|
PLATE ULNA MIDSHAFT 12H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSHAFT 6H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSHAFT 6H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSHAFT 8H
|
Facility
|
IP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
|
|
PLATE ULNA MIDSHAFT 8H
|
Facility
|
OP
|
$4,688.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$609.50 |
| Max. Negotiated Rate |
$4,500.96 |
| Rate for Payer: Humana Commercial |
$3,985.22
|
| Rate for Payer: Humana KY Medicaid |
$1,612.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,125.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$937.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$609.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,453.44
|
| Rate for Payer: PHCS Commercial |
$4,500.96
|
| Rate for Payer: United Healthcare All Payer |
$4,125.88
|
| Rate for Payer: Aetna Commercial |
$3,610.14
|
| Rate for Payer: Anthem Medicaid |
$1,612.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.03
|
| Rate for Payer: Cash Price |
$2,344.25
|
| Rate for Payer: Cigna Commercial |
$3,891.46
|
| Rate for Payer: First Health Commercial |
$4,454.08
|
|
|
PLATE ULNAR COL SMARTLCK SHT L
|
Facility
|
IP
|
$4,006.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$3,845.89 |
| Rate for Payer: Aetna Commercial |
$3,084.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,124.79
|
| Rate for Payer: Cash Price |
$2,003.07
|
| Rate for Payer: Cigna Commercial |
$3,325.10
|
| Rate for Payer: First Health Commercial |
$3,805.83
|
| Rate for Payer: Humana Commercial |
$3,405.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.90
|
| Rate for Payer: PHCS Commercial |
$3,845.89
|
| Rate for Payer: United Healthcare All Payer |
$3,525.40
|
|
|
PLATE ULNAR COL SMARTLCK SHT L
|
Facility
|
OP
|
$4,006.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$3,845.89 |
| Rate for Payer: Aetna Commercial |
$3,084.73
|
| Rate for Payer: Anthem Medicaid |
$1,377.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,124.79
|
| Rate for Payer: Cash Price |
$2,003.07
|
| Rate for Payer: Cigna Commercial |
$3,325.10
|
| Rate for Payer: First Health Commercial |
$3,805.83
|
| Rate for Payer: Humana Commercial |
$3,405.22
|
| Rate for Payer: Humana KY Medicaid |
$1,377.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,391.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,405.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.90
|
| Rate for Payer: PHCS Commercial |
$3,845.89
|
| Rate for Payer: United Healthcare All Payer |
$3,525.40
|
|
|
PLATE ULNAR COL SMARTLCK SHT R
|
Facility
|
IP
|
$4,006.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$3,845.89 |
| Rate for Payer: Aetna Commercial |
$3,084.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,124.79
|
| Rate for Payer: Cash Price |
$2,003.07
|
| Rate for Payer: Cigna Commercial |
$3,325.10
|
| Rate for Payer: First Health Commercial |
$3,805.83
|
| Rate for Payer: Humana Commercial |
$3,405.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.90
|
| Rate for Payer: PHCS Commercial |
$3,845.89
|
| Rate for Payer: United Healthcare All Payer |
$3,525.40
|
|
|
PLATE ULNAR COL SMARTLCK SHT R
|
Facility
|
OP
|
$4,006.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$520.80 |
| Max. Negotiated Rate |
$3,845.89 |
| Rate for Payer: Aetna Commercial |
$3,084.73
|
| Rate for Payer: Anthem Medicaid |
$1,377.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,124.79
|
| Rate for Payer: Cash Price |
$2,003.07
|
| Rate for Payer: Cigna Commercial |
$3,325.10
|
| Rate for Payer: First Health Commercial |
$3,805.83
|
| Rate for Payer: Humana Commercial |
$3,405.22
|
| Rate for Payer: Humana KY Medicaid |
$1,377.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,391.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,405.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$801.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$520.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,241.90
|
| Rate for Payer: PHCS Commercial |
$3,845.89
|
| Rate for Payer: United Healthcare All Payer |
$3,525.40
|
|
|
PLATE UNIV 5TH METARSAL HOOK
|
Facility
|
IP
|
$5,437.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$706.88 |
| Max. Negotiated Rate |
$5,220.00 |
| Rate for Payer: Aetna Commercial |
$4,186.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,241.25
|
| Rate for Payer: Cash Price |
$2,718.75
|
| Rate for Payer: Cigna Commercial |
$4,513.12
|
| Rate for Payer: First Health Commercial |
$5,165.62
|
| Rate for Payer: Humana Commercial |
$4,621.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,458.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,012.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,631.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,785.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,078.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$706.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,685.62
