|
PLATE FIB LK PL LD 3.5*07 7 R
|
Facility
|
IP
|
$4,411.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.47 |
| Max. Negotiated Rate |
$4,234.85 |
| Rate for Payer: Aetna Commercial |
$3,396.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,440.81
|
| Rate for Payer: Cash Price |
$2,205.65
|
| Rate for Payer: Cigna Commercial |
$3,661.38
|
| Rate for Payer: First Health Commercial |
$4,190.74
|
| Rate for Payer: Humana Commercial |
$3,749.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,255.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,881.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,308.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.50
|
| Rate for Payer: PHCS Commercial |
$4,234.85
|
| Rate for Payer: United Healthcare All Payer |
$3,881.94
|
|
|
PLATE FIB LK PL LD 3.5*07 7 R
|
Facility
|
OP
|
$4,411.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$573.47 |
| Max. Negotiated Rate |
$4,234.85 |
| Rate for Payer: Aetna Commercial |
$3,396.70
|
| Rate for Payer: Anthem Medicaid |
$1,517.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,440.81
|
| Rate for Payer: Cash Price |
$2,205.65
|
| Rate for Payer: Cigna Commercial |
$3,661.38
|
| Rate for Payer: First Health Commercial |
$4,190.74
|
| Rate for Payer: Humana Commercial |
$3,749.60
|
| Rate for Payer: Humana KY Medicaid |
$1,517.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,532.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,617.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,255.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,323.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,547.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,881.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,308.48
|
| Rate for Payer: Ohio Health Group PPO Differential |
$882.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$573.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,367.50
|
| Rate for Payer: PHCS Commercial |
$4,234.85
|
| Rate for Payer: United Healthcare All Payer |
$3,881.94
|
|
|
PLATE FIB LK PL LD 3.5*131 9 R
|
Facility
|
IP
|
$4,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.03 |
| Max. Negotiated Rate |
$4,349.76 |
| Rate for Payer: Aetna Commercial |
$3,488.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.18
|
| Rate for Payer: Cash Price |
$2,265.50
|
| Rate for Payer: Cigna Commercial |
$3,760.73
|
| Rate for Payer: First Health Commercial |
$4,304.45
|
| Rate for Payer: Humana Commercial |
$3,851.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,404.61
|
| Rate for Payer: PHCS Commercial |
$4,349.76
|
| Rate for Payer: United Healthcare All Payer |
$3,987.28
|
|
|
PLATE FIB LK PL LD 3.5*131 9 R
|
Facility
|
OP
|
$4,531.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$589.03 |
| Max. Negotiated Rate |
$4,349.76 |
| Rate for Payer: Aetna Commercial |
$3,488.87
|
| Rate for Payer: Anthem Medicaid |
$1,558.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,534.18
|
| Rate for Payer: Cash Price |
$2,265.50
|
| Rate for Payer: Cigna Commercial |
$3,760.73
|
| Rate for Payer: First Health Commercial |
$4,304.45
|
| Rate for Payer: Humana Commercial |
$3,851.35
|
| Rate for Payer: Humana KY Medicaid |
$1,558.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,574.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,715.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,343.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,359.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,589.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,987.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,398.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$906.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$589.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,404.61
|
| Rate for Payer: PHCS Commercial |
$4,349.76
|
| Rate for Payer: United Healthcare All Payer |
$3,987.28
|
|
|
PLATE FIB LK PL LD 3.5*155 11R
|
Facility
|
IP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE FIB LK PL LD 3.5*155 11R
|
Facility
|
OP
|
$4,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$605.41 |
| Max. Negotiated Rate |
$4,470.72 |
| Rate for Payer: Aetna Commercial |
$3,585.89
|
| Rate for Payer: Anthem Medicaid |
$1,601.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,632.46
|
| Rate for Payer: Cash Price |
$2,328.50
|
| Rate for Payer: Cigna Commercial |
$3,865.31
|
| Rate for Payer: First Health Commercial |
$4,424.15
|
| Rate for Payer: Humana Commercial |
$3,958.45
|
| Rate for Payer: Humana KY Medicaid |
$1,601.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,617.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,818.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,436.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,397.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,633.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,098.16
|
| Rate for Payer: Ohio Health Group HMO |
