|
PLATE 1/3 TUB 8H 98 71829438
|
Facility
|
OP
|
$1,147.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$149.18 |
| Max. Negotiated Rate |
$1,101.66 |
| Rate for Payer: Aetna Commercial |
$883.62
|
| Rate for Payer: Anthem Medicaid |
$394.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$895.10
|
| Rate for Payer: Cash Price |
$573.78
|
| Rate for Payer: Cigna Commercial |
$952.47
|
| Rate for Payer: First Health Commercial |
$1,090.18
|
| Rate for Payer: Humana Commercial |
$975.43
|
| Rate for Payer: Humana KY Medicaid |
$394.65
|
| Rate for Payer: Kentucky WC Medicaid |
$398.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$941.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$846.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$344.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$402.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,009.85
|
| Rate for Payer: Ohio Health Group HMO |
$860.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$229.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$149.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$355.74
|
| Rate for Payer: PHCS Commercial |
$1,101.66
|
| Rate for Payer: United Healthcare All Payer |
$1,009.85
|
|
|
PLATE 1/3 TUB LCK 3.5M 5H 62M
|
Facility
|
IP
|
$2,024.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$1,943.14 |
| Rate for Payer: Aetna Commercial |
$1,558.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.80
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna Commercial |
$1,680.00
|
| Rate for Payer: First Health Commercial |
$1,922.90
|
| Rate for Payer: Humana Commercial |
$1,720.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.47
|
| Rate for Payer: PHCS Commercial |
$1,943.14
|
| Rate for Payer: United Healthcare All Payer |
$1,781.21
|
|
|
PLATE 1/3 TUB LCK 3.5M 5H 62M
|
Facility
|
OP
|
$2,024.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$1,943.14 |
| Rate for Payer: Aetna Commercial |
$1,558.56
|
| Rate for Payer: Anthem Medicaid |
$696.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,578.80
|
| Rate for Payer: Cash Price |
$1,012.05
|
| Rate for Payer: Cigna Commercial |
$1,680.00
|
| Rate for Payer: First Health Commercial |
$1,922.90
|
| Rate for Payer: Humana Commercial |
$1,720.48
|
| Rate for Payer: Humana KY Medicaid |
$696.09
|
| Rate for Payer: Kentucky WC Medicaid |
$703.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,659.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,493.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,781.21
|
| Rate for Payer: Ohio Health Group HMO |
$1,518.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$263.13
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$627.47
|
| Rate for Payer: PHCS Commercial |
$1,943.14
|
| Rate for Payer: United Healthcare All Payer |
$1,781.21
|
|
|
PLATE 1/3 TUB LCK 3.5M 6H 74M
|
Facility
|
IP
|
$2,112.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$2,027.81 |
| Rate for Payer: Aetna Commercial |
$1,626.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.59
|
| Rate for Payer: Cash Price |
$1,056.15
|
| Rate for Payer: Cigna Commercial |
$1,753.21
|
| Rate for Payer: First Health Commercial |
$2,006.68
|
| Rate for Payer: Humana Commercial |
$1,795.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,732.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,584.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.81
|
| Rate for Payer: PHCS Commercial |
$2,027.81
|
| Rate for Payer: United Healthcare All Payer |
$1,858.82
|
|
|
PLATE 1/3 TUB LCK 3.5M 6H 74M
|
Facility
|
OP
|
$2,112.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$2,027.81 |
| Rate for Payer: Anthem Medicaid |
$726.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,647.59
|
| Rate for Payer: Cash Price |
$1,056.15
|
| Rate for Payer: Cigna Commercial |
$1,753.21
|
| Rate for Payer: First Health Commercial |
$2,006.68
|
| Rate for Payer: Humana Commercial |
$1,795.46
|
| Rate for Payer: Humana KY Medicaid |
$726.42
|
| Rate for Payer: Kentucky WC Medicaid |
$733.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,732.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,558.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$633.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,858.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,584.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$422.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$654.81
|
| Rate for Payer: PHCS Commercial |
$2,027.81
|
| Rate for Payer: United Healthcare All Payer |
$1,858.82
|
| Rate for Payer: Aetna Commercial |
$1,626.47
|
|
|
PLATE 1/3 TUB LCK 3.5M 7H 86M
|
