|
PLATE DISTAL FIB 4H RT
|
Facility
|
OP
|
$4,300.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.00 |
| Max. Negotiated Rate |
$4,128.00 |
| Rate for Payer: Aetna Commercial |
$3,311.00
|
| Rate for Payer: Anthem Medicaid |
$1,478.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,354.00
|
| Rate for Payer: Cash Price |
$2,150.00
|
| Rate for Payer: Cigna Commercial |
$3,569.00
|
| Rate for Payer: First Health Commercial |
$4,085.00
|
| Rate for Payer: Humana Commercial |
$3,655.00
|
| Rate for Payer: Humana KY Medicaid |
$1,478.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,493.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,526.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,173.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,290.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,508.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,784.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,225.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,333.00
|
| Rate for Payer: PHCS Commercial |
$4,128.00
|
| Rate for Payer: United Healthcare All Payer |
$3,784.00
|
|
|
PLATE DISTAL FIB 5H LT
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
PLATE DISTAL FIB 5H LT
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
PLATE DISTAL FIB 5H RT
|
Facility
|
IP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
PLATE DISTAL FIB 5H RT
|
Facility
|
OP
|
$4,650.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$604.50 |
| Max. Negotiated Rate |
$4,464.00 |
| Rate for Payer: Aetna Commercial |
$3,580.50
|
| Rate for Payer: Anthem Medicaid |
$1,599.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,627.00
|
| Rate for Payer: Cash Price |
$2,325.00
|
| Rate for Payer: Cigna Commercial |
$3,859.50
|
| Rate for Payer: First Health Commercial |
$4,417.50
|
| Rate for Payer: Humana Commercial |
$3,952.50
|
| Rate for Payer: Humana KY Medicaid |
$1,599.14
|
| Rate for Payer: Kentucky WC Medicaid |
$1,615.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,813.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,431.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,395.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,631.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,092.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,487.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$930.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$604.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,441.50
|
| Rate for Payer: PHCS Commercial |
$4,464.00
|
| Rate for Payer: United Healthcare All Payer |
$4,092.00
|
|
|
PLATE DISTAL FIB 6H LT
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PLATE DISTAL FIB 6H LT
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PLATE DISTAL FIB 6H RT
|
Facility
|
IP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PLATE DISTAL FIB 6H RT
|
Facility
|
OP
|
$4,912.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$638.62 |
| Max. Negotiated Rate |
$4,716.00 |
| Rate for Payer: Anthem Medicaid |
$1,689.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,831.75
|
| Rate for Payer: Cash Price |
$2,456.25
|
| Rate for Payer: Cigna Commercial |
$4,077.38
|
| Rate for Payer: First Health Commercial |
$4,666.88
|
| Rate for Payer: Humana Commercial |
$4,175.62
|
| Rate for Payer: Humana KY Medicaid |
$1,689.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,706.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,028.25
|
| Rate for Payer: Aetna Commercial |
$3,782.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,625.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,473.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,723.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,323.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,684.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$982.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$638.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,522.88
|
| Rate for Payer: PHCS Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Payer |
$4,323.00
|
|
|
PLATE DISTAL FIB 8H LT
|
Facility
|
IP
|
$5,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$4,951.20 |
| Rate for Payer: Aetna Commercial |
$3,971.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,022.85
|
| Rate for Payer: Cash Price |
$2,578.75
|
| Rate for Payer: Cigna Commercial |
$4,280.72
|
| Rate for Payer: First Health Commercial |
$4,899.62
|
| Rate for Payer: Humana Commercial |
$4,383.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,229.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,806.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,547.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,538.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,598.82
|
| Rate for Payer: PHCS Commercial |
$4,951.20
|
| Rate for Payer: United Healthcare All Payer |
$4,538.60
|
|
|
PLATE DISTAL FIB 8H LT
|
Facility
|
OP
|