$3,492.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$931.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$605.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,443.67
|
| Rate for Payer: PHCS Commercial |
$4,470.72
|
| Rate for Payer: United Healthcare All Payer |
$4,098.16
|
|
|
PLATE FIB LK PL LD 3.5*59 3 R
|
Facility
|
OP
|
$4,052.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.79 |
| Max. Negotiated Rate |
$3,890.11 |
| Rate for Payer: Anthem Medicaid |
$1,393.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.72
|
| Rate for Payer: Cash Price |
$2,026.10
|
| Rate for Payer: Cigna Commercial |
$3,363.33
|
| Rate for Payer: First Health Commercial |
$3,849.59
|
| Rate for Payer: Humana Commercial |
$3,444.37
|
| Rate for Payer: Humana KY Medicaid |
$1,393.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,407.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.80
|
| Rate for Payer: Aetna Commercial |
$3,120.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,421.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$810.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.18
|
| Rate for Payer: PHCS Commercial |
$3,890.11
|
| Rate for Payer: United Healthcare All Payer |
$3,565.94
|
|
|
PLATE FIB LK PL LD 3.5*59 3 R
|
Facility
|
IP
|
$4,052.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.79 |
| Max. Negotiated Rate |
$3,890.11 |
| Rate for Payer: Aetna Commercial |
$3,120.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,160.72
|
| Rate for Payer: Cash Price |
$2,026.10
|
| Rate for Payer: Cigna Commercial |
$3,363.33
|
| Rate for Payer: First Health Commercial |
$3,849.59
|
| Rate for Payer: Humana Commercial |
$3,444.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,322.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,990.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,215.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,565.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,039.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$810.44
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$526.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,256.18
|
| Rate for Payer: PHCS Commercial |
$3,890.11
|
| Rate for Payer: United Healthcare All Payer |
$3,565.94
|
|
|
PLATE FIBLUA COMP 7 HOLE
|
Facility
|
IP
|
$2,060.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.86 |
| Max. Negotiated Rate |
$1,978.08 |
| Rate for Payer: Aetna Commercial |
$1,586.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.19
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cigna Commercial |
$1,710.22
|
| Rate for Payer: First Health Commercial |
$1,957.48
|
| Rate for Payer: Humana Commercial |
$1,751.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.76
|
| Rate for Payer: PHCS Commercial |
$1,978.08
|
| Rate for Payer: United Healthcare All Payer |
$1,813.24
|
|
|
PLATE FIBLUA COMP 7 HOLE
|
Facility
|
OP
|
$2,060.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$267.86 |
| Max. Negotiated Rate |
$1,978.08 |
| Rate for Payer: Aetna Commercial |
$1,586.58
|
| Rate for Payer: Anthem Medicaid |
$708.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,607.19
|
| Rate for Payer: Cash Price |
$1,030.25
|
| Rate for Payer: Cigna Commercial |
$1,710.22
|
| Rate for Payer: First Health Commercial |
$1,957.48
|
| Rate for Payer: Humana Commercial |
$1,751.42
|
| Rate for Payer: Humana KY Medicaid |
$708.61
|
| Rate for Payer: Kentucky WC Medicaid |
$715.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,689.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,520.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$618.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$722.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,813.24
|
| Rate for Payer: Ohio Health Group HMO |
$1,545.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$412.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$267.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$638.76
|
| Rate for Payer: PHCS Commercial |
$1,978.08
|
| Rate for Payer: United Healthcare All Payer |
$1,813.24
|
|
|
PLATE FIBULA COMP 10H
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
PLATE FIBULA COMP 10H
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
PLATE FIBULA COMP 11H
|
Facility
|
IP
|
$2,144.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.78 |
| Max. Negotiated Rate |
$2,058.72 |
| Rate for Payer: Aetna Commercial |
$1,651.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.71
|
| Rate for Payer: Cash Price |
$1,072.25
|
| Rate for Payer: Cigna Commercial |
$1,779.94
|
| Rate for Payer: First Health Commercial |
$2,037.28
|
| Rate for Payer: Humana Commercial |
$1,822.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.80
|
| Rate for Payer: PHCS Commercial |
$2,058.72
|
| Rate for Payer: United Healthcare All Payer |
$1,887.16
|
|
|
PLATE FIBULA COMP 11H
|
Facility
|
OP
|
$2,144.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.78 |
| Max. Negotiated Rate |
$2,058.72 |