Facility
|
IP
|
$2,194.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$2,106.43 |
| Rate for Payer: Aetna Commercial |
$1,689.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,711.48
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$1,821.19
|
| Rate for Payer: First Health Commercial |
$2,084.49
|
| Rate for Payer: Humana Commercial |
$1,865.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,799.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,619.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,930.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,645.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$680.20
|
| Rate for Payer: PHCS Commercial |
$2,106.43
|
| Rate for Payer: United Healthcare All Payer |
$1,930.90
|
|
|
PLATE 1/3 TUB LCK 3.5M 7H 86M
|
Facility
|
OP
|
$2,194.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$285.25 |
| Max. Negotiated Rate |
$2,106.43 |
| Rate for Payer: Aetna Commercial |
$1,689.53
|
| Rate for Payer: Anthem Medicaid |
$754.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,711.48
|
| Rate for Payer: Cash Price |
$1,097.10
|
| Rate for Payer: Cigna Commercial |
$1,821.19
|
| Rate for Payer: First Health Commercial |
$2,084.49
|
| Rate for Payer: Humana Commercial |
$1,865.07
|
| Rate for Payer: Humana KY Medicaid |
$754.59
|
| Rate for Payer: Kentucky WC Medicaid |
$762.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,799.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,619.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$658.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$769.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,930.90
|
| Rate for Payer: Ohio Health Group HMO |
$1,645.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$438.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$285.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$680.20
|
| Rate for Payer: PHCS Commercial |
$2,106.43
|
| Rate for Payer: United Healthcare All Payer |
$1,930.90
|
|
|
PLATE 14H 3.5*189MM SM FRAG
|
Facility
|
IP
|
$3,856.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.38 |
| Max. Negotiated Rate |
$3,702.53 |
| Rate for Payer: Aetna Commercial |
$2,969.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.30
|
| Rate for Payer: Cash Price |
$1,928.40
|
| Rate for Payer: Cigna Commercial |
$3,201.14
|
| Rate for Payer: First Health Commercial |
$3,663.96
|
| Rate for Payer: Humana Commercial |
$3,278.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.61
|
| Rate for Payer: PHCS Commercial |
$3,702.53
|
| Rate for Payer: United Healthcare All Payer |
$3,393.98
|
|
|
PLATE 14H 3.5*189MM SM FRAG
|
Facility
|
OP
|
$3,856.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$501.38 |
| Max. Negotiated Rate |
$3,702.53 |
| Rate for Payer: Aetna Commercial |
$2,969.74
|
| Rate for Payer: Anthem Medicaid |
$1,326.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,008.30
|
| Rate for Payer: Cash Price |
$1,928.40
|
| Rate for Payer: Cigna Commercial |
$3,201.14
|
| Rate for Payer: First Health Commercial |
$3,663.96
|
| Rate for Payer: Humana Commercial |
$3,278.28
|
| Rate for Payer: Humana KY Medicaid |
$1,326.35
|
| Rate for Payer: Kentucky WC Medicaid |
$1,339.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,162.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,846.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,157.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,352.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,393.98
|
| Rate for Payer: Ohio Health Group HMO |
$2,892.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$771.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$501.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,195.61
|
| Rate for Payer: PHCS Commercial |
$3,702.53
|
| Rate for Payer: United Healthcare All Payer |
$3,393.98
|
|
|
PLATE 1.5MM 7 HOLE LEFT SMALL
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 1.5MM 7 HOLE LEFT SMALL
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 1.5MM 7 HOLE RIGHT SMALL
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 1.5MM 7 HOLE RIGHT SMALL
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 1ST TARSOMETATARSAL 4H
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE 1ST TARSOMETATARSAL 4H
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE 1ST TARSOMETATARSAL 5H
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE 1ST TARSOMETATARSAL 5H
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE 20 HOLE 1.5 STRAIGHT
|
Facility
|
OP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem Medicaid |
$649.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Humana KY Medicaid |
