|
PLATE DOR DIST RAD TI STD R 4H
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE DOR DIST RAD TI STD R 4H
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE DORSAL DIST RAD LT-XLNG
|
Facility
|
IP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
PLATE DORSAL DIST RAD LT-XLNG
|
Facility
|
OP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem Medicaid |
$760.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Humana KY Medicaid |
$760.36
|
| Rate for Payer: Kentucky WC Medicaid |
$768.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
PLATE DORSAL DIST RAD RT-XLNG
|
Facility
|
IP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
PLATE DORSAL DIST RAD RT-XLNG
|
Facility
|
OP
|
$2,211.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$287.43 |
| Max. Negotiated Rate |
$2,122.56 |
| Rate for Payer: Aetna Commercial |
$1,702.47
|
| Rate for Payer: Anthem Medicaid |
$760.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,724.58
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$1,835.13
|
| Rate for Payer: First Health Commercial |
$2,100.45
|
| Rate for Payer: Humana Commercial |
$1,879.35
|
| Rate for Payer: Humana KY Medicaid |
$760.36
|
| Rate for Payer: Kentucky WC Medicaid |
$768.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,813.02
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,631.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$663.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$775.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,945.68
|
| Rate for Payer: Ohio Health Group HMO |
$1,658.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$442.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$287.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$685.41
|
| Rate for Payer: PHCS Commercial |
$2,122.56
|
| Rate for Payer: United Healthcare All Payer |
$1,945.68
|
|
|
PLATE DORSAL LEFT 3H
|
Facility
|
OP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Anthem Medicaid |
$1,619.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Humana KY Medicaid |
$1,619.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL LEFT 3H
|
Facility
|
IP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL LEFT 4H
|
Facility
|
OP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem Medicaid |
$1,619.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Humana KY Medicaid |
$1,619.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL LEFT 4H
|
Facility
|
IP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL LUNATE LEFT
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DORSAL LUNATE LEFT
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem Medicaid |
$1,464.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Humana KY Medicaid |
$1,464.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DORSAL LUNATE RIGHT
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DORSAL LUNATE RIGHT
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem Medicaid |
$1,464.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Humana KY Medicaid |
$1,464.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DORSAL NAIL LEFT
|
Facility
|
IP
|
$6,891.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.91 |
| Max. Negotiated Rate |
$6,615.98 |
| Rate for Payer: Aetna Commercial |
$5,306.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,375.49
|
| Rate for Payer: Cash Price |
$3,445.82
|
| Rate for Payer: Cigna Commercial |
$5,720.07
|
| Rate for Payer: First Health Commercial |
$6,547.07
|
| Rate for Payer: Humana Commercial |
$5,857.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,651.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,086.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,067.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,064.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,168.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.41
|
| Rate for Payer: PHCS Commercial |
$6,615.98
|
| Rate for Payer: United Healthcare All Payer |
$6,064.65
|
|
|
PLATE DORSAL NAIL LEFT
|
Facility
|
OP
|
$6,891.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.91 |
| Max. Negotiated Rate |
$6,615.98 |
| Rate for Payer: Aetna Commercial |
$5,306.57
|
| Rate for Payer: Anthem Medicaid |
$2,370.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,375.49
|
| Rate for Payer: Cash Price |
$3,445.82
|
| Rate for Payer: Cigna Commercial |
$5,720.07
|
| Rate for Payer: First Health Commercial |
$6,547.07
|
| Rate for Payer: Humana Commercial |
$5,857.90
|
| Rate for Payer: Humana KY Medicaid |
$2,370.04
|
| Rate for Payer: Kentucky WC Medicaid |
$2,394.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,651.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,086.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,067.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,417.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,064.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,168.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,378.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,136.41
|
| Rate for Payer: PHCS Commercial |
$6,615.98
|
| Rate for Payer: United Healthcare All Payer |
$6,064.65
|
|
|
PLATE DORSAL NAIL RIGHT
|
Facility
|
IP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
PLATE DORSAL NAIL RIGHT
|
Facility
|
OP
|
$5,535.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$719.62 |
| Max. Negotiated Rate |
$5,314.08 |
| Rate for Payer: Anthem Medicaid |
$1,903.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,317.69
|
| Rate for Payer: Cash Price |
$2,767.75
|
| Rate for Payer: Cigna Commercial |
$4,594.46
|
| Rate for Payer: First Health Commercial |
$5,258.72
|
| Rate for Payer: Humana Commercial |
$4,705.18
|
| Rate for Payer: Humana KY Medicaid |
$1,903.66
|
| Rate for Payer: Kentucky WC Medicaid |
$1,923.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,539.11
|
| Rate for Payer: Aetna Commercial |
$4,262.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,085.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,660.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,941.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,871.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,151.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,107.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$719.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,716.00
|
| Rate for Payer: PHCS Commercial |
$5,314.08
|
| Rate for Payer: United Healthcare All Payer |
$4,871.24
|
|
|
PLATE DORSAL RIGHT 3H
|
Facility
|
IP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL RIGHT 3H
|
Facility
|
OP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem Medicaid |
$1,619.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Humana KY Medicaid |
$1,619.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL RIGHT 4H
|
Facility
|
IP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL RIGHT 4H
|
Facility
|
OP
|
$4,709.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$612.24 |
| Max. Negotiated Rate |
$4,521.12 |
| Rate for Payer: Aetna Commercial |
$3,626.32
|
| Rate for Payer: Anthem Medicaid |
$1,619.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,673.41
|
| Rate for Payer: Cash Price |
$2,354.75
|
| Rate for Payer: Cigna Commercial |
$3,908.88
|
| Rate for Payer: First Health Commercial |
$4,474.02
|
| Rate for Payer: Humana Commercial |
$4,003.08
|
| Rate for Payer: Humana KY Medicaid |
$1,619.60
|
| Rate for Payer: Kentucky WC Medicaid |
$1,636.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,861.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,475.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,412.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,652.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,144.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,532.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$941.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$612.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,459.94
|
| Rate for Payer: PHCS Commercial |
$4,521.12
|
| Rate for Payer: United Healthcare All Payer |
$4,144.36
|
|
|
PLATE DORSAL RIM BUTTRESS LEFT
|
Facility
|
OP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem Medicaid |
$1,464.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Humana KY Medicaid |
$1,464.33
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,493.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DORSAL RIM BUTTRESS LEFT
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
|
PLATE DORSAL RIM BUTTRESS RT
|
Facility
|
IP
|
$4,258.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.54 |
| Max. Negotiated Rate |
$4,087.68 |
| Rate for Payer: Aetna Commercial |
$3,278.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,321.24
|
| Rate for Payer: Cash Price |
$2,129.00
|
| Rate for Payer: Cigna Commercial |
$3,534.14
|
| Rate for Payer: First Health Commercial |
$4,045.10
|
| Rate for Payer: Humana Commercial |
$3,619.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,491.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,142.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,747.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,193.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,319.98
|
| Rate for Payer: PHCS Commercial |
$4,087.68
|
| Rate for Payer: United Healthcare All Payer |
$3,747.04
|
|
