|
ACE PLATE COMPRESSION 3.5MM 9H
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
|
ACE PLATE (L) 6 HOLE RIGHT
|
Facility
|
IP
|
$3,219.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.50 |
| Max. Negotiated Rate |
$3,090.43 |
| Rate for Payer: Aetna Commercial |
$2,478.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.98
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cigna Commercial |
$2,671.94
|
| Rate for Payer: First Health Commercial |
$3,058.24
|
| Rate for Payer: Humana Commercial |
$2,736.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.95
|
| Rate for Payer: PHCS Commercial |
$3,090.43
|
| Rate for Payer: United Healthcare All Payer |
$2,832.90
|
|
|
ACE PLATE (L) 6 HOLE RIGHT
|
Facility
|
OP
|
$3,219.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$418.50 |
| Max. Negotiated Rate |
$3,090.43 |
| Rate for Payer: Aetna Commercial |
$2,478.78
|
| Rate for Payer: Anthem Medicaid |
$1,107.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,510.98
|
| Rate for Payer: Cash Price |
$1,609.60
|
| Rate for Payer: Cigna Commercial |
$2,671.94
|
| Rate for Payer: First Health Commercial |
$3,058.24
|
| Rate for Payer: Humana Commercial |
$2,736.32
|
| Rate for Payer: Humana KY Medicaid |
$1,107.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,118.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,639.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,375.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$965.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,129.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,832.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,414.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$643.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$418.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$997.95
|
| Rate for Payer: PHCS Commercial |
$3,090.43
|
| Rate for Payer: United Healthcare All Payer |
$2,832.90
|
|
|
ACE PLATE TUBULAR 12 HOLE
|
Facility
|
IP
|
$1,116.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$1,071.94 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.95
|
| Rate for Payer: Cash Price |
$558.30
|
| Rate for Payer: Cigna Commercial |
$926.78
|
| Rate for Payer: First Health Commercial |
$1,060.77
|
| Rate for Payer: Humana Commercial |
$949.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.61
|
| Rate for Payer: Ohio Health Group HMO |
$837.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.15
|
| Rate for Payer: PHCS Commercial |
$1,071.94
|
| Rate for Payer: United Healthcare All Payer |
$982.61
|
|
|
ACE PLATE TUBULAR 12 HOLE
|
Facility
|
OP
|
$1,116.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$1,071.94 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Anthem Medicaid |
$384.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.95
|
| Rate for Payer: Cash Price |
$558.30
|
| Rate for Payer: Cigna Commercial |
$926.78
|
| Rate for Payer: First Health Commercial |
$1,060.77
|
| Rate for Payer: Humana Commercial |
$949.11
|
| Rate for Payer: Humana KY Medicaid |
$384.00
|
| Rate for Payer: Kentucky WC Medicaid |
$387.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.61
|
| Rate for Payer: Ohio Health Group HMO |
$837.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.15
|
| Rate for Payer: PHCS Commercial |
$1,071.94
|
| Rate for Payer: United Healthcare All Payer |
$982.61
|
|
|
ACE PLATE TUBULAR 3 HOLE
|
Facility
|
OP
|
$1,082.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.69 |
| Max. Negotiated Rate |
$1,038.91 |
| Rate for Payer: Anthem Medicaid |
$372.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.12
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cigna Commercial |
$898.23
|
| Rate for Payer: First Health Commercial |
$1,028.09
|
| Rate for Payer: Humana Commercial |
$919.87
|
| Rate for Payer: Humana KY Medicaid |
$372.17
|
| Rate for Payer: Kentucky WC Medicaid |
$375.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$887.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$798.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$379.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$952.34
|
| Rate for Payer: Ohio Health Group HMO |
$811.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.48
|
| Rate for Payer: PHCS Commercial |
$1,038.91
|
| Rate for Payer: United Healthcare All Payer |
$952.34
|
| Rate for Payer: Aetna Commercial |
$833.29
|
|
|
ACE PLATE TUBULAR 3 HOLE
|
Facility
|
IP
|
$1,082.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.69 |
| Max. Negotiated Rate |
$1,038.91 |
| Rate for Payer: Aetna Commercial |
$833.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$844.12
|
| Rate for Payer: Cash Price |
$541.10
|
| Rate for Payer: Cigna Commercial |
$898.23
|
| Rate for Payer: First Health Commercial |