$649.63
|
| Rate for Payer: Kentucky WC Medicaid |
$656.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$662.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
|
|
PLATE 20 HOLE 1.5 STRAIGHT
|
Facility
|
IP
|
$1,889.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.57 |
| Max. Negotiated Rate |
$1,813.44 |
| Rate for Payer: Humana Commercial |
$1,605.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,548.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,394.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$566.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,662.32
|
| Rate for Payer: Ohio Health Group HMO |
$1,416.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$377.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$245.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$585.59
|
| Rate for Payer: PHCS Commercial |
$1,813.44
|
| Rate for Payer: United Healthcare All Payer |
$1,662.32
|
| Rate for Payer: Aetna Commercial |
$1,454.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,473.42
|
| Rate for Payer: Cash Price |
$944.50
|
| Rate for Payer: Cigna Commercial |
$1,567.87
|
| Rate for Payer: First Health Commercial |
$1,794.55
|
|
|
PLATE 2.0MM 7 HOLE LEFT MED
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 2.0MM 7 HOLE LEFT MED
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 2.0MM 7 HOLE RIGHT MED
|
Facility
|
OP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem Medicaid |
$686.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Humana KY Medicaid |
$686.94
|
| Rate for Payer: Kentucky WC Medicaid |
$693.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$700.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 2.0MM 7 HOLE RIGHT MED
|
Facility
|
IP
|
$1,997.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.68 |
| Max. Negotiated Rate |
$1,917.60 |
| Rate for Payer: Aetna Commercial |
$1,538.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,558.05
|
| Rate for Payer: Cash Price |
$998.75
|
| Rate for Payer: Cigna Commercial |
$1,657.92
|
| Rate for Payer: First Health Commercial |
$1,897.62
|
| Rate for Payer: Humana Commercial |
$1,697.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,637.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,474.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$599.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,757.80
|
| Rate for Payer: Ohio Health Group HMO |
$1,498.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$399.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.68
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$619.22
|
| Rate for Payer: PHCS Commercial |
$1,917.60
|
| Rate for Payer: United Healthcare All Payer |
$1,757.80
|
|
|
PLATE 2.0 TI 20 HOLE 100MM
|
Facility
|
IP
|
$1,848.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$1,774.10 |
| Rate for Payer: Aetna Commercial |
$1,422.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,441.46
|
| Rate for Payer: Cash Price |
$924.01
|
| Rate for Payer: Cigna Commercial |
$1,533.86
|
| Rate for Payer: First Health Commercial |
$1,755.62
|
| Rate for Payer: Humana Commercial |
$1,570.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,515.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,626.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.89
|
| Rate for Payer: PHCS Commercial |
$1,774.10
|
| Rate for Payer: United Healthcare All Payer |
$1,626.26
|
|
|
PLATE 2.0 TI 20 HOLE 100MM
|
Facility
|
OP
|
$1,848.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.24 |
| Max. Negotiated Rate |
$1,774.10 |
| Rate for Payer: Aetna Commercial |
$1,422.98
|
| Rate for Payer: Anthem Medicaid |
$635.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,441.46
|
| Rate for Payer: Cash Price |
$924.01
|
| Rate for Payer: Cigna Commercial |
$1,533.86
|
| Rate for Payer: First Health Commercial |
$1,755.62
|
| Rate for Payer: Humana Commercial |
$1,570.82
|
| Rate for Payer: Humana KY Medicaid |
$635.53
|
| Rate for Payer: Kentucky WC Medicaid |
$642.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,515.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,363.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$554.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$648.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,626.26
|
| Rate for Payer: Ohio Health Group HMO |
$1,386.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$369.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$240.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$572.89
|
| Rate for Payer: PHCS Commercial |
$1,774.10
|
| Rate for Payer: United Healthcare All Payer |
$1,626.26
|
|