| Rate for Payer: Aetna Commercial |
$1,651.26
|
| Rate for Payer: Anthem Medicaid |
$737.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.71
|
| Rate for Payer: Cash Price |
$1,072.25
|
| Rate for Payer: Cigna Commercial |
$1,779.94
|
| Rate for Payer: First Health Commercial |
$2,037.28
|
| Rate for Payer: Humana Commercial |
$1,822.82
|
| Rate for Payer: Humana KY Medicaid |
$737.49
|
| Rate for Payer: Kentucky WC Medicaid |
$745.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.80
|
| Rate for Payer: PHCS Commercial |
$2,058.72
|
| Rate for Payer: United Healthcare All Payer |
$1,887.16
|
|
|
PLATE FIBULA COMP 12H
|
Facility
|
OP
|
$2,144.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.78 |
| Max. Negotiated Rate |
$2,058.72 |
| Rate for Payer: Aetna Commercial |
$1,651.26
|
| Rate for Payer: Anthem Medicaid |
$737.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.71
|
| Rate for Payer: Cash Price |
$1,072.25
|
| Rate for Payer: Cigna Commercial |
$1,779.94
|
| Rate for Payer: First Health Commercial |
$2,037.28
|
| Rate for Payer: Humana Commercial |
$1,822.82
|
| Rate for Payer: Humana KY Medicaid |
$737.49
|
| Rate for Payer: Kentucky WC Medicaid |
$745.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$752.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.80
|
| Rate for Payer: PHCS Commercial |
$2,058.72
|
| Rate for Payer: United Healthcare All Payer |
$1,887.16
|
|
|
PLATE FIBULA COMP 12H
|
Facility
|
IP
|
$2,144.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$278.78 |
| Max. Negotiated Rate |
$2,058.72 |
| Rate for Payer: Aetna Commercial |
$1,651.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,672.71
|
| Rate for Payer: Cash Price |
$1,072.25
|
| Rate for Payer: Cigna Commercial |
$1,779.94
|
| Rate for Payer: First Health Commercial |
$2,037.28
|
| Rate for Payer: Humana Commercial |
$1,822.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,758.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,582.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$643.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,887.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,608.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$428.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$278.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$664.80
|
| Rate for Payer: PHCS Commercial |
$2,058.72
|
| Rate for Payer: United Healthcare All Payer |
$1,887.16
|
|
|
PLATE FIBULA COMP 13H
|
Facility
|
OP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Anthem Medicaid |
$723.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Humana KY Medicaid |
$723.05
|
| Rate for Payer: Kentucky WC Medicaid |
$730.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$737.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
PLATE FIBULA COMP 13H
|
Facility
|
IP
|
$2,102.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.32 |
| Max. Negotiated Rate |
$2,018.40 |
| Rate for Payer: Aetna Commercial |
$1,618.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,639.95
|
| Rate for Payer: Cash Price |
$1,051.25
|
| Rate for Payer: Cigna Commercial |
$1,745.08
|
| Rate for Payer: First Health Commercial |
$1,997.38
|
| Rate for Payer: Humana Commercial |
$1,787.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,724.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,551.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,850.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,576.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$420.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$273.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$651.78
|
| Rate for Payer: PHCS Commercial |
$2,018.40
|
| Rate for Payer: United Healthcare All Payer |
$1,850.20
|
|
|
PLATE FIBULA COMP 14H
|
Facility
|
IP
|
$3,078.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.20 |
| Max. Negotiated Rate |
$2,955.36 |
| Rate for Payer: Aetna Commercial |
$2,370.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,401.23
|
| Rate for Payer: Cash Price |
$1,539.25
|
| Rate for Payer: Cigna Commercial |
$2,555.16
|
| Rate for Payer: First Health Commercial |
$2,924.58
|
| Rate for Payer: Humana Commercial |
$2,616.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,524.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,271.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$923.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,709.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,308.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$400.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$954.34
|
| Rate for Payer: PHCS Commercial |
$2,955.36
|
| Rate for Payer: United Healthcare All Payer |
$2,709.08
|
|
|
PLATE FIBULA COMP 14H
|
Facility
|
OP
|
$3,078.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$400.20 |
| Max. Negotiated Rate |
$2,955.36 |
| Rate for Payer: Aetna Commercial |
$2,370.44
|
| Rate for Payer: Anthem Medicaid |