$1,028.09
|
| Rate for Payer: Humana Commercial |
$919.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$887.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$798.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$324.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$952.34
|
| Rate for Payer: Ohio Health Group HMO |
$811.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$216.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$140.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$335.48
|
| Rate for Payer: PHCS Commercial |
$1,038.91
|
| Rate for Payer: United Healthcare All Payer |
$952.34
|
|
|
ACE PLATE TUBULAR 4 HOLE
|
Facility
|
IP
|
$1,116.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$1,071.94 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.95
|
| Rate for Payer: Cash Price |
$558.30
|
| Rate for Payer: Cigna Commercial |
$926.78
|
| Rate for Payer: First Health Commercial |
$1,060.77
|
| Rate for Payer: Humana Commercial |
$949.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.61
|
| Rate for Payer: Ohio Health Group HMO |
$837.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.15
|
| Rate for Payer: PHCS Commercial |
$1,071.94
|
| Rate for Payer: United Healthcare All Payer |
$982.61
|
|
|
ACE PLATE TUBULAR 4 HOLE
|
Facility
|
OP
|
$1,116.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.16 |
| Max. Negotiated Rate |
$1,071.94 |
| Rate for Payer: Aetna Commercial |
$859.78
|
| Rate for Payer: Anthem Medicaid |
$384.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$870.95
|
| Rate for Payer: Cash Price |
$558.30
|
| Rate for Payer: Cigna Commercial |
$926.78
|
| Rate for Payer: First Health Commercial |
$1,060.77
|
| Rate for Payer: Humana Commercial |
$949.11
|
| Rate for Payer: Humana KY Medicaid |
$384.00
|
| Rate for Payer: Kentucky WC Medicaid |
$387.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$915.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$824.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$334.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$391.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$982.61
|
| Rate for Payer: Ohio Health Group HMO |
$837.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$223.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$145.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$346.15
|
| Rate for Payer: PHCS Commercial |
$1,071.94
|
| Rate for Payer: United Healthcare All Payer |
$982.61
|
|
|
ACE PLATE TUBULAR 5 HOLE
|
Facility
|
IP
|
$1,707.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$1,638.72 |
| Rate for Payer: Aetna Commercial |
$1,314.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,331.46
|
| Rate for Payer: Cash Price |
$853.50
|
| Rate for Payer: Cigna Commercial |
$1,416.81
|
| Rate for Payer: First Health Commercial |
$1,621.65
|
| Rate for Payer: Humana Commercial |
$1,450.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,502.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,280.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.17
|
| Rate for Payer: PHCS Commercial |
$1,638.72
|
| Rate for Payer: United Healthcare All Payer |
$1,502.16
|
|
|
ACE PLATE TUBULAR 5 HOLE
|
Facility
|
OP
|
$1,707.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.91 |
| Max. Negotiated Rate |
$1,638.72 |
| Rate for Payer: Aetna Commercial |
$1,314.39
|
| Rate for Payer: Anthem Medicaid |
$587.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,331.46
|
| Rate for Payer: Cash Price |
$853.50
|
| Rate for Payer: Cigna Commercial |
$1,416.81
|
| Rate for Payer: First Health Commercial |
$1,621.65
|
| Rate for Payer: Humana Commercial |
$1,450.95
|
| Rate for Payer: Humana KY Medicaid |
$587.04
|
| Rate for Payer: Kentucky WC Medicaid |
$593.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,399.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,259.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$512.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$598.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,502.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,280.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$341.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$529.17
|
| Rate for Payer: PHCS Commercial |
$1,638.72
|
| Rate for Payer: United Healthcare All Payer |
$1,502.16
|
|
|
ACE PLATE TUBULAR 6 HOLE
|
Facility
|
OP
|
$1,773.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.56 |
| Max. Negotiated Rate |
$1,702.56 |
| Rate for Payer: Aetna Commercial |
$1,365.60
|
| Rate for Payer: Anthem Medicaid |
$609.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.33
|
| Rate for Payer: Cash Price |
$886.75
|
| Rate for Payer: Cigna Commercial |
$1,472.00
|
| Rate for Payer: First Health Commercial |