$5,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$4,951.20 |
| Rate for Payer: Aetna Commercial |
$3,971.28
|
| Rate for Payer: Anthem Medicaid |
$1,773.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,022.85
|
| Rate for Payer: Cash Price |
$2,578.75
|
| Rate for Payer: Cigna Commercial |
$4,280.72
|
| Rate for Payer: First Health Commercial |
$4,899.62
|
| Rate for Payer: Humana Commercial |
$4,383.88
|
| Rate for Payer: Humana KY Medicaid |
$1,773.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,791.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,229.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,806.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,547.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,809.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,538.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,598.82
|
| Rate for Payer: PHCS Commercial |
$4,951.20
|
| Rate for Payer: United Healthcare All Payer |
$4,538.60
|
|
|
PLATE DISTAL FIB 8H RT
|
Facility
|
IP
|
$5,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$4,951.20 |
| Rate for Payer: Aetna Commercial |
$3,971.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,022.85
|
| Rate for Payer: Cash Price |
$2,578.75
|
| Rate for Payer: Cigna Commercial |
$4,280.72
|
| Rate for Payer: First Health Commercial |
$4,899.62
|
| Rate for Payer: Humana Commercial |
$4,383.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,229.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,806.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,547.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,538.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,598.82
|
| Rate for Payer: PHCS Commercial |
$4,951.20
|
| Rate for Payer: United Healthcare All Payer |
$4,538.60
|
|
|
PLATE DISTAL FIB 8H RT
|
Facility
|
OP
|
$5,157.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.48 |
| Max. Negotiated Rate |
$4,951.20 |
| Rate for Payer: Aetna Commercial |
$3,971.28
|
| Rate for Payer: Anthem Medicaid |
$1,773.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,022.85
|
| Rate for Payer: Cash Price |
$2,578.75
|
| Rate for Payer: Cigna Commercial |
$4,280.72
|
| Rate for Payer: First Health Commercial |
$4,899.62
|
| Rate for Payer: Humana Commercial |
$4,383.88
|
| Rate for Payer: Humana KY Medicaid |
$1,773.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,791.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,229.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,806.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,547.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,809.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,538.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,868.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,031.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$670.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,598.82
|
| Rate for Payer: PHCS Commercial |
$4,951.20
|
| Rate for Payer: United Healthcare All Payer |
$4,538.60
|
|
|
PLATE DISTAL LAT FEM 4.5 8H R
|
Facility
|
OP
|
$8,356.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.38 |
| Max. Negotiated Rate |
$8,022.49 |
| Rate for Payer: Aetna Commercial |
$6,434.71
|
| Rate for Payer: Anthem Medicaid |
$2,873.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.27
|
| Rate for Payer: Cash Price |
$4,178.38
|
| Rate for Payer: Cigna Commercial |
$6,936.11
|
| Rate for Payer: First Health Commercial |
$7,938.92
|
| Rate for Payer: Humana Commercial |
$7,103.25
|
| Rate for Payer: Humana KY Medicaid |
$2,873.89
|
| Rate for Payer: Kentucky WC Medicaid |
$2,903.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,931.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,353.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.60
|
| Rate for Payer: PHCS Commercial |
$8,022.49
|
| Rate for Payer: United Healthcare All Payer |
$7,353.95
|
|
|
PLATE DISTAL LAT FEM 4.5 8H R
|
Facility
|
IP
|
$8,356.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,086.38 |
| Max. Negotiated Rate |
$8,022.49 |
| Rate for Payer: Aetna Commercial |
$6,434.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,518.27
|
| Rate for Payer: Cash Price |
$4,178.38
|
| Rate for Payer: Cigna Commercial |
$6,936.11
|
| Rate for Payer: First Health Commercial |
$7,938.92
|
| Rate for Payer: Humana Commercial |
$7,103.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,852.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,167.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,507.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,353.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,267.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,671.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,086.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,590.60
|
| Rate for Payer: PHCS Commercial |
$8,022.49
|
| Rate for Payer: United Healthcare All Payer |
$7,353.95
|
|
|
PLATE DISTAL LAT HUM 10H R
|
Facility
