|
ACCORD 200MM TITANIUM PLATE
|
Facility
|
OP
|
$5,316.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.95 |
| Max. Negotiated Rate |
$5,103.84 |
| Rate for Payer: Aetna Commercial |
$4,093.70
|
| Rate for Payer: Anthem Medicaid |
$1,828.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,146.87
|
| Rate for Payer: Cash Price |
$2,658.25
|
| Rate for Payer: Cigna Commercial |
$4,412.69
|
| Rate for Payer: First Health Commercial |
$5,050.68
|
| Rate for Payer: Humana Commercial |
$4,519.02
|
| Rate for Payer: Humana KY Medicaid |
$1,828.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,846.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,359.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,923.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,865.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,678.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,987.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,253.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,625.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,668.39
|
| Rate for Payer: PHCS Commercial |
$5,103.84
|
| Rate for Payer: United Healthcare All Payer |
$4,678.52
|
|
|
ACCORD 200MM TITANIUM PLATE
|
Facility
|
IP
|
$5,316.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,594.95 |
| Max. Negotiated Rate |
$5,103.84 |
| Rate for Payer: Aetna Commercial |
$4,093.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,146.87
|
| Rate for Payer: Cash Price |
$2,658.25
|
| Rate for Payer: Cigna Commercial |
$4,412.69
|
| Rate for Payer: First Health Commercial |
$5,050.68
|
| Rate for Payer: Humana Commercial |
$4,519.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,359.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,923.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,594.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,678.52
|
| Rate for Payer: Ohio Health Group HMO |
$3,987.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,253.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,625.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,668.39
|
| Rate for Payer: PHCS Commercial |
$5,103.84
|
| Rate for Payer: United Healthcare All Payer |
$4,678.52
|
|
|
ACCORD 250MM TITANIUM PLATE
|
Facility
|
IP
|
$7,227.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.20 |
| Max. Negotiated Rate |
$6,938.23 |
| Rate for Payer: Aetna Commercial |
$5,565.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.31
|
| Rate for Payer: Cash Price |
$3,613.66
|
| Rate for Payer: Cigna Commercial |
$5,998.68
|
| Rate for Payer: First Health Commercial |
$6,865.95
|
| Rate for Payer: Humana Commercial |
$6,143.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,926.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,333.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,420.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,781.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,287.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,986.85
|
| Rate for Payer: PHCS Commercial |
$6,938.23
|
| Rate for Payer: United Healthcare All Payer |
$6,360.04
|
|
|
ACCORD 250MM TITANIUM PLATE
|
Facility
|
OP
|
$7,227.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,168.20 |
| Max. Negotiated Rate |
$6,938.23 |
| Rate for Payer: Aetna Commercial |
$5,565.04
|
| Rate for Payer: Anthem Medicaid |
$2,485.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,637.31
|
| Rate for Payer: Cash Price |
$3,613.66
|
| Rate for Payer: Cigna Commercial |
$5,998.68
|
| Rate for Payer: First Health Commercial |
$6,865.95
|
| Rate for Payer: Humana Commercial |
$6,143.22
|
| Rate for Payer: Humana KY Medicaid |
$2,485.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,510.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,926.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,333.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,168.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,535.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,360.04
|
| Rate for Payer: Ohio Health Group HMO |
$5,420.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,781.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,287.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,986.85
|
| Rate for Payer: PHCS Commercial |
$6,938.23
|
| Rate for Payer: United Healthcare All Payer |
$6,360.04
|
|
|
ACCORD GUIDEWIRE .040 (1.02M)
|
Facility
|
OP
|
$1,556.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.88 |
| Max. Negotiated Rate |
$1,494.00 |
| Rate for Payer: Aetna Commercial |
$1,198.31
|
| Rate for Payer: Anthem Medicaid |
$535.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.88
|
| Rate for Payer: Cash Price |
$778.12
|
| Rate for Payer: Cigna Commercial |
$1,291.69
|
| Rate for Payer: First Health Commercial |
$1,478.44
|
| Rate for Payer: Humana Commercial |
$1,322.81
|
| Rate for Payer: Humana KY Medicaid |
$535.19
|
| Rate for Payer: Kentucky WC Medicaid |
