|
PLATE PROX LAT TIBIA 10H R
|
Facility
|
OP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem Medicaid |
$4,867.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Humana KY Medicaid |
$4,867.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,917.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,965.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 10H R
|
Facility
|
IP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 12H L
|
Facility
|
IP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 12H L
|
Facility
|
OP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem Medicaid |
$4,867.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Humana KY Medicaid |
$4,867.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,917.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,965.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 12H R
|
Facility
|
IP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 12H R
|
Facility
|
OP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem Medicaid |
$4,867.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Humana KY Medicaid |
$4,867.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,917.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,965.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 14H L
|
Facility
|
IP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 14H L
|
Facility
|
OP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem Medicaid |
$4,867.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Humana KY Medicaid |
$4,867.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,917.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,965.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 14H R
|
Facility
|
IP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 14H R
|
Facility
|
OP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem Medicaid |
$4,867.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Humana KY Medicaid |
$4,867.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,917.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,965.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 2H L
|
Facility
|
OP
|
$9,258.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.55 |
| Max. Negotiated Rate |
$8,888.17 |
| Rate for Payer: Aetna Commercial |
$7,129.05
|
| Rate for Payer: Anthem Medicaid |
$3,184.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,221.64
|
| Rate for Payer: Cash Price |
$4,629.25
|
| Rate for Payer: Cigna Commercial |
$7,684.56
|
| Rate for Payer: First Health Commercial |
$8,795.58
|
| Rate for Payer: Humana Commercial |
$7,869.73
|
| Rate for Payer: Humana KY Medicaid |
$3,184.00
|
| Rate for Payer: Kentucky WC Medicaid |
$3,216.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,591.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,832.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,247.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,147.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,943.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,406.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,054.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,388.37
|
| Rate for Payer: PHCS Commercial |
$8,888.17
|
| Rate for Payer: United Healthcare All Payer |
$8,147.49
|
|
|
PLATE PROX LAT TIBIA 2H L
|
Facility
|
IP
|
$9,258.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,777.55 |
| Max. Negotiated Rate |
$8,888.17 |
| Rate for Payer: Aetna Commercial |
$7,129.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,221.64
|
| Rate for Payer: Cash Price |
$4,629.25
|
| Rate for Payer: Cigna Commercial |
$7,684.56
|
| Rate for Payer: First Health Commercial |
$8,795.58
|
| Rate for Payer: Humana Commercial |
$7,869.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,591.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,832.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,777.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,147.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,943.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,406.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,054.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,388.37
|
| Rate for Payer: PHCS Commercial |
$8,888.17
|
| Rate for Payer: United Healthcare All Payer |
$8,147.49
|
|
|
PLATE PROX LAT TIBIA 2H R
|
Facility
|
OP
|
$8,247.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,474.11 |
| Max. Negotiated Rate |
$7,917.14 |
| Rate for Payer: Aetna Commercial |
$6,350.21
|
| Rate for Payer: Anthem Medicaid |
$2,836.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,432.68
|
| Rate for Payer: Cash Price |
$4,123.51
|
| Rate for Payer: Cigna Commercial |
$6,845.03
|
| Rate for Payer: First Health Commercial |
$7,834.67
|
| Rate for Payer: Humana Commercial |
$7,009.97
|
| Rate for Payer: Humana KY Medicaid |
$2,836.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,865.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,762.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,086.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,474.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,893.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,257.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,185.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,597.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,174.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,690.44
|
| Rate for Payer: PHCS Commercial |
$7,917.14
|
| Rate for Payer: United Healthcare All Payer |
$7,257.38
|
|
|
PLATE PROX LAT TIBIA 2H R
|
Facility
|
IP
|
$8,247.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,474.11 |
| Max. Negotiated Rate |
$7,917.14 |
| Rate for Payer: Aetna Commercial |
$6,350.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,432.68
|
| Rate for Payer: Cash Price |
$4,123.51
|
| Rate for Payer: Cigna Commercial |
$6,845.03
|
| Rate for Payer: First Health Commercial |
$7,834.67
|
| Rate for Payer: Humana Commercial |
