|
PLATE TI VA-LP 5H 2.4*55-20 3H
|
Facility
|
OP
|
$4,298.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.61 |
| Max. Negotiated Rate |
$4,126.76 |
| Rate for Payer: Aetna Commercial |
$3,310.01
|
| Rate for Payer: Anthem Medicaid |
$1,478.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,352.99
|
| Rate for Payer: Cash Price |
$2,149.36
|
| Rate for Payer: Cigna Commercial |
$3,567.93
|
| Rate for Payer: First Health Commercial |
$4,083.77
|
| Rate for Payer: Humana Commercial |
$3,653.90
|
| Rate for Payer: Humana KY Medicaid |
$1,478.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,524.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,507.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,782.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,438.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,739.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.11
|
| Rate for Payer: PHCS Commercial |
$4,126.76
|
| Rate for Payer: United Healthcare All Payer |
$3,782.86
|
|
|
PLATE TI VA-LP 5H 2.4*55-20 3H
|
Facility
|
IP
|
$4,298.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,289.61 |
| Max. Negotiated Rate |
$4,126.76 |
| Rate for Payer: Aetna Commercial |
$3,310.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,352.99
|
| Rate for Payer: Cash Price |
$2,149.36
|
| Rate for Payer: Cigna Commercial |
$3,567.93
|
| Rate for Payer: First Health Commercial |
$4,083.77
|
| Rate for Payer: Humana Commercial |
$3,653.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,524.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,172.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,289.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,782.86
|
| Rate for Payer: Ohio Health Group HMO |
$3,224.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,438.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,739.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,966.11
|
| Rate for Payer: PHCS Commercial |
$4,126.76
|
| Rate for Payer: United Healthcare All Payer |
$3,782.86
|
|
|
PLATE TI VA-LP 5HS 2.4*57 L 6H
|
Facility
|
OP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem Medicaid |
$1,969.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Humana KY Medicaid |
$1,969.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,989.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,008.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI VA-LP 5HS 2.4*57 L 6H
|
Facility
|
IP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI VA-LP 5HS 2.4*57 L 7H
|
Facility
|
IP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI VA-LP 5HS 2.4*57 L 7H
|
Facility
|
OP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem Medicaid |
$1,969.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Humana KY Medicaid |
$1,969.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,989.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,008.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 6H
|
Facility
|
OP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem Medicaid |
$1,969.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Humana KY Medicaid |
$1,969.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,989.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,008.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 6H
|
Facility
|
IP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 7H
|
Facility
|
OP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem Medicaid |
$1,969.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Humana KY Medicaid |
$1,969.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,989.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,008.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI VA-LP 5HS 2.4*57 R 7H
|
Facility
|
IP
|
$5,726.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,717.95 |
| Max. Negotiated Rate |
$5,497.43 |
| Rate for Payer: Aetna Commercial |
$4,409.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,466.66
|
| Rate for Payer: Cash Price |
$2,863.24
|
| Rate for Payer: Cigna Commercial |
$4,752.99
|
| Rate for Payer: First Health Commercial |
$5,440.17
|
| Rate for Payer: Humana Commercial |
$4,867.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,695.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,226.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,717.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,039.31
|
| Rate for Payer: Ohio Health Group HMO |
$4,294.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,581.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,982.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,951.28
|
| Rate for Payer: PHCS Commercial |
$5,497.43
|
| Rate for Payer: United Healthcare All Payer |
$5,039.31
|
|
|
PLATE TI WRIST FUSION 8 HOLE
|
Facility
|
IP
|
$4,265.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,279.50 |
| Max. Negotiated Rate |
$4,094.40 |
| Rate for Payer: Aetna Commercial |
$3,284.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,326.70
|
| Rate for Payer: Cash Price |
$2,132.50
|
| Rate for Payer: Cigna Commercial |
$3,539.95
|
| Rate for Payer: First Health Commercial |
$4,051.75
|
| Rate for Payer: Humana Commercial |
$3,625.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,497.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,147.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,753.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,710.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.85
|
| Rate for Payer: PHCS Commercial |
$4,094.40
|
| Rate for Payer: United Healthcare All Payer |
$3,753.20
|
|
|
PLATE TI WRIST FUSION 8 HOLE
|
Facility
|
OP
|
$4,265.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,279.50 |
| Max. Negotiated Rate |
$4,094.40 |
| Rate for Payer: Aetna Commercial |
$3,284.05
|
| Rate for Payer: Anthem Medicaid |
$1,466.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,326.70
|
| Rate for Payer: Cash Price |
$2,132.50
|
| Rate for Payer: Cigna Commercial |
$3,539.95
|
| Rate for Payer: First Health Commercial |
$4,051.75
|
| Rate for Payer: Humana Commercial |
$3,625.25
|
| Rate for Payer: Humana KY Medicaid |
$1,466.73
|
| Rate for Payer: Kentucky WC Medicaid |
$1,481.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,497.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,147.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,279.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,496.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,753.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,198.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,412.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,710.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,942.85
|
| Rate for Payer: PHCS Commercial |
$4,094.40
|
| Rate for Payer: United Healthcare All Payer |
