|
PLATE CALCANEUS LG 3.5MM LT
|
Facility
|
IP
|
$5,622.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.92 |
| Max. Negotiated Rate |
$5,397.58 |
| Rate for Payer: Aetna Commercial |
$4,329.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.53
|
| Rate for Payer: Cash Price |
$2,811.24
|
| Rate for Payer: Cigna Commercial |
$4,666.66
|
| Rate for Payer: First Health Commercial |
$5,341.36
|
| Rate for Payer: Humana Commercial |
$4,779.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,947.78
|
| Rate for Payer: Ohio Health Group HMO |
$4,216.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.97
|
| Rate for Payer: PHCS Commercial |
$5,397.58
|
| Rate for Payer: United Healthcare All Payer |
$4,947.78
|
|
|
PLATE CALCANEUS LG 3.5MM LT
|
Facility
|
OP
|
$5,622.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.92 |
| Max. Negotiated Rate |
$5,397.58 |
| Rate for Payer: Aetna Commercial |
$4,329.31
|
| Rate for Payer: Anthem Medicaid |
$1,933.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.53
|
| Rate for Payer: Cash Price |
$2,811.24
|
| Rate for Payer: Cigna Commercial |
$4,666.66
|
| Rate for Payer: First Health Commercial |
$5,341.36
|
| Rate for Payer: Humana Commercial |
$4,779.11
|
| Rate for Payer: Humana KY Medicaid |
$1,933.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,953.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,972.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,947.78
|
| Rate for Payer: Ohio Health Group HMO |
$4,216.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.97
|
| Rate for Payer: PHCS Commercial |
$5,397.58
|
| Rate for Payer: United Healthcare All Payer |
$4,947.78
|
|
|
PLATE CALCANEUS LG 3.5MM RT
|
Facility
|
IP
|
$5,622.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.92 |
| Max. Negotiated Rate |
$5,397.58 |
| Rate for Payer: Aetna Commercial |
$4,329.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.53
|
| Rate for Payer: Cash Price |
$2,811.24
|
| Rate for Payer: Cigna Commercial |
$4,666.66
|
| Rate for Payer: First Health Commercial |
$5,341.36
|
| Rate for Payer: Humana Commercial |
$4,779.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,947.78
|
| Rate for Payer: Ohio Health Group HMO |
$4,216.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.97
|
| Rate for Payer: PHCS Commercial |
$5,397.58
|
| Rate for Payer: United Healthcare All Payer |
$4,947.78
|
|
|
PLATE CALCANEUS LG 3.5MM RT
|
Facility
|
OP
|
$5,622.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.92 |
| Max. Negotiated Rate |
$5,397.58 |
| Rate for Payer: Kentucky WC Medicaid |
$1,953.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,610.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,149.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,972.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,947.78
|
| Rate for Payer: Ohio Health Group HMO |
$4,216.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.97
|
| Rate for Payer: PHCS Commercial |
$5,397.58
|
| Rate for Payer: United Healthcare All Payer |
$4,947.78
|
| Rate for Payer: Aetna Commercial |
$4,329.31
|
| Rate for Payer: Anthem Medicaid |
$1,933.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,385.53
|
| Rate for Payer: Cash Price |
$2,811.24
|
| Rate for Payer: Cigna Commercial |
$4,666.66
|
| Rate for Payer: First Health Commercial |
$5,341.36
|
| Rate for Payer: Humana Commercial |
$4,779.11
|
| Rate for Payer: Humana KY Medicaid |
$1,933.57
|
|
|
PLATE CALCANEUS MD LT 3.5MM
|
Facility
|
OP
|
$6,601.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$6,337.24 |
| Rate for Payer: Aetna Commercial |
$5,082.99
|
| Rate for Payer: Anthem Medicaid |
$2,270.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,149.01
|
| Rate for Payer: Cash Price |
$3,300.65
|
| Rate for Payer: Cigna Commercial |
$5,479.07
|
| Rate for Payer: First Health Commercial |
$6,271.23
|
| Rate for Payer: Humana Commercial |
$5,611.10
|
| Rate for Payer: Humana KY Medicaid |
$2,270.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,293.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,413.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,871.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,980.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,315.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,809.14
|
| Rate for Payer: Ohio Health Group HMO |
$4,950.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$858.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.40
|
| Rate for Payer: PHCS Commercial |
$6,337.24
|
| Rate for Payer: United Healthcare All Payer |
$5,809.14
|
|
|
PLATE CALCANEUS MD LT 3.5MM
|
Facility
|
IP
|
$6,601.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$6,337.24 |
| Rate for Payer: Aetna Commercial |