|
OP
|
$12,001.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.21 |
| Max. Negotiated Rate |
$11,521.54 |
| Rate for Payer: Aetna Commercial |
$9,241.23
|
| Rate for Payer: Anthem Medicaid |
$4,127.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,361.25
|
| Rate for Payer: Cash Price |
$6,000.80
|
| Rate for Payer: Cigna Commercial |
$9,961.33
|
| Rate for Payer: First Health Commercial |
$11,401.52
|
| Rate for Payer: Humana Commercial |
$10,201.36
|
| Rate for Payer: Humana KY Medicaid |
$4,127.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,169.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,841.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,210.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,561.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,001.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.50
|
| Rate for Payer: PHCS Commercial |
$11,521.54
|
| Rate for Payer: United Healthcare All Payer |
$10,561.41
|
|
|
PLATE DISTAL LAT HUM 10H R
|
Facility
|
IP
|
$12,001.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.21 |
| Max. Negotiated Rate |
$11,521.54 |
| Rate for Payer: Aetna Commercial |
$9,241.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,361.25
|
| Rate for Payer: Cash Price |
$6,000.80
|
| Rate for Payer: Cigna Commercial |
$9,961.33
|
| Rate for Payer: First Health Commercial |
$11,401.52
|
| Rate for Payer: Humana Commercial |
$10,201.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,841.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,561.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,001.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.50
|
| Rate for Payer: PHCS Commercial |
$11,521.54
|
| Rate for Payer: United Healthcare All Payer |
$10,561.41
|
|
|
PLATE DISTAL LAT HUM 3H R
|
Facility
|
OP
|
$6,948.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.24 |
| Max. Negotiated Rate |
$6,670.09 |
| Rate for Payer: Aetna Commercial |
$5,349.97
|
| Rate for Payer: Anthem Medicaid |
$2,389.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,419.45
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Cigna Commercial |
$5,766.85
|
| Rate for Payer: First Health Commercial |
$6,600.61
|
| Rate for Payer: Humana Commercial |
$5,905.81
|
| Rate for Payer: Humana KY Medicaid |
$2,389.42
|
| Rate for Payer: Kentucky WC Medicaid |
$2,413.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,697.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,127.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,437.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,114.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,211.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.88
|
| Rate for Payer: PHCS Commercial |
$6,670.09
|
| Rate for Payer: United Healthcare All Payer |
$6,114.25
|
|
|
PLATE DISTAL LAT HUM 3H R
|
Facility
|
IP
|
$6,948.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$903.24 |
| Max. Negotiated Rate |
$6,670.09 |
| Rate for Payer: Aetna Commercial |
$5,349.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,419.45
|
| Rate for Payer: Cash Price |
$3,474.00
|
| Rate for Payer: Cigna Commercial |
$5,766.85
|
| Rate for Payer: First Health Commercial |
$6,600.61
|
| Rate for Payer: Humana Commercial |
$5,905.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,697.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,127.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,084.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,114.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,211.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,389.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$903.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.88
|
| Rate for Payer: PHCS Commercial |
$6,670.09
|
| Rate for Payer: United Healthcare All Payer |
$6,114.25
|
|
|
PLATE DISTAL LAT HUM 4H R
|
Facility
|
IP
|
$9,621.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.84 |
| Max. Negotiated Rate |
$9,236.98 |
| Rate for Payer: Aetna Commercial |
$7,408.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,505.04
|
| Rate for Payer: Cash Price |
$4,810.92
|
| Rate for Payer: Cigna Commercial |
$7,986.14
|
| Rate for Payer: First Health Commercial |
$9,140.76
|
| Rate for Payer: Humana Commercial |
$8,178.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,889.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,467.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,216.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,250.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.77
|
| Rate for Payer: PHCS Commercial |
$9,236.98
|
| Rate for Payer: United Healthcare All Payer |
$8,467.23
|
|
|
PLATE DISTAL LAT HUM 4H R
|
Facility
|
OP
|
$9,621.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,250.84 |
| Max. Negotiated Rate |
$9,236.98 |
| Rate for Payer: Aetna Commercial |
$7,408.82
|
| Rate for Payer: Anthem Medicaid |