$1,058.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,401.23
|
| Rate for Payer: Cash Price |
$1,539.25
|
| Rate for Payer: Cigna Commercial |
$2,555.16
|
| Rate for Payer: First Health Commercial |
$2,924.58
|
| Rate for Payer: Humana Commercial |
$2,616.72
|
| Rate for Payer: Humana KY Medicaid |
$1,058.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,069.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,524.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,271.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$923.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,079.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,709.08
|
| Rate for Payer: Ohio Health Group HMO |
$2,308.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$615.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$400.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$954.34
|
| Rate for Payer: PHCS Commercial |
$2,955.36
|
| Rate for Payer: United Healthcare All Payer |
$2,709.08
|
|
|
PLATE FIBULA COMP 5 HOLE
|
Facility
|
IP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
PLATE FIBULA COMP 5 HOLE
|
Facility
|
OP
|
$1,700.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$1,632.00 |
| Rate for Payer: Aetna Commercial |
$1,309.00
|
| Rate for Payer: Anthem Medicaid |
$584.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,326.00
|
| Rate for Payer: Cash Price |
$850.00
|
| Rate for Payer: Cigna Commercial |
$1,411.00
|
| Rate for Payer: First Health Commercial |
$1,615.00
|
| Rate for Payer: Humana Commercial |
$1,445.00
|
| Rate for Payer: Humana KY Medicaid |
$584.63
|
| Rate for Payer: Kentucky WC Medicaid |
$590.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,394.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,254.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$510.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$596.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,496.00
|
| Rate for Payer: Ohio Health Group HMO |
$1,275.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$340.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$221.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$527.00
|
| Rate for Payer: PHCS Commercial |
$1,632.00
|
| Rate for Payer: United Healthcare All Payer |
$1,496.00
|
|
|
PLATE FIBULA COMP 6H
|
Facility
|
IP
|
$2,018.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.40 |
| Max. Negotiated Rate |
$1,937.76 |
| Rate for Payer: Aetna Commercial |
$1,554.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.43
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: First Health Commercial |
$1,917.58
|
| Rate for Payer: Humana Commercial |
$1,715.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.74
|
| Rate for Payer: PHCS Commercial |
$1,937.76
|
| Rate for Payer: United Healthcare All Payer |
$1,776.28
|
|
|
PLATE FIBULA COMP 6H
|
Facility
|
OP
|
$2,018.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.40 |
| Max. Negotiated Rate |
$1,937.76 |
| Rate for Payer: Aetna Commercial |
$1,554.24
|
| Rate for Payer: Anthem Medicaid |
$694.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,574.43
|
| Rate for Payer: Cash Price |
$1,009.25
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: First Health Commercial |
$1,917.58
|
| Rate for Payer: Humana Commercial |
$1,715.72
|
| Rate for Payer: Humana KY Medicaid |
$694.16
|
| Rate for Payer: Kentucky WC Medicaid |
$701.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,655.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,489.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$605.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$708.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,776.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,513.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$403.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$625.74
|
| Rate for Payer: PHCS Commercial |
$1,937.76
|
| Rate for Payer: United Healthcare All Payer |
$1,776.28
|
|
|
PLATE FIBULA COMP 8H
|
Facility
|
IP
|
$2,021.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.80 |
| Max. Negotiated Rate |
$1,940.65 |
| Rate for Payer: Aetna Commercial |
$1,556.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,576.78
|
| Rate for Payer: Cash Price |
$1,010.76
|
| Rate for Payer: Cigna Commercial |
$1,677.85
|
| Rate for Payer: First Health Commercial |
$1,920.43
|
| Rate for Payer: Humana Commercial |
$1,718.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,657.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,491.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$606.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,778.93
|
| Rate for Payer: Ohio Health Group HMO |
$1,516.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$404.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$262.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$626.67
|
| Rate for Payer: PHCS Commercial |
$1,940.65
|
| Rate for Payer: United Healthcare All Payer |
$1,778.93
|
|