$5,082.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,149.01
|
| Rate for Payer: Cash Price |
$3,300.65
|
| Rate for Payer: Cigna Commercial |
$5,479.07
|
| Rate for Payer: First Health Commercial |
$6,271.23
|
| Rate for Payer: Humana Commercial |
$5,611.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,413.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,871.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,980.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,809.14
|
| Rate for Payer: Ohio Health Group HMO |
$4,950.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$858.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.40
|
| Rate for Payer: PHCS Commercial |
$6,337.24
|
| Rate for Payer: United Healthcare All Payer |
$5,809.14
|
|
|
PLATE CALCANEUS MD RT 3.5MM
|
Facility
|
OP
|
$6,601.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$6,337.24 |
| Rate for Payer: Aetna Commercial |
$5,082.99
|
| Rate for Payer: Anthem Medicaid |
$2,270.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,149.01
|
| Rate for Payer: Cash Price |
$3,300.65
|
| Rate for Payer: Cigna Commercial |
$5,479.07
|
| Rate for Payer: First Health Commercial |
$6,271.23
|
| Rate for Payer: Humana Commercial |
$5,611.10
|
| Rate for Payer: Humana KY Medicaid |
$2,270.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,293.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,413.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,871.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,980.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,315.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,809.14
|
| Rate for Payer: Ohio Health Group HMO |
$4,950.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$858.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.40
|
| Rate for Payer: PHCS Commercial |
$6,337.24
|
| Rate for Payer: United Healthcare All Payer |
$5,809.14
|
|
|
PLATE CALCANEUS MD RT 3.5MM
|
Facility
|
IP
|
$6,601.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$6,337.24 |
| Rate for Payer: Aetna Commercial |
$5,082.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,149.01
|
| Rate for Payer: Cash Price |
$3,300.65
|
| Rate for Payer: Cigna Commercial |
$5,479.07
|
| Rate for Payer: First Health Commercial |
$6,271.23
|
| Rate for Payer: Humana Commercial |
$5,611.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,413.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,871.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,980.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,809.14
|
| Rate for Payer: Ohio Health Group HMO |
$4,950.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,320.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$858.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,046.40
|
| Rate for Payer: PHCS Commercial |
$6,337.24
|
| Rate for Payer: United Healthcare All Payer |
$5,809.14
|
|
|
PLATE CALCANEUS MESH MEDIUM
|
Facility
|
OP
|
$7,031.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.04 |
| Max. Negotiated Rate |
$6,749.84 |
| Rate for Payer: Aetna Commercial |
$5,413.93
|
| Rate for Payer: Anthem Medicaid |
$2,417.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,484.24
|
| Rate for Payer: Cash Price |
$3,515.54
|
| Rate for Payer: Cigna Commercial |
$5,835.80
|
| Rate for Payer: First Health Commercial |
$6,679.53
|
| Rate for Payer: Humana Commercial |
$5,976.42
|
| Rate for Payer: Humana KY Medicaid |
$2,417.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,442.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,765.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,188.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,109.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,466.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,187.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,273.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,179.63
|
| Rate for Payer: PHCS Commercial |
$6,749.84
|
| Rate for Payer: United Healthcare All Payer |
$6,187.35
|
|
|
PLATE CALCANEUS MESH MEDIUM
|
Facility
|
IP
|
$7,031.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.04 |
| Max. Negotiated Rate |
$6,749.84 |
| Rate for Payer: Aetna Commercial |
$5,413.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,484.24
|
| Rate for Payer: Cash Price |
$3,515.54
|
| Rate for Payer: Cigna Commercial |
$5,835.80
|
| Rate for Payer: First Health Commercial |
$6,679.53
|
| Rate for Payer: Humana Commercial |
$5,976.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,765.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,188.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,109.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,187.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,273.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,179.63