|
| Rate for Payer: PHCS Commercial |
$5,220.00
|
| Rate for Payer: United Healthcare All Payer |
$4,785.00
|
|
|
PLATE UNIV 5TH METARSAL HOOK
|
Facility
|
OP
|
$5,437.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$706.88 |
| Max. Negotiated Rate |
$5,220.00 |
| Rate for Payer: Aetna Commercial |
$4,186.88
|
| Rate for Payer: Anthem Medicaid |
$1,869.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,241.25
|
| Rate for Payer: Cash Price |
$2,718.75
|
| Rate for Payer: Cigna Commercial |
$4,513.12
|
| Rate for Payer: First Health Commercial |
$5,165.62
|
| Rate for Payer: Humana Commercial |
$4,621.88
|
| Rate for Payer: Humana KY Medicaid |
$1,869.96
|
| Rate for Payer: Kentucky WC Medicaid |
$1,888.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,458.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,012.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,631.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,907.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,785.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,078.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,087.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$706.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,685.62
|
| Rate for Payer: PHCS Commercial |
$5,220.00
|
| Rate for Payer: United Healthcare All Payer |
$4,785.00
|
|
|
PLATE UNIV LOCKING FIB 4H 53MM
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKING FIB 4H 53MM
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKING FIB 6H 76MM
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKING FIB 6H 76MM
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKING FIB 8H 99MM
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKING FIB 8H 99MM
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKNG FIB 10H 121M
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKNG FIB 10H 121M
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKNG FIB 12H 144M
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKNG FIB 12H 144M
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKNG FIB 14H 167M
|
Facility
|
IP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Aetna Commercial |
$1,659.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
|
|
PLATE UNIV LOCKNG FIB 14H 167M
|
Facility
|
OP
|
$2,155.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$280.15 |
| Max. Negotiated Rate |
$2,068.80 |
| Rate for Payer: Anthem Medicaid |
$741.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,680.90
|
| Rate for Payer: Cash Price |
$1,077.50
|
| Rate for Payer: Cigna Commercial |
$1,788.65
|
| Rate for Payer: First Health Commercial |
$2,047.25
|
| Rate for Payer: Humana Commercial |
$1,831.75
|
| Rate for Payer: Humana KY Medicaid |
$741.10
|
| Rate for Payer: Kentucky WC Medicaid |
$748.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,767.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,590.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$646.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$755.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,896.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,616.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$431.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$280.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$668.05
|
| Rate for Payer: PHCS Commercial |
$2,068.80
|
| Rate for Payer: United Healthcare All Payer |
$1,896.40
|
| Rate for Payer: Aetna Commercial |
$1,659.35
|
|
|
PLATE UNIV RADIAL 5H
|
Facility
|
IP
|
$4,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
|
|
PLATE UNIV RADIAL 5H
|
Facility
|
OP
|
$4,902.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.26 |
| Max. Negotiated Rate |
$4,705.92 |
| Rate for Payer: Aetna Commercial |
$3,774.54
|
| Rate for Payer: Anthem Medicaid |
$1,685.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,823.56
|
| Rate for Payer: Cash Price |
$2,451.00
|
| Rate for Payer: Cigna Commercial |
$4,068.66
|
| Rate for Payer: First Health Commercial |
$4,656.90
|
| Rate for Payer: Humana Commercial |
$4,166.70
|
| Rate for Payer: Humana KY Medicaid |
$1,685.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,702.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,019.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,617.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,470.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,719.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,313.76
|
| Rate for Payer: Ohio Health Group HMO |
$3,676.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$980.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$637.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,519.62
|
| Rate for Payer: PHCS Commercial |
$4,705.92
|
| Rate for Payer: United Healthcare All Payer |
$4,313.76
|
|