$540.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,276.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$545.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,369.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,167.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,353.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.81
|
| Rate for Payer: PHCS Commercial |
$1,494.00
|
| Rate for Payer: United Healthcare All Payer |
$1,369.50
|
|
|
ACCORD GUIDEWIRE .040 (1.02M)
|
Facility
|
IP
|
$1,556.25
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
27000056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.88 |
| Max. Negotiated Rate |
$1,494.00 |
| Rate for Payer: Aetna Commercial |
$1,198.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,213.88
|
| Rate for Payer: Cash Price |
$778.12
|
| Rate for Payer: Cigna Commercial |
$1,291.69
|
| Rate for Payer: First Health Commercial |
$1,478.44
|
| Rate for Payer: Humana Commercial |
$1,322.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,276.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,148.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$466.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,369.50
|
| Rate for Payer: Ohio Health Group HMO |
$1,167.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,245.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,353.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,073.81
|
| Rate for Payer: PHCS Commercial |
$1,494.00
|
| Rate for Payer: United Healthcare All Payer |
$1,369.50
|
|
|
ACCUFILL INJ BONE SUB MAT 3CC
|
Facility
|
IP
|
$12,227.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,668.18 |
| Max. Negotiated Rate |
$11,738.17 |
| Rate for Payer: Aetna Commercial |
$9,414.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,537.26
|
| Rate for Payer: Cash Price |
$6,113.63
|
| Rate for Payer: Cigna Commercial |
$10,148.63
|
| Rate for Payer: First Health Commercial |
$11,615.90
|
| Rate for Payer: Humana Commercial |
$10,393.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,026.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,023.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,668.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,759.99
|
| Rate for Payer: Ohio Health Group HMO |
$9,170.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,781.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,637.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,436.81
|
| Rate for Payer: PHCS Commercial |
$11,738.17
|
| Rate for Payer: United Healthcare All Payer |
$10,759.99
|
|
|
ACCUFILL INJ BONE SUB MAT 3CC
|
Facility
|
OP
|
$12,227.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,668.18 |
| Max. Negotiated Rate |
$11,738.17 |
| Rate for Payer: Aetna Commercial |
$9,414.99
|
| Rate for Payer: Anthem Medicaid |
$4,204.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,537.26
|
| Rate for Payer: Cash Price |
$6,113.63
|
| Rate for Payer: Cigna Commercial |
$10,148.63
|
| Rate for Payer: First Health Commercial |
$11,615.90
|
| Rate for Payer: Humana Commercial |
$10,393.17
|
| Rate for Payer: Humana KY Medicaid |
$4,204.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,247.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,026.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,023.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,668.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,289.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,759.99
|
| Rate for Payer: Ohio Health Group HMO |
$9,170.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,781.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,637.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,436.81
|
| Rate for Payer: PHCS Commercial |
$11,738.17
|
| Rate for Payer: United Healthcare All Payer |
$10,759.99
|
|
|
ACCUPRIL (QUINAPRIL) 20MG TAB
|
Facility
|
IP
|
$22.16
|
|
|
Service Code
|
NDC 71053223
|
| Hospital Charge Code |
25000137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.29
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACCUPRIL (QUINAPRIL) 20MG TAB
|
Facility
|
OP
|
$22.16
|
|
|
Service Code
|
NDC 71053223
|
| Hospital Charge Code |
25000137
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Anthem Medicaid |
$7.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Humana KY Medicaid |
$7.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.29
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACCUPRIL(QUINAPRIL)5 MG TABLET
|
Facility
|
OP
|
$22.16
|
|
|
Service Code
|
NDC 71052723
|
| Hospital Charge Code |
25000138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Anthem Medicaid |
$7.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Humana KY Medicaid |
$7.62
|
| Rate for Payer: Kentucky WC Medicaid |
$7.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$7.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.29
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACCUPRIL(QUINAPRIL)5 MG TABLET
|
Facility
|
IP
|
$22.16
|
|
|
Service Code
|
NDC 71052723
|
| Hospital Charge Code |
25000138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.65 |
| Max. Negotiated Rate |
$21.27 |
| Rate for Payer: Aetna Commercial |
$17.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$17.28