|
| Rate for Payer: PHCS Commercial |
$6,749.84
|
| Rate for Payer: United Healthcare All Payer |
$6,187.35
|
|
|
PLATE CALCANEUS SM 3.5MM LT
|
Facility
|
OP
|
$5,501.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.25 |
| Max. Negotiated Rate |
$5,281.82 |
| Rate for Payer: Aetna Commercial |
$4,236.46
|
| Rate for Payer: Anthem Medicaid |
$1,892.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.48
|
| Rate for Payer: Cash Price |
$2,750.95
|
| Rate for Payer: Cigna Commercial |
$4,566.58
|
| Rate for Payer: First Health Commercial |
$5,226.80
|
| Rate for Payer: Humana Commercial |
$4,676.62
|
| Rate for Payer: Humana KY Medicaid |
$1,892.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,841.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.59
|
| Rate for Payer: PHCS Commercial |
$5,281.82
|
| Rate for Payer: United Healthcare All Payer |
$4,841.67
|
|
|
PLATE CALCANEUS SM 3.5MM LT
|
Facility
|
IP
|
$5,501.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.25 |
| Max. Negotiated Rate |
$5,281.82 |
| Rate for Payer: Aetna Commercial |
$4,236.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.48
|
| Rate for Payer: Cash Price |
$2,750.95
|
| Rate for Payer: Cigna Commercial |
$4,566.58
|
| Rate for Payer: First Health Commercial |
$5,226.80
|
| Rate for Payer: Humana Commercial |
$4,676.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,841.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.59
|
| Rate for Payer: PHCS Commercial |
$5,281.82
|
| Rate for Payer: United Healthcare All Payer |
$4,841.67
|
|
|
PLATE CALCANEUS SM 3.5MM RT
|
Facility
|
OP
|
$5,501.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.25 |
| Max. Negotiated Rate |
$5,281.82 |
| Rate for Payer: Aetna Commercial |
$4,236.46
|
| Rate for Payer: Anthem Medicaid |
$1,892.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.48
|
| Rate for Payer: Cash Price |
$2,750.95
|
| Rate for Payer: Cigna Commercial |
$4,566.58
|
| Rate for Payer: First Health Commercial |
$5,226.80
|
| Rate for Payer: Humana Commercial |
$4,676.62
|
| Rate for Payer: Humana KY Medicaid |
$1,892.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,911.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,930.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,841.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.59
|
| Rate for Payer: PHCS Commercial |
$5,281.82
|
| Rate for Payer: United Healthcare All Payer |
$4,841.67
|
|
|
PLATE CALCANEUS SM 3.5MM RT
|
Facility
|
IP
|
$5,501.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$715.25 |
| Max. Negotiated Rate |
$5,281.82 |
| Rate for Payer: Humana Commercial |
$4,676.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,511.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,841.67
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,100.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$715.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,705.59
|
| Rate for Payer: PHCS Commercial |
$5,281.82
|
| Rate for Payer: United Healthcare All Payer |
$4,841.67
|
| Rate for Payer: Aetna Commercial |
$4,236.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.48
|
| Rate for Payer: Cash Price |
$2,750.95
|
| Rate for Payer: Cigna Commercial |
$4,566.58
|
| Rate for Payer: First Health Commercial |
$5,226.80
|
|
|
PLATE CALCANEUS STD MEDIUM
|
Facility
|
OP
|
$7,031.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.04 |
| Max. Negotiated Rate |
$6,749.84 |
| Rate for Payer: Aetna Commercial |
$5,413.93
|
| Rate for Payer: Anthem Medicaid |
$2,417.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,484.24
|
| Rate for Payer: Cash Price |
$3,515.54
|
| Rate for Payer: Cigna Commercial |
$5,835.80
|
| Rate for Payer: First Health Commercial |
$6,679.53
|
| Rate for Payer: Humana Commercial |
$5,976.42
|
| Rate for Payer: Humana KY Medicaid |
$2,417.99
|
| Rate for Payer: Kentucky WC Medicaid |
$2,442.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,765.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,188.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,109.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,466.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,187.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,273.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,179.63
|
| Rate for Payer: PHCS Commercial |
$6,749.84
|
| Rate for Payer: United Healthcare All Payer |
$6,187.35
|
|
|
PLATE CALCANEUS STD MEDIUM
|
Facility
|
IP
|
$7,031.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$914.04 |
| Max. Negotiated Rate |
$6,749.84 |
| Rate for Payer: Aetna Commercial |
