|
PLATE DISTAL MEDIAL TIB R 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 R 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 R 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: 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 6H
|
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 6H
|
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 8H
|
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 8H
|
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 POST LAT 3H 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: 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: Aetna Commercial |
$3,644.16
|
| 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 POST LAT 3H 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 POST LAT 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 POST LAT 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 POST LAT LEFT
|
Facility
|
IP
|
$8,986.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.28 |
| Max. Negotiated Rate |
$8,627.28 |
| Rate for Payer: Aetna Commercial |
$6,919.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.66
|
| Rate for Payer: Cash Price |
$4,493.38
|
| Rate for Payer: Cigna Commercial |
$7,459.00
|
| Rate for Payer: First Health Commercial |
$8,537.41
|
| Rate for Payer: Humana Commercial |
$7,638.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,369.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,632.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,696.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,908.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,740.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.89
|
| Rate for Payer: PHCS Commercial |
$8,627.28
|
| Rate for Payer: United Healthcare All Payer |
$7,908.34
|
|
|
PLATE DISTAL POST LAT LEFT
|
Facility
|
OP
|
$8,986.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,168.28 |
| Max. Negotiated Rate |
$8,627.28 |
| Rate for Payer: Aetna Commercial |
$6,919.80
|
| Rate for Payer: Anthem Medicaid |
$3,090.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,009.66
|
| Rate for Payer: Cash Price |
$4,493.38
|
| Rate for Payer: Cigna Commercial |
$7,459.00
|
| Rate for Payer: First Health Commercial |
$8,537.41
|
| Rate for Payer: Humana Commercial |
$7,638.74
|
| Rate for Payer: Humana KY Medicaid |
$3,090.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,122.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,369.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,632.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,696.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,152.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,908.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,740.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,797.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,168.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,785.89
|
| Rate for Payer: PHCS Commercial |
$8,627.28
|
| Rate for Payer: United Healthcare All Payer |
$7,908.34
|
|
|
PLATE DISTAL POST MEDIAL 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 POST MEDIAL 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 RADIUS 26MM LEFT
|
Facility
|
IP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE DISTAL RADIUS 26MM LEFT
|
Facility
|
OP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Anthem Medicaid |
$1,116.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Humana KY Medicaid |
$1,116.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE DISTAL RADIUS 26MM RIGHT
|
Facility
|
IP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE DISTAL RADIUS 26MM RIGHT
|
Facility
|
OP
|
$3,246.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$422.04 |
| Max. Negotiated Rate |
$3,116.64 |
| Rate for Payer: Anthem Medicaid |
$1,116.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,532.27
|
| Rate for Payer: Cash Price |
$1,623.25
|
| Rate for Payer: Cigna Commercial |
$2,694.60
|
| Rate for Payer: First Health Commercial |
$3,084.18
|
| Rate for Payer: Humana Commercial |
$2,759.52
|
| Rate for Payer: Humana KY Medicaid |
$1,116.47
|
| Rate for Payer: Kentucky WC Medicaid |
$1,127.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,662.13
|
| Rate for Payer: Aetna Commercial |
$2,499.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,395.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$973.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,138.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,856.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,434.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$649.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$422.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,006.42
|
| Rate for Payer: PHCS Commercial |
$3,116.64
|
| Rate for Payer: United Healthcare All Payer |
$2,856.92
|
|
|
PLATE DIST ANTERLAT TIB 6H R
|
Facility
|
IP
|
$14,056.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.35 |
| Max. Negotiated Rate |
$13,494.29 |
| Rate for Payer: Aetna Commercial |
$10,823.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,964.11
|
| Rate for Payer: Cash Price |
$7,028.27
|
| Rate for Payer: Cigna Commercial |
$11,666.94
|
| Rate for Payer: First Health Commercial |
$13,353.72
|
| Rate for Payer: Humana Commercial |
$11,948.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,526.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,373.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,216.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,542.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,811.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,357.53
|
| Rate for Payer: PHCS Commercial |
$13,494.29
|
| Rate for Payer: United Healthcare All Payer |
$12,369.76
|
|
|
PLATE DIST ANTERLAT TIB 6H R
|
Facility
|
OP
|
$14,056.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,827.35 |
| Max. Negotiated Rate |
$13,494.29 |
| Rate for Payer: Aetna Commercial |
$10,823.54
|
| Rate for Payer: Anthem Medicaid |
$4,834.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,964.11
|
| Rate for Payer: Cash Price |
$7,028.27
|
| Rate for Payer: Cigna Commercial |
$11,666.94
|
| Rate for Payer: First Health Commercial |
$13,353.72
|
| Rate for Payer: Humana Commercial |
$11,948.07
|
| Rate for Payer: Humana KY Medicaid |
$4,834.05
|
| Rate for Payer: Kentucky WC Medicaid |
$4,883.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,526.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,373.73
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,216.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,931.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,369.76
|
| Rate for Payer: Ohio Health Group HMO |
$10,542.41
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,811.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,357.53
|
| Rate for Payer: PHCS Commercial |
$13,494.29
|
| Rate for Payer: United Healthcare All Payer |
$12,369.76
|
|
|
PLATE DIST ANTEROLATERAL L 10H
|
Facility
|
OP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem Medicaid |
$2,368.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Humana KY Medicaid |
$2,368.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
|
|
PLATE DIST ANTEROLATERAL L 10H
|
Facility
|
IP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL L 12H
|
Facility
|
OP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem Medicaid |
$2,368.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Humana KY Medicaid |
$2,368.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST ANTEROLATERAL L 12H
|
Facility
|
IP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
