: United Healthcare All Payer |
$1,495.12
|
|
|
PLATE ONE-THIRD TUBULAR 3H
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.50 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$920.15
|
| Rate for Payer: Anthem Medicaid |
$410.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.10
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cigna Commercial |
$991.85
|
| Rate for Payer: First Health Commercial |
$1,135.25
|
| Rate for Payer: Humana Commercial |
$1,015.75
|
| Rate for Payer: Humana KY Medicaid |
$410.96
|
| Rate for Payer: Kentucky WC Medicaid |
$415.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$419.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,051.60
|
| Rate for Payer: Ohio Health Group HMO |
$896.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,039.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$824.55
|
| Rate for Payer: PHCS Commercial |
$1,147.20
|
| Rate for Payer: United Healthcare All Payer |
$1,051.60
|
|
|
PLATE ONE-THIRD TUBULAR 3H
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$358.50 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$920.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$932.10
|
| Rate for Payer: Cash Price |
$597.50
|
| Rate for Payer: Cigna Commercial |
$991.85
|
| Rate for Payer: First Health Commercial |
$1,135.25
|
| Rate for Payer: Humana Commercial |
$1,015.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$979.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$881.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$358.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,051.60
|
| Rate for Payer: Ohio Health Group HMO |
$896.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$956.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,039.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$824.55
|
| Rate for Payer: PHCS Commercial |
$1,147.20
|
| Rate for Payer: United Healthcare All Payer |
$1,051.60
|
|
|
PLATE ONE-THIRD TUBULAR 4H
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$366.00 |
| Max. Negotiated Rate |
$1,171.20 |
| Rate for Payer: Aetna Commercial |
$939.40
|
| Rate for Payer: Anthem Medicaid |
$419.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$951.60
|
| Rate for Payer: Cash Price |
$610.00
|
| Rate for Payer: Cigna Commercial |
$1,012.60
|
| Rate for Payer: First Health Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial |
$1,037.00
|
| Rate for Payer: Humana KY Medicaid |
$419.56
|
| Rate for Payer: Kentucky WC Medicaid |
$423.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,000.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$900.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$366.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$427.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,073.60
|
| Rate for Payer: Ohio Health Group HMO |
$915.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$841.80
|
| Rate for Payer: PHCS Commercial |
$1,171.20
|
| Rate for Payer: United Healthcare All Payer |
$1,073.60
|
|
