|
PLATE 1ST TARSOMETATARSAL 4H
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE 1ST TARSOMETATARSAL 5H
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE 1ST TARSOMETATARSAL 5H
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE 20 HOLE 1.5 STRAIGHT
|
Facility
|
IP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
PLATE 20 HOLE 1.5 STRAIGHT
|
Facility
|
OP
|
$1,885.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$565.56 |
| Max. Negotiated Rate |
$1,809.79 |
| Rate for Payer: Aetna Commercial |
$1,451.60
|
| Rate for Payer: Anthem Medicaid |
$648.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,470.46
|
| Rate for Payer: Cash Price |
$942.60
|
| Rate for Payer: Cigna Commercial |
$1,564.72
|
| Rate for Payer: First Health Commercial |
$1,790.94
|
| Rate for Payer: Humana Commercial |
$1,602.42
|
| Rate for Payer: Humana KY Medicaid |
$648.32
|
| Rate for Payer: Kentucky WC Medicaid |
$654.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,545.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,391.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$565.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,658.98
|
| Rate for Payer: Ohio Health Group HMO |
$1,413.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,508.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,640.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,300.79
|
| Rate for Payer: PHCS Commercial |
$1,809.79
|
| Rate for Payer: United Healthcare All Payer |
$1,658.98
|
|
|
PLATE 2.0MM 7 HOLE LEFT MED
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 2.0MM 7 HOLE LEFT MED
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 2.0MM 7 HOLE RIGHT MED
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 2.0MM 7 HOLE RIGHT MED
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 2.0 TI 20 HOLE 100MM
|
Facility
|
IP
|
$1,840.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.21 |
| Max. Negotiated Rate |
$1,767.07 |
| Rate for Payer: Aetna Commercial |
$1,417.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.75
|
| Rate for Payer: Cash Price |
$920.35
|
| Rate for Payer: Cigna Commercial |
$1,527.78
|
| Rate for Payer: First Health Commercial |
$1,748.66
|
| Rate for Payer: Humana Commercial |
$1,564.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,509.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,358.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,270.08
|
| Rate for Payer: PHCS Commercial |
$1,767.07
|
| Rate for Payer: United Healthcare All Payer |
$1,619.82
|
|
|
PLATE 2.0 TI 20 HOLE 100MM
|
Facility
|
OP
|
$1,840.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$552.21 |
| Max. Negotiated Rate |
$1,767.07 |
| Rate for Payer: Aetna Commercial |
$1,417.34
|
| Rate for Payer: Anthem Medicaid |
$633.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.75
|
| Rate for Payer: Cash Price |
$920.35
|
| Rate for Payer: Cigna Commercial |
$1,527.78
|
| Rate for Payer: First Health Commercial |
$1,748.66
|
| Rate for Payer: Humana Commercial |
$1,564.60
|
| Rate for Payer: Humana KY Medicaid |
$633.02
|
| Rate for Payer: Kentucky WC Medicaid |
$639.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,509.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,358.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.82
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,472.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,601.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,270.08
|
| Rate for Payer: PHCS Commercial |
$1,767.07
|
| Rate for Payer: United Healthcare All Payer |
$1,619.82
|
|
|
PLATE 2&3 ST TARSOMETATRSAL 4H
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE 2&3 ST TARSOMETATRSAL 4H
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE 2.4 VLR DRP IMP KIT NAR
|
Facility
|
IP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
PLATE 2.4 VLR DRP IMP KIT NAR
|
Facility
|
OP
|
$18,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,482.50 |
| Max. Negotiated Rate |
$17,544.00 |
| Rate for Payer: Aetna Commercial |
$14,071.75
|
| Rate for Payer: Anthem Medicaid |
$6,284.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,254.50
|
| Rate for Payer: Cash Price |
$9,137.50
|
| Rate for Payer: Cigna Commercial |
$15,168.25
|
| Rate for Payer: First Health Commercial |
$17,361.25
|
| Rate for Payer: Humana Commercial |
$15,533.75
|
| Rate for Payer: Humana KY Medicaid |
$6,284.77
|
| Rate for Payer: Kentucky WC Medicaid |
$6,348.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,985.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,486.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,482.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,410.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,082.00