$3,308.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,505.04
|
| Rate for Payer: Cash Price |
$4,810.92
|
| Rate for Payer: Cigna Commercial |
$7,986.14
|
| Rate for Payer: First Health Commercial |
$9,140.76
|
| Rate for Payer: Humana Commercial |
$8,178.57
|
| Rate for Payer: Humana KY Medicaid |
$3,308.95
|
| Rate for Payer: Kentucky WC Medicaid |
$3,342.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,889.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,100.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,886.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,375.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,467.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,216.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,924.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,250.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,982.77
|
| Rate for Payer: PHCS Commercial |
$9,236.98
|
| Rate for Payer: United Healthcare All Payer |
$8,467.23
|
|
|
PLATE DISTAL MED HUM EXT L/R
|
Facility
|
IP
|
$4,732.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$4,543.36 |
| Rate for Payer: Aetna Commercial |
$3,644.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,691.48
|
| Rate for Payer: Cash Price |
$2,366.34
|
| Rate for Payer: Cigna Commercial |
$3,928.12
|
| Rate for Payer: First Health Commercial |
$4,496.04
|
| Rate for Payer: Humana Commercial |
$4,022.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,880.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,492.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,164.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,549.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.13
|
| Rate for Payer: PHCS Commercial |
$4,543.36
|
| Rate for Payer: United Healthcare All Payer |
$4,164.75
|
|
|
PLATE DISTAL MED HUM EXT L/R
|
Facility
|
OP
|
$4,732.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$615.25 |
| Max. Negotiated Rate |
$4,543.36 |
| Rate for Payer: Aetna Commercial |
$3,644.16
|
| Rate for Payer: Anthem Medicaid |
$1,627.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,691.48
|
| Rate for Payer: Cash Price |
$2,366.34
|
| Rate for Payer: Cigna Commercial |
$3,928.12
|
| Rate for Payer: First Health Commercial |
$4,496.04
|
| Rate for Payer: Humana Commercial |
$4,022.77
|
| Rate for Payer: Humana KY Medicaid |
$1,627.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,644.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,880.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,492.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,660.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,164.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,549.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$946.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,467.13
|
| Rate for Payer: PHCS Commercial |
$4,543.36
|
| Rate for Payer: United Healthcare All Payer |
$4,164.75
|
|
|
PLATE DISTAL MEDIAL HUM 10H
|
Facility
|
IP
|
$12,001.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.21 |
| Max. Negotiated Rate |
$11,521.54 |
| Rate for Payer: Aetna Commercial |
$9,241.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,361.25
|
| Rate for Payer: Cash Price |
$6,000.80
|
| Rate for Payer: Cigna Commercial |
$9,961.33
|
| Rate for Payer: First Health Commercial |
$11,401.52
|
| Rate for Payer: Humana Commercial |
$10,201.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,841.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,561.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,001.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.50
|
| Rate for Payer: PHCS Commercial |
$11,521.54
|
| Rate for Payer: United Healthcare All Payer |
$10,561.41
|
|
|
PLATE DISTAL MEDIAL HUM 10H
|
Facility
|
OP
|
$12,001.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,560.21 |
| Max. Negotiated Rate |
$11,521.54 |
| Rate for Payer: Aetna Commercial |
$9,241.23
|
| Rate for Payer: Anthem Medicaid |
$4,127.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,361.25
|
| Rate for Payer: Cash Price |
$6,000.80
|
| Rate for Payer: Cigna Commercial |
$9,961.33
|
| Rate for Payer: First Health Commercial |
$11,401.52
|
| Rate for Payer: Humana Commercial |
$10,201.36
|
| Rate for Payer: Humana KY Medicaid |
$4,127.35
|
| Rate for Payer: Kentucky WC Medicaid |
$4,169.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,841.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,857.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,600.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,210.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,561.41
|
| Rate for Payer: Ohio Health Group HMO |
$9,001.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,400.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,560.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,720.50
|
| Rate for Payer: PHCS Commercial |
$11,521.54
|
| Rate for Payer: United Healthcare All Payer |
$10,561.41
|
|