$3,753.20
|
|
|
PLATE TI WRIST FUSION 9 HOLE
|
Facility
|
OP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.50 |
| Max. Negotiated Rate |
$4,180.80 |
| Rate for Payer: Aetna Commercial |
$3,353.35
|
| Rate for Payer: Anthem Medicaid |
$1,497.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.90
|
| Rate for Payer: Cash Price |
$2,177.50
|
| Rate for Payer: Cigna Commercial |
$3,614.65
|
| Rate for Payer: First Health Commercial |
$4,137.25
|
| Rate for Payer: Humana Commercial |
$3,701.75
|
| Rate for Payer: Humana KY Medicaid |
$1,497.68
|
| Rate for Payer: Kentucky WC Medicaid |
$1,512.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,213.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,527.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.95
|
| Rate for Payer: PHCS Commercial |
$4,180.80
|
| Rate for Payer: United Healthcare All Payer |
$3,832.40
|
|
|
PLATE TI WRIST FUSION 9 HOLE
|
Facility
|
IP
|
$4,355.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,306.50 |
| Max. Negotiated Rate |
$4,180.80 |
| Rate for Payer: Aetna Commercial |
$3,353.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,396.90
|
| Rate for Payer: Cash Price |
$2,177.50
|
| Rate for Payer: Cigna Commercial |
$3,614.65
|
| Rate for Payer: First Health Commercial |
$4,137.25
|
| Rate for Payer: Humana Commercial |
$3,701.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,571.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,213.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,306.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,832.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,266.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,484.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,788.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,004.95
|
| Rate for Payer: PHCS Commercial |
$4,180.80
|
| Rate for Payer: United Healthcare All Payer |
$3,832.40
|
|
|
PLATE T LOPRO 3.0MM 3H TI
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T LOPRO 3.0MM 3H TI
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T LOPRO 3.0MM 4H TI
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T LOPRO 3.0MM 4H TI
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE T-METATAR 4 HOLE
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PLATE T-METATAR 4 HOLE
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PLATE T OBLIQUE 3H 52MM
|
Facility
|
IP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE T OBLIQUE 3H 52MM
|
Facility
|
OP
|
$2,066.27
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$619.88 |
| Max. Negotiated Rate |
$1,983.62 |
| Rate for Payer: Aetna Commercial |
$1,591.03
|
| Rate for Payer: Anthem Medicaid |
$710.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,611.69
|
| Rate for Payer: Cash Price |
$1,033.13
|
| Rate for Payer: Cigna Commercial |
$1,715.00
|
| Rate for Payer: First Health Commercial |
$1,962.96
|
| Rate for Payer: Humana Commercial |
$1,756.33
|
| Rate for Payer: Humana KY Medicaid |
$710.59
|
| Rate for Payer: Kentucky WC Medicaid |
$717.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,694.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,524.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$619.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$724.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,818.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,549.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,653.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,797.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,425.73
|
| Rate for Payer: PHCS Commercial |
$1,983.62
|
| Rate for Payer: United Healthcare All Payer |
$1,818.32
|
|
|
PLATE T OBLIQUE 3H 71829613
|
Facility
|
IP
|
$2,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,995.84 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,621.62
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cigna Commercial |
$1,725.57
|
| Rate for Payer: First Health Commercial |
$1,975.05
|
| Rate for Payer: Humana Commercial |
$1,767.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,704.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,829.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,559.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,808.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.51
|
| Rate for Payer: PHCS Commercial |
$1,995.84
|
| Rate for Payer: United Healthcare All Payer |
$1,829.52
|
|
|
PLATE T OBLIQUE 3H 71829613
|
Facility
|
OP
|
$2,079.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.70 |
| Max. Negotiated Rate |
$1,995.84 |
| Rate for Payer: Aetna Commercial |
$1,600.83
|
| Rate for Payer: Anthem Medicaid |
$714.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,621.62
|
| Rate for Payer: Cash Price |
$1,039.50
|
| Rate for Payer: Cigna Commercial |
$1,725.57
|
| Rate for Payer: First Health Commercial |
$1,975.05
|
| Rate for Payer: Humana Commercial |
$1,767.15
|
| Rate for Payer: Humana KY Medicaid |
$714.97
|
| Rate for Payer: Kentucky WC Medicaid |
$722.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,704.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,534.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$623.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$729.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,829.52
|
| Rate for Payer: Ohio Health Group HMO |
$1,559.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,663.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,808.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,434.51
|
| Rate for Payer: PHCS Commercial |
$1,995.84
|
| Rate for Payer: United Healthcare All Payer |
$1,829.52
|
|
|
PLATE T OBLIQUE 4H 63MM
|
Facility
|
OP
|
$2,108.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$632.53 |
| Max. Negotiated Rate |
$2,024.11 |
| Rate for Payer: Aetna Commercial |
$1,623.51
|
| Rate for Payer: Anthem Medicaid |
$725.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,644.59
|
| Rate for Payer: Cash Price |
$1,054.22
|
| Rate for Payer: Cigna Commercial |
$1,750.01
|
| Rate for Payer: First Health Commercial |
$2,003.03
|
| Rate for Payer: Humana Commercial |
$1,792.18
|
| Rate for Payer: Humana KY Medicaid |
$725.10
|
| Rate for Payer: Kentucky WC Medicaid |
$732.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,728.93
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$739.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,855.44
|
| Rate for Payer: Ohio Health Group HMO |
$1,581.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,686.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,834.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,454.83
|
| Rate for Payer: PHCS Commercial |
$2,024.11
|
| Rate for Payer: United Healthcare All Payer |
$1,855.44
|
|