$7,009.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,762.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,086.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,474.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,257.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,185.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,597.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,174.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,690.44
|
| Rate for Payer: PHCS Commercial |
$7,917.14
|
| Rate for Payer: United Healthcare All Payer |
$7,257.38
|
|
|
PLATE PROX LAT TIBIA 4H L
|
Facility
|
IP
|
$8,356.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.03 |
| Max. Negotiated Rate |
$8,022.51 |
| Rate for Payer: Aetna Commercial |
$6,434.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.29
|
| Rate for Payer: Cash Price |
$4,178.39
|
| Rate for Payer: Cigna Commercial |
$6,936.13
|
| Rate for Payer: First Health Commercial |
$7,938.94
|
| Rate for Payer: Humana Commercial |
$7,103.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,353.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,685.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,270.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,766.18
|
| Rate for Payer: PHCS Commercial |
$8,022.51
|
| Rate for Payer: United Healthcare All Payer |
$7,353.97
|
|
|
PLATE PROX LAT TIBIA 4H L
|
Facility
|
OP
|
$8,356.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,507.03 |
| Max. Negotiated Rate |
$8,022.51 |
| Rate for Payer: Aetna Commercial |
$6,434.72
|
| Rate for Payer: Anthem Medicaid |
$2,873.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.29
|
| Rate for Payer: Cash Price |
$4,178.39
|
| Rate for Payer: Cigna Commercial |
$6,936.13
|
| Rate for Payer: First Health Commercial |
$7,938.94
|
| Rate for Payer: Humana Commercial |
$7,103.26
|
| Rate for Payer: Humana KY Medicaid |
$2,873.90
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,931.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,353.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,685.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,270.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,766.18
|
| Rate for Payer: PHCS Commercial |
$8,022.51
|
| Rate for Payer: United Healthcare All Payer |
$7,353.97
|
|
|
PLATE PROX LAT TIBIA 4H R
|
Facility
|
OP
|
$7,679.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,303.79 |
| Max. Negotiated Rate |
$7,372.13 |
| Rate for Payer: Aetna Commercial |
$5,913.06
|
| Rate for Payer: Anthem Medicaid |
$2,640.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,989.85
|
| Rate for Payer: Cash Price |
$3,839.65
|
| Rate for Payer: Cigna Commercial |
$6,373.82
|
| Rate for Payer: First Health Commercial |
$7,295.34
|
| Rate for Payer: Humana Commercial |
$6,527.40
|
| Rate for Payer: Humana KY Medicaid |
$2,640.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,667.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,297.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,667.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,303.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,693.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,757.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,759.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,143.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,680.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,298.72
|
| Rate for Payer: PHCS Commercial |
$7,372.13
|
| Rate for Payer: United Healthcare All Payer |
$6,757.78
|
|
|
PLATE PROX LAT TIBIA 4H R
|
Facility
|
IP
|
$7,679.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,303.79 |
| Max. Negotiated Rate |
$7,372.13 |
| Rate for Payer: Aetna Commercial |
$5,913.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,989.85
|
| Rate for Payer: Cash Price |
$3,839.65
|
| Rate for Payer: Cigna Commercial |
$6,373.82
|
| Rate for Payer: First Health Commercial |
$7,295.34
|
| Rate for Payer: Humana Commercial |
$6,527.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,297.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,667.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,303.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,757.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,759.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,143.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,680.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,298.72
|
| Rate for Payer: PHCS Commercial |
$7,372.13
|
| Rate for Payer: United Healthcare All Payer |
$6,757.78
|
|
|
PLATE PROX LAT TIBIA 6H L
|
Facility
|
OP
|
$9,403.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,821.18 |
| Max. Negotiated Rate |
$9,027.76 |
| Rate for Payer: Aetna Commercial |
$7,241.02
|
| Rate for Payer: Anthem Medicaid |
$3,234.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,335.06
|
| Rate for Payer: Cash Price |
$4,701.96
|
| Rate for Payer: Cigna Commercial |
$7,805.25
|
| Rate for Payer: First Health Commercial |
$8,933.72
|
| Rate for Payer: Humana Commercial |
$7,993.33
|
| Rate for Payer: Humana KY Medicaid |
$3,234.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,266.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,711.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,940.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,298.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,275.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,052.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,523.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,181.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,488.70
|
| Rate for Payer: PHCS Commercial |
$9,027.76
|
| Rate for Payer: United Healthcare All Payer |
$8,275.45
|
|
|
PLATE PROX LAT TIBIA 6H L
|
Facility
|
IP
|
$9,403.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,821.18 |
| Max. Negotiated Rate |
$9,027.76 |
| Rate for Payer: Aetna Commercial |
$7,241.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,335.06
|
| Rate for Payer: Cash Price |
$4,701.96
|
| Rate for Payer: Cigna Commercial |
$7,805.25
|