|
| Rate for Payer: Ohio Health Group HMO |
$13,706.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,899.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,609.75
|
| Rate for Payer: PHCS Commercial |
$17,544.00
|
| Rate for Payer: United Healthcare All Payer |
$16,082.00
|
|
|
PLATE 2.4 VOL DRP N 3H LT
|
Facility
|
IP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE 2.4 VOL DRP N 3H LT
|
Facility
|
OP
|
$4,981.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,494.38 |
| Max. Negotiated Rate |
$4,782.00 |
| Rate for Payer: Aetna Commercial |
$3,835.56
|
| Rate for Payer: Anthem Medicaid |
$1,713.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,885.38
|
| Rate for Payer: Cash Price |
$2,490.62
|
| Rate for Payer: Cigna Commercial |
$4,134.44
|
| Rate for Payer: First Health Commercial |
$4,732.19
|
| Rate for Payer: Humana Commercial |
$4,234.06
|
| Rate for Payer: Humana KY Medicaid |
$1,713.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,730.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,084.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,676.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,494.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,747.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,383.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,735.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,985.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,333.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,437.06
|
| Rate for Payer: PHCS Commercial |
$4,782.00
|
| Rate for Payer: United Healthcare All Payer |
$4,383.50
|
|
|
PLATE 2.7/3.5 POST DST HM 9H L
|
Facility
|
IP
|
$7,398.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,219.47 |
| Max. Negotiated Rate |
$7,102.32 |
| Rate for Payer: Aetna Commercial |
$5,696.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,770.64
|
| Rate for Payer: Cash Price |
$3,699.12
|
| Rate for Payer: Cigna Commercial |
$6,140.55
|
| Rate for Payer: First Health Commercial |
$7,028.34
|
| Rate for Payer: Humana Commercial |
$6,288.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,066.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,459.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,510.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,548.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,918.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,436.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,104.79
|
| Rate for Payer: PHCS Commercial |
$7,102.32
|
| Rate for Payer: United Healthcare All Payer |
$6,510.46
|
|
|
PLATE 2.7/3.5 POST DST HM 9H L
|
Facility
|
OP
|
$7,398.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,219.47 |
| Max. Negotiated Rate |
$7,102.32 |
| Rate for Payer: Aetna Commercial |
$5,696.65
|
| Rate for Payer: Anthem Medicaid |
$2,544.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,770.64
|
| Rate for Payer: Cash Price |
$3,699.12
|
| Rate for Payer: Cigna Commercial |
$6,140.55
|
| Rate for Payer: First Health Commercial |
$7,028.34
|
| Rate for Payer: Humana Commercial |
$6,288.51
|
| Rate for Payer: Humana KY Medicaid |
$2,544.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,570.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,066.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,459.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,219.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,595.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,510.46
|
| Rate for Payer: Ohio Health Group HMO |
$5,548.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,918.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,436.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,104.79
|
| Rate for Payer: PHCS Commercial |
$7,102.32
|
| Rate for Payer: United Healthcare All Payer |
$6,510.46
|
|
|
PLATE 2.7/3.5 VA ANTEROLT 6H R
|
Facility
|
IP
|
$9,114.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.26 |
| Max. Negotiated Rate |
$8,749.62 |
| Rate for Payer: Aetna Commercial |
$7,017.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,109.07
|
| Rate for Payer: Cash Price |
$4,557.09
|
| Rate for Payer: Cigna Commercial |
$7,564.78
|
| Rate for Payer: First Health Commercial |
$8,658.48
|
| Rate for Payer: Humana Commercial |
$7,747.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,726.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,291.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,929.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.79
|
| Rate for Payer: PHCS Commercial |
$8,749.62
|
| Rate for Payer: United Healthcare All Payer |
$8,020.49
|
|
|
PLATE 2.7/3.5 VA ANTEROLT 6H R
|
Facility
|
OP
|
$9,114.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,734.26 |