$1,684.82
|
| Rate for Payer: Humana Commercial |
$1,507.48
|
| Rate for Payer: Humana KY Medicaid |
$609.91
|
| Rate for Payer: Kentucky WC Medicaid |
$616.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$622.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.78
|
| Rate for Payer: PHCS Commercial |
$1,702.56
|
| Rate for Payer: United Healthcare All Payer |
$1,560.68
|
|
|
ACE PLATE TUBULAR 6 HOLE
|
Facility
|
IP
|
$1,773.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.56 |
| Max. Negotiated Rate |
$1,702.56 |
| Rate for Payer: Aetna Commercial |
$1,365.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,383.33
|
| Rate for Payer: Cash Price |
$886.75
|
| Rate for Payer: Cigna Commercial |
$1,472.00
|
| Rate for Payer: First Health Commercial |
$1,684.82
|
| Rate for Payer: Humana Commercial |
$1,507.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,454.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,308.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$532.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,560.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,330.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$354.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$230.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$549.78
|
| Rate for Payer: PHCS Commercial |
$1,702.56
|
| Rate for Payer: United Healthcare All Payer |
$1,560.68
|
|
|
ACE PLATE TUBULAR 7 HOLE
|
Facility
|
OP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem Medicaid |
$594.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Humana KY Medicaid |
$594.26
|
| Rate for Payer: Kentucky WC Medicaid |
$600.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
|
ACE PLATE TUBULAR 7 HOLE
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
|
ACE PLATE TUBULAR 8 HOLE
|
Facility
|
OP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem Medicaid |
$594.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Humana KY Medicaid |
$594.26
|
| Rate for Payer: Kentucky WC Medicaid |
$600.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$606.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
|
ACE PLATE TUBULAR 8 HOLE
|
Facility
|
IP
|
$1,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$224.64 |
| Max. Negotiated Rate |
$1,658.88 |
| Rate for Payer: Aetna Commercial |
$1,330.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,347.84
|
| Rate for Payer: Cash Price |
$864.00
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: First Health Commercial |
$1,641.60
|
| Rate for Payer: Humana Commercial |
$1,468.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,416.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,275.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$518.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,520.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,296.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$345.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$224.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$535.68
|
| Rate for Payer: PHCS Commercial |
$1,658.88
|
| Rate for Payer: United Healthcare All Payer |
$1,520.64
|
|
|
ACE SCREW CANC LAG 4.0*14MM
|
Facility
|
OP
|
$1,091.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$1,047.91 |
| Rate for Payer: Aetna Commercial |
$840.51
|
| Rate for Payer: Anthem Medicaid |
$375.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.42
|
| Rate for Payer: Cash Price |
$545.79
|
| Rate for Payer: Cigna Commercial |
$906.00
|
| Rate for Payer: First Health Commercial |
$1,036.99
|
| Rate for Payer: Humana Commercial |
$927.83
|
| Rate for Payer: Humana KY Medicaid |
$375.39
|
| Rate for Payer: Kentucky WC Medicaid |
$379.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$382.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.58
|
| Rate for Payer: Ohio Health Group HMO |
$818.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.39
|
| Rate for Payer: PHCS Commercial |
$1,047.91
|
| Rate for Payer: United Healthcare All Payer |
$960.58
|
|
|
ACE SCREW CANC LAG 4.0*14MM
|
Facility
|
IP
|
$1,091.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$141.90 |
| Max. Negotiated Rate |
$1,047.91 |
| Rate for Payer: Aetna Commercial |
$840.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$851.42
|
| Rate for Payer: Cash Price |
$545.79
|
| Rate for Payer: Cigna Commercial |
$906.00
|
| Rate for Payer: First Health Commercial |
$1,036.99
|
| Rate for Payer: Humana Commercial |
$927.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$895.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$805.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$327.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$960.58
|
| Rate for Payer: Ohio Health Group HMO |