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna Commercial |
$18.39
|
| Rate for Payer: First Health Commercial |
$21.05
|
| Rate for Payer: Humana Commercial |
$18.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$18.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$16.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$6.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$19.50
|
| Rate for Payer: Ohio Health Group HMO |
$16.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$17.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$19.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$15.29
|
| Rate for Payer: PHCS Commercial |
$21.27
|
| Rate for Payer: United Healthcare All Payer |
$19.50
|
|
|
ACEBTABULAR SHELL 3 HOLE 52MM
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
ACEBTABULAR SHELL 3 HOLE 52MM
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
ACE CHS PLATE 10 HOLE
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 10 HOLE
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 12 HOLE
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 12 HOLE
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 14 HOLE
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 14 HOLE
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 2 HOLE
|
Facility
|
OP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem Medicaid |
$1,024.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Humana KY Medicaid |
$1,024.39
|
| Rate for Payer: Kentucky WC Medicaid |
$1,034.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,044.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 2 HOLE
|
Facility
|
IP
|
$2,978.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.62 |
| Max. Negotiated Rate |
$2,859.60 |
| Rate for Payer: Aetna Commercial |
$2,293.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,323.43
|
| Rate for Payer: Cash Price |
$1,489.38
|
| Rate for Payer: Cigna Commercial |
$2,472.36
|
| Rate for Payer: First Health Commercial |
$2,829.81
|
| Rate for Payer: Humana Commercial |
$2,531.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,442.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,198.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$893.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,621.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,234.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,383.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,591.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,055.34
|
| Rate for Payer: PHCS Commercial |
$2,859.60
|
| Rate for Payer: United Healthcare All Payer |
$2,621.30
|
|
|
ACE CHS PLATE 4 HOLE
|
Facility
|
IP
|
$3,106.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
ACE CHS PLATE 4 HOLE
|
Facility
|
OP
|
$3,106.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.88 |
| Max. Negotiated Rate |
$2,982.00 |
| Rate for Payer: Aetna Commercial |
$2,391.81
|
| Rate for Payer: Anthem Medicaid |
$1,068.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,422.88
|
| Rate for Payer: Cash Price |
$1,553.12
|
| Rate for Payer: Cigna Commercial |
$2,578.19
|
| Rate for Payer: First Health Commercial |
$2,950.94
|
| Rate for Payer: Humana Commercial |
$2,640.31
|
| Rate for Payer: Humana KY Medicaid |
$1,068.24
|
| Rate for Payer: Kentucky WC Medicaid |
$1,079.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,547.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,292.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$931.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,089.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,733.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,329.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,702.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,143.31
|
| Rate for Payer: PHCS Commercial |
$2,982.00
|
| Rate for Payer: United Healthcare All Payer |
$2,733.50
|
|
|
ACE CHS PLATE 6 HOLE
|
Facility
|
OP
|
$3,087.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$926.25 |
| Max. Negotiated Rate |
$2,964.00 |
| Rate for Payer: Aetna Commercial |
$2,377.38
|
| Rate for Payer: Anthem Medicaid |
$1,061.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,408.25
|
| Rate for Payer: Cash Price |
$1,543.75
|
| Rate for Payer: Cigna Commercial |
$2,562.62
|
| Rate for Payer: First Health Commercial |
$2,933.12
|
| Rate for Payer: Humana Commercial |
$2,624.38
|
| Rate for Payer: Humana KY Medicaid |
$1,061.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,072.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,531.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,278.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$926.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,083.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,717.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,315.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,470.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,686.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,130.38
|
| Rate for Payer: PHCS Commercial |
$2,964.00
|
| Rate for Payer: United Healthcare All Payer |
$2,717.00
|
|