| Max. Negotiated Rate |
$8,749.62 |
| Rate for Payer: Aetna Commercial |
$7,017.93
|
| Rate for Payer: Anthem Medicaid |
$3,134.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,109.07
|
| Rate for Payer: Cash Price |
$4,557.09
|
| Rate for Payer: Cigna Commercial |
$7,564.78
|
| Rate for Payer: First Health Commercial |
$8,658.48
|
| Rate for Payer: Humana Commercial |
$7,747.06
|
| Rate for Payer: Humana KY Medicaid |
$3,134.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,166.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,473.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,726.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,734.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,197.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,020.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,835.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,291.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,929.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,288.79
|
| Rate for Payer: PHCS Commercial |
$8,749.62
|
| Rate for Payer: United Healthcare All Payer |
$8,020.49
|
|
|
PLATE 2.7/3.5 VA ANTEROLT 8H R
|
Facility
|
OP
|
$9,179.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,753.72 |
| Max. Negotiated Rate |
$8,811.92 |
| Rate for Payer: Aetna Commercial |
$7,067.89
|
| Rate for Payer: Anthem Medicaid |
$3,156.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,159.68
|
| Rate for Payer: Cash Price |
$4,589.54
|
| Rate for Payer: Cigna Commercial |
$7,618.64
|
| Rate for Payer: First Health Commercial |
$8,720.13
|
| Rate for Payer: Humana Commercial |
$7,802.22
|
| Rate for Payer: Humana KY Medicaid |
$3,156.69
|
| Rate for Payer: Kentucky WC Medicaid |
$3,188.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,526.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,774.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,753.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,220.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,077.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,884.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,343.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,985.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,333.57
|
| Rate for Payer: PHCS Commercial |
$8,811.92
|
| Rate for Payer: United Healthcare All Payer |
$8,077.59
|
|
|
PLATE 2.7/3.5 VA ANTEROLT 8H R
|
Facility
|
IP
|
$9,179.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,753.72 |
| Max. Negotiated Rate |
$8,811.92 |
| Rate for Payer: Aetna Commercial |
$7,067.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,159.68
|
| Rate for Payer: Cash Price |
$4,589.54
|
| Rate for Payer: Cigna Commercial |
$7,618.64
|
| Rate for Payer: First Health Commercial |
$8,720.13
|
| Rate for Payer: Humana Commercial |
$7,802.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,526.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,774.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,753.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,077.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,884.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,343.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,985.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,333.57
|
| Rate for Payer: PHCS Commercial |
$8,811.92
|
| Rate for Payer: United Healthcare All Payer |
$8,077.59
|
|
|
PLATE 2.7MM 7 HOLE LEFT LARGE
|
Facility
|
IP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
|
PLATE 2.7MM 7 HOLE LEFT LARGE
|
Facility
|
OP
|
$2,003.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$600.90 |
| Max. Negotiated Rate |
$1,922.88 |
| Rate for Payer: Aetna Commercial |
$1,542.31
|
| Rate for Payer: Anthem Medicaid |
$688.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,562.34
|
| Rate for Payer: Cash Price |
$1,001.50
|
| Rate for Payer: Cigna Commercial |
$1,662.49
|
| Rate for Payer: First Health Commercial |
$1,902.85
|
| Rate for Payer: Humana Commercial |
$1,702.55
|
| Rate for Payer: Humana KY Medicaid |
$688.83
|
| Rate for Payer: Kentucky WC Medicaid |
$695.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,642.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,478.21
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$600.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$702.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,762.64
|
| Rate for Payer: Ohio Health Group HMO |
$1,502.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,602.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,742.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,382.07
|
| Rate for Payer: PHCS Commercial |
$1,922.88
|
| Rate for Payer: United Healthcare All Payer |
$1,762.64
|
|