$818.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$218.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$141.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$338.39
|
| Rate for Payer: PHCS Commercial |
$1,047.91
|
| Rate for Payer: United Healthcare All Payer |
$960.58
|
|
|
ACE SCREW CANC LAG 4.0*16MM
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
ACE SCREW CANC LAG 4.0*16MM
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$95.55 |
| Max. Negotiated Rate |
$705.60 |
| Rate for Payer: Aetna Commercial |
$565.95
|
| Rate for Payer: Anthem Medicaid |
$252.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$573.30
|
| Rate for Payer: Cash Price |
$367.50
|
| Rate for Payer: Cigna Commercial |
$610.05
|
| Rate for Payer: First Health Commercial |
$698.25
|
| Rate for Payer: Humana Commercial |
$624.75
|
| Rate for Payer: Humana KY Medicaid |
$252.77
|
| Rate for Payer: Kentucky WC Medicaid |
$255.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$602.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$542.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$220.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$257.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$646.80
|
| Rate for Payer: Ohio Health Group HMO |
$551.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$147.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$95.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$227.85
|
| Rate for Payer: PHCS Commercial |
$705.60
|
| Rate for Payer: United Healthcare All Payer |
$646.80
|
|
|
ACE SCREW CANC LAG 4.0*18MM
|
Facility
|
OP
|
$1,125.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$1,080.19 |
| Rate for Payer: Aetna Commercial |
$866.40
|
| Rate for Payer: Anthem Medicaid |
$386.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.66
|
| Rate for Payer: Cash Price |
$562.60
|
| Rate for Payer: Cigna Commercial |
$933.92
|
| Rate for Payer: First Health Commercial |
$1,068.94
|
| Rate for Payer: Humana Commercial |
$956.42
|
| Rate for Payer: Humana KY Medicaid |
$386.96
|
| Rate for Payer: Kentucky WC Medicaid |
$390.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$394.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.18
|
| Rate for Payer: Ohio Health Group HMO |
$843.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.81
|
| Rate for Payer: PHCS Commercial |
$1,080.19
|
| Rate for Payer: United Healthcare All Payer |
$990.18
|
|
|
ACE SCREW CANC LAG 4.0*18MM
|
Facility
|
IP
|
$1,125.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$146.28 |
| Max. Negotiated Rate |
$1,080.19 |
| Rate for Payer: Aetna Commercial |
$866.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$877.66
|
| Rate for Payer: Cash Price |
$562.60
|
| Rate for Payer: Cigna Commercial |
$933.92
|
| Rate for Payer: First Health Commercial |
$1,068.94
|
| Rate for Payer: Humana Commercial |
$956.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$922.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$830.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$337.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$990.18
|
| Rate for Payer: Ohio Health Group HMO |
$843.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$225.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$146.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$348.81
|
| Rate for Payer: PHCS Commercial |
$1,080.19
|
| Rate for Payer: United Healthcare All Payer |
$990.18
|
|
|
ACETABULAR CUP 44MM
|
Facility
|
IP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
|
ACETABULAR CUP 44MM
|
Facility
|
OP
|
$27,758.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,608.60 |
| Max. Negotiated Rate |
$26,648.16 |
| Rate for Payer: Aetna Commercial |
$21,374.04
|
| Rate for Payer: Anthem Medicaid |
$9,546.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$21,651.63
|
| Rate for Payer: Cash Price |
$13,879.25
|
| Rate for Payer: Cigna Commercial |
$23,039.56
|
| Rate for Payer: First Health Commercial |
$26,370.58
|
| Rate for Payer: Humana Commercial |
$23,594.72
|
| Rate for Payer: Humana KY Medicaid |
$9,546.15
|
| Rate for Payer: Kentucky WC Medicaid |
$9,643.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$22,761.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$20,485.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$8,327.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,737.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$24,427.48
|
| Rate for Payer: Ohio Health Group HMO |
$20,818.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,551.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,608.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,605.14
|
| Rate for Payer: PHCS Commercial |
$26,648.16
|
| Rate for Payer: United Healthcare All Payer |
$24,427.48
|
|