$5,413.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,484.24
|
| Rate for Payer: Cash Price |
$3,515.54
|
| Rate for Payer: Cigna Commercial |
$5,835.80
|
| Rate for Payer: First Health Commercial |
$6,679.53
|
| Rate for Payer: Humana Commercial |
$5,976.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,765.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,188.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,109.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,187.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,273.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,406.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$914.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,179.63
|
| Rate for Payer: PHCS Commercial |
$6,749.84
|
| Rate for Payer: United Healthcare All Payer |
$6,187.35
|
|
|
PLATE CALCANEUS XL LT 3.5MM
|
Facility
|
OP
|
$6,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.06 |
| Max. Negotiated Rate |
$6,513.67 |
| Rate for Payer: Aetna Commercial |
$5,224.50
|
| Rate for Payer: Anthem Medicaid |
$2,333.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,292.35
|
| Rate for Payer: Cash Price |
$3,392.53
|
| Rate for Payer: Cigna Commercial |
$5,631.61
|
| Rate for Payer: First Health Commercial |
$6,445.82
|
| Rate for Payer: Humana Commercial |
$5,767.31
|
| Rate for Payer: Humana KY Medicaid |
$2,333.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,357.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,563.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,007.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,035.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,380.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,970.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,088.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,103.37
|
| Rate for Payer: PHCS Commercial |
$6,513.67
|
| Rate for Payer: United Healthcare All Payer |
$5,970.86
|
|
|
PLATE CALCANEUS XL LT 3.5MM
|
Facility
|
IP
|
$6,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.06 |
| Max. Negotiated Rate |
$6,513.67 |
| Rate for Payer: Aetna Commercial |
$5,224.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,292.35
|
| Rate for Payer: Cash Price |
$3,392.53
|
| Rate for Payer: Cigna Commercial |
$5,631.61
|
| Rate for Payer: First Health Commercial |
$6,445.82
|
| Rate for Payer: Humana Commercial |
$5,767.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,563.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,007.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,035.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,970.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,088.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,103.37
|
| Rate for Payer: PHCS Commercial |
$6,513.67
|
| Rate for Payer: United Healthcare All Payer |
$5,970.86
|
|
|
PLATE CALCANEUS XL RT 3.5MM
|
Facility
|
IP
|
$6,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.06 |
| Max. Negotiated Rate |
$6,513.67 |
| Rate for Payer: Aetna Commercial |
$5,224.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,292.35
|
| Rate for Payer: Cash Price |
$3,392.53
|
| Rate for Payer: Cigna Commercial |
$5,631.61
|
| Rate for Payer: First Health Commercial |
$6,445.82
|
| Rate for Payer: Humana Commercial |
$5,767.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,563.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,007.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,035.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,970.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,088.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,103.37
|
| Rate for Payer: PHCS Commercial |
$6,513.67
|
| Rate for Payer: United Healthcare All Payer |
$5,970.86
|
|
|
PLATE CALCANEUS XL RT 3.5MM
|
Facility
|
OP
|
$6,785.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.06 |
| Max. Negotiated Rate |
$6,513.67 |
| Rate for Payer: Aetna Commercial |
$5,224.50
|
| Rate for Payer: Anthem Medicaid |
$2,333.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,292.35
|
| Rate for Payer: Cash Price |
$3,392.53
|
| Rate for Payer: Cigna Commercial |
$5,631.61
|
| Rate for Payer: First Health Commercial |
$6,445.82
|
| Rate for Payer: Humana Commercial |
$5,767.31
|
| Rate for Payer: Humana KY Medicaid |
$2,333.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,357.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,563.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,007.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,035.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,380.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,970.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,088.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,357.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$882.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,103.37