| Rate for Payer: First Health Commercial |
$8,933.72
|
| Rate for Payer: Humana Commercial |
$7,993.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,711.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,940.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,275.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,052.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,523.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,181.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,488.70
|
| Rate for Payer: PHCS Commercial |
$9,027.76
|
| Rate for Payer: United Healthcare All Payer |
$8,275.45
|
|
|
PLATE PROX LAT TIBIA 6H R
|
Facility
|
OP
|
$15,592.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,677.75 |
| Max. Negotiated Rate |
$14,968.80 |
| Rate for Payer: Aetna Commercial |
$12,006.23
|
| Rate for Payer: Anthem Medicaid |
$5,362.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,162.15
|
| Rate for Payer: Cash Price |
$7,796.25
|
| Rate for Payer: Cigna Commercial |
$12,941.77
|
| Rate for Payer: First Health Commercial |
$14,812.88
|
| Rate for Payer: Humana Commercial |
$13,253.62
|
| Rate for Payer: Humana KY Medicaid |
$5,362.26
|
| Rate for Payer: Kentucky WC Medicaid |
$5,416.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,785.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,507.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,677.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,469.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,694.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,474.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,565.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,758.83
|
| Rate for Payer: PHCS Commercial |
$14,968.80
|
| Rate for Payer: United Healthcare All Payer |
$13,721.40
|
|
|
PLATE PROX LAT TIBIA 6H R
|
Facility
|
IP
|
$15,592.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,677.75 |
| Max. Negotiated Rate |
$14,968.80 |
| Rate for Payer: Aetna Commercial |
$12,006.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,162.15
|
| Rate for Payer: Cash Price |
$7,796.25
|
| Rate for Payer: Cigna Commercial |
$12,941.77
|
| Rate for Payer: First Health Commercial |
$14,812.88
|
| Rate for Payer: Humana Commercial |
$13,253.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,785.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,507.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,677.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,721.40
|
| Rate for Payer: Ohio Health Group HMO |
$11,694.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,474.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,565.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,758.83
|
| Rate for Payer: PHCS Commercial |
$14,968.80
|
| Rate for Payer: United Healthcare All Payer |
$13,721.40
|
|
|
PLATE PROX LAT TIBIA 8H L
|
Facility
|
IP
|
$15,818.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,745.46 |
| Max. Negotiated Rate |
$15,185.47 |
| Rate for Payer: Aetna Commercial |
$12,180.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,338.20
|
| Rate for Payer: Cash Price |
$7,909.10
|
| Rate for Payer: Cigna Commercial |
$13,129.11
|
| Rate for Payer: First Health Commercial |
$15,027.29
|
| Rate for Payer: Humana Commercial |
$13,445.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,970.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,673.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,745.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,920.02
|
| Rate for Payer: Ohio Health Group HMO |
$11,863.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,654.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,761.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,914.56
|
| Rate for Payer: PHCS Commercial |
$15,185.47
|
| Rate for Payer: United Healthcare All Payer |
$13,920.02
|
|
|
PLATE PROX LAT TIBIA 8H L
|
Facility
|
OP
|
$15,818.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,745.46 |
| Max. Negotiated Rate |
$15,185.47 |
| Rate for Payer: Aetna Commercial |
$12,180.01
|
| Rate for Payer: Anthem Medicaid |
$5,439.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,338.20
|
| Rate for Payer: Cash Price |
$7,909.10
|
| Rate for Payer: Cigna Commercial |
$13,129.11
|
| Rate for Payer: First Health Commercial |
$15,027.29
|
| Rate for Payer: Humana Commercial |
$13,445.47
|
| Rate for Payer: Humana KY Medicaid |
$5,439.88
|
| Rate for Payer: Kentucky WC Medicaid |
$5,495.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,970.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,673.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,745.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,549.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,920.02
|
| Rate for Payer: Ohio Health Group HMO |
$11,863.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,654.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,761.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,914.56
|
| Rate for Payer: PHCS Commercial |
$15,185.47
|
| Rate for Payer: United Healthcare All Payer |
$13,920.02
|
|
|
PLATE PROX LAT TIBIA 8H R
|
Facility
|
OP
|
$8,576.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,572.89 |
| Max. Negotiated Rate |
$8,233.24 |
| Rate for Payer: Aetna Commercial |
$6,603.74
|
| Rate for Payer: Anthem Medicaid |
$2,949.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,689.51
|
| Rate for Payer: Cash Price |
$4,288.14
|
| Rate for Payer: Cigna Commercial |
$7,118.32
|
| Rate for Payer: First Health Commercial |
$8,147.48
|
| Rate for Payer: Humana Commercial |
$7,289.85
|
| Rate for Payer: Humana KY Medicaid |
$2,949.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,979.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,032.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,008.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,461.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,917.64
|
| Rate for Payer: PHCS Commercial |
$8,233.24
|
| Rate for Payer: United Healthcare All Payer |
$7,547.14
|
|
