|
PLATE DISTAL MEDIAL HUMERUS 3H
|
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 HUMERUS 3H
|
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 MEDIAL HUMERUS 4H
|
Facility
|
IP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE DISTAL MEDIAL HUMERUS 4H
|
Facility
|
OP
|
$7,373.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$958.60 |
| Max. Negotiated Rate |
$7,078.86 |
| Rate for Payer: Aetna Commercial |
$5,677.83
|
| Rate for Payer: Anthem Medicaid |
$2,535.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,751.57
|
| Rate for Payer: Cash Price |
$3,686.91
|
| Rate for Payer: Cigna Commercial |
$6,120.26
|
| Rate for Payer: First Health Commercial |
$7,005.12
|
| Rate for Payer: Humana Commercial |
$6,267.74
|
| Rate for Payer: Humana KY Medicaid |
$2,535.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,561.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,046.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,441.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,212.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,586.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,488.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,530.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,474.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$958.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,285.88
|
| Rate for Payer: PHCS Commercial |
$7,078.86
|
| Rate for Payer: United Healthcare All Payer |
$6,488.95
|
|
|
PLATE DISTAL MEDIAL TIB L 10H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 10H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 12H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 12H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 14H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 14H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 16H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 16H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 4H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 4H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB L 6H
|
Facility
|
OP
|
$7,182.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.78 |
| Max. Negotiated Rate |
$6,895.60 |
| Rate for Payer: Aetna Commercial |
$5,530.85
|
| Rate for Payer: Anthem Medicaid |
$2,470.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,602.68
|
| Rate for Payer: Cash Price |
$3,591.46
|
| Rate for Payer: Cigna Commercial |
$5,961.82
|
| Rate for Payer: First Health Commercial |
$6,823.77
|
| Rate for Payer: Humana Commercial |
$6,105.48
|
| Rate for Payer: Humana KY Medicaid |
$2,470.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,495.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,519.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.71
|
| Rate for Payer: PHCS Commercial |
$6,895.60
|
| Rate for Payer: United Healthcare All Payer |
$6,320.97
|
|
|
PLATE DISTAL MEDIAL TIB L 6H
|
Facility
|
IP
|
$7,182.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.78 |
| Max. Negotiated Rate |
$6,895.60 |
| Rate for Payer: Aetna Commercial |
$5,530.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,602.68
|
| Rate for Payer: Cash Price |
$3,591.46
|
| Rate for Payer: Cigna Commercial |
$5,961.82
|
| Rate for Payer: First Health Commercial |
$6,823.77
|
| Rate for Payer: Humana Commercial |
$6,105.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,889.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,300.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,320.97
|
| Rate for Payer: Ohio Health Group HMO |
$5,387.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,226.71
|
| Rate for Payer: PHCS Commercial |
$6,895.60
|
| Rate for Payer: United Healthcare All Payer |
$6,320.97
|
|
|
PLATE DISTAL MEDIAL TIB L 8H
|
Facility
|
OP
|
$9,075.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.76 |
| Max. Negotiated Rate |
$8,712.08 |
| Rate for Payer: Aetna Commercial |
$6,987.81
|
| Rate for Payer: Anthem Medicaid |
$3,120.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,078.56
|
| Rate for Payer: Cash Price |
$4,537.54
|
| Rate for Payer: Cigna Commercial |
$7,532.32
|
| Rate for Payer: First Health Commercial |
$8,621.33
|
| Rate for Payer: Humana Commercial |
$7,713.82
|
| Rate for Payer: Humana KY Medicaid |
$3,120.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,152.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,441.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,722.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,183.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,986.07
|
| Rate for Payer: Ohio Health Group HMO |
$6,806.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,815.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,179.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,813.27
|
| Rate for Payer: PHCS Commercial |
$8,712.08
|
| Rate for Payer: United Healthcare All Payer |
$7,986.07
|
|
|
PLATE DISTAL MEDIAL TIB L 8H
|
Facility
|
IP
|
$9,075.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.76 |
| Max. Negotiated Rate |
$8,712.08 |
| Rate for Payer: Aetna Commercial |
$6,987.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,078.56
|
| Rate for Payer: Cash Price |
$4,537.54
|
| Rate for Payer: Cigna Commercial |
$7,532.32
|
| Rate for Payer: First Health Commercial |
$8,621.33
|
| Rate for Payer: Humana Commercial |
$7,713.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,441.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,697.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,722.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,986.07
|
| Rate for Payer: Ohio Health Group HMO |
$6,806.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,815.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,179.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,813.27
|
| Rate for Payer: PHCS Commercial |
$8,712.08
|
| Rate for Payer: United Healthcare All Payer |
$7,986.07
|
|
|
PLATE DISTAL MEDIAL TIB R 10H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB R 10H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB R 12H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB R 12H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB R 14H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB R 14H
|
Facility
|
IP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
|
PLATE DISTAL MEDIAL TIB R 16H
|
Facility
|
OP
|
$6,742.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$876.46 |
| Max. Negotiated Rate |
$6,472.32 |
| Rate for Payer: Aetna Commercial |
$5,191.34
|
| Rate for Payer: Anthem Medicaid |
$2,318.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,258.76
|
| Rate for Payer: Cash Price |
$3,371.00
|
| Rate for Payer: Cigna Commercial |
$5,595.86
|
| Rate for Payer: First Health Commercial |
$6,404.90
|
| Rate for Payer: Humana Commercial |
$5,730.70
|
| Rate for Payer: Humana KY Medicaid |
$2,318.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,342.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,528.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,975.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,022.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,365.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,932.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,056.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,348.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$876.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,090.02
|
| Rate for Payer: PHCS Commercial |
$6,472.32
|
| Rate for Payer: United Healthcare All Payer |
$5,932.96
|
|