|
| Rate for Payer: PHCS Commercial |
$6,513.67
|
| Rate for Payer: United Healthcare All Payer |
$5,970.86
|
|
|
PLATE CALC PERC LG 2.7M 62M L
|
Facility
|
OP
|
$7,084.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.04 |
| Max. Negotiated Rate |
$6,801.52 |
| Rate for Payer: Humana Commercial |
$6,022.18
|
| Rate for Payer: Humana KY Medicaid |
$2,436.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,196.33
|
| Rate for Payer: PHCS Commercial |
$6,801.52
|
| Rate for Payer: United Healthcare All Payer |
$6,234.73
|
| Rate for Payer: Aetna Commercial |
$5,455.39
|
| Rate for Payer: Anthem Medicaid |
$2,436.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,526.24
|
| Rate for Payer: Cash Price |
$3,542.46
|
| Rate for Payer: Cigna Commercial |
$5,880.48
|
| Rate for Payer: First Health Commercial |
$6,730.67
|
|
|
PLATE CALC PERC LG 2.7M 62M L
|
Facility
|
IP
|
$7,084.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.04 |
| Max. Negotiated Rate |
$6,801.52 |
| Rate for Payer: Aetna Commercial |
$5,455.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,526.24
|
| Rate for Payer: Cash Price |
$3,542.46
|
| Rate for Payer: Cigna Commercial |
$5,880.48
|
| Rate for Payer: First Health Commercial |
$6,730.67
|
| Rate for Payer: Humana Commercial |
$6,022.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,196.33
|
| Rate for Payer: PHCS Commercial |
$6,801.52
|
| Rate for Payer: United Healthcare All Payer |
$6,234.73
|
|
|
PLATE CALC PERC LG 2.7M 62M R
|
Facility
|
OP
|
$7,084.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.04 |
| Max. Negotiated Rate |
$6,801.52 |
| Rate for Payer: Aetna Commercial |
$5,455.39
|
| Rate for Payer: Anthem Medicaid |
$2,436.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,526.24
|
| Rate for Payer: Cash Price |
$3,542.46
|
| Rate for Payer: Cigna Commercial |
$5,880.48
|
| Rate for Payer: First Health Commercial |
$6,730.67
|
| Rate for Payer: Humana Commercial |
$6,022.18
|
| Rate for Payer: Humana KY Medicaid |
$2,436.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,461.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,485.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,196.33
|
| Rate for Payer: PHCS Commercial |
$6,801.52
|
| Rate for Payer: United Healthcare All Payer |
$6,234.73
|
|
|
PLATE CALC PERC LG 2.7M 62M R
|
Facility
|
IP
|
$7,084.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$921.04 |
| Max. Negotiated Rate |
$6,801.52 |
| Rate for Payer: Aetna Commercial |
$5,455.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,526.24
|
| Rate for Payer: Cash Price |
$3,542.46
|
| Rate for Payer: Cigna Commercial |
$5,880.48
|
| Rate for Payer: First Health Commercial |
$6,730.67
|
| Rate for Payer: Humana Commercial |
$6,022.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,809.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,228.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,125.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,234.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,313.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,416.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$921.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,196.33
|
| Rate for Payer: PHCS Commercial |
$6,801.52
|
| Rate for Payer: United Healthcare All Payer |
$6,234.73
|
|
|
PLATE CALC PERC SM 2.7M 55M L
|
Facility
|
OP
|
$6,727.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$874.52 |
| Max. Negotiated Rate |
$6,457.96 |
| Rate for Payer: Aetna Commercial |
$5,179.82
|
| Rate for Payer: Anthem Medicaid |
$2,313.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,247.09
|
| Rate for Payer: Cash Price |
$3,363.52
|
| Rate for Payer: Cigna Commercial |
$5,583.44
|
| Rate for Payer: First Health Commercial |
$6,390.69
|
| Rate for Payer: Humana Commercial |
$5,717.98
|
| Rate for Payer: Humana KY Medicaid |
$2,313.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,336.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,516.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,964.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,018.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,359.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,919.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,045.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,345.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$874.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,085.38
|
| Rate for Payer: PHCS Commercial |
$6,457.96
|
| Rate for Payer: United Healthcare All Payer |
$5,919.80
|
|
