|
PLATE BSRD LCKG CMP 4.5MM 10H
|
Facility
|
IP
|
$4,317.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.25 |
| Max. Negotiated Rate |
$4,144.80 |
| Rate for Payer: Aetna Commercial |
$3,324.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,367.65
|
| Rate for Payer: Cash Price |
$2,158.75
|
| Rate for Payer: Cigna Commercial |
$3,583.53
|
| Rate for Payer: First Health Commercial |
$4,101.62
|
| Rate for Payer: Humana Commercial |
$3,669.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,540.35
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,186.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,295.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,799.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,238.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,454.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,756.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,979.07
|
| Rate for Payer: PHCS Commercial |
$4,144.80
|
| Rate for Payer: United Healthcare All Payer |
$3,799.40
|
|
|
PLATE BSRD LCKG CMP 4.5MM 12H
|
Facility
|
OP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem Medicaid |
$1,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Humana KY Medicaid |
$1,523.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,538.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE BSRD LCKG CMP 4.5MM 12H
|
Facility
|
IP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE BSRD LCKG CMP 4.5MM 14H
|
Facility
|
IP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE BSRD LCKG CMP 4.5MM 14H
|
Facility
|
OP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem Medicaid |
$1,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Humana KY Medicaid |
$1,523.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,538.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE BTTRS LAT TIB RT 5X118MM
|
Facility
|
IP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE BTTRS LAT TIB RT 5X118MM
|
Facility
|
OP
|
$4,698.31
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,409.49 |
| Max. Negotiated Rate |
$4,510.38 |
| Rate for Payer: Aetna Commercial |
$3,617.70
|
| Rate for Payer: Anthem Medicaid |
$1,615.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,664.68
|
| Rate for Payer: Cash Price |
$2,349.16
|
| Rate for Payer: Cigna Commercial |
$3,899.60
|
| Rate for Payer: First Health Commercial |
$4,463.39
|
| Rate for Payer: Humana Commercial |
$3,993.56
|
| Rate for Payer: Humana KY Medicaid |
$1,615.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,632.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,852.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,467.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,409.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,648.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,134.51
|
| Rate for Payer: Ohio Health Group HMO |
$3,523.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,758.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,087.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,241.83
|
| Rate for Payer: PHCS Commercial |
$4,510.38
|
| Rate for Payer: United Healthcare All Payer |
$4,134.51
|
|
|
PLATE BTTRS LAT TIB RT 7X149MM
|
Facility
|
OP
|
$4,882.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.84 |
| Max. Negotiated Rate |
$4,687.50 |
| Rate for Payer: Aetna Commercial |
$3,759.76
|
| Rate for Payer: Anthem Medicaid |
$1,679.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,808.59
|
| Rate for Payer: Cash Price |
$2,441.41
|
| Rate for Payer: Cigna Commercial |
$4,052.73
|
| Rate for Payer: First Health Commercial |
$4,638.67
|
| Rate for Payer: Humana Commercial |
$4,150.39
|
| Rate for Payer: Humana KY Medicaid |
$1,679.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,696.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,603.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,712.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,662.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,906.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,248.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,369.14
|
| Rate for Payer: PHCS Commercial |
$4,687.50
|
| Rate for Payer: United Healthcare All Payer |
$4,296.87
|
|
|
PLATE BTTRS LAT TIB RT 7X149MM
|
Facility
|
IP
|
$4,882.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,464.84 |
| Max. Negotiated Rate |
$4,687.50 |
| Rate for Payer: Aetna Commercial |
$3,759.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,808.59
|
| Rate for Payer: Cash Price |
$2,441.41
|
| Rate for Payer: Cigna Commercial |
$4,052.73
|
| Rate for Payer: First Health Commercial |
$4,638.67
|
| Rate for Payer: Humana Commercial |
$4,150.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,003.90
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,603.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,464.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,296.87
|
| Rate for Payer: Ohio Health Group HMO |
$3,662.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,906.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,248.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,369.14
|
| Rate for Payer: PHCS Commercial |
$4,687.50
|
| Rate for Payer: United Healthcare All Payer |
$4,296.87
|
|
|
PLATE CABLE 6HOLE 187MM
|
Facility
|
OP
|
$6,841.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.39 |
| Max. Negotiated Rate |
$6,567.65 |
| Rate for Payer: Aetna Commercial |
$5,267.80
|
| Rate for Payer: Anthem Medicaid |
$2,352.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,336.21
|
| Rate for Payer: Cash Price |
$3,420.65
|
| Rate for Payer: Cigna Commercial |
$5,678.28
|
| Rate for Payer: First Health Commercial |
$6,499.23
|
| Rate for Payer: Humana Commercial |
$5,815.10
|
| Rate for Payer: Humana KY Medicaid |
$2,352.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,376.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,609.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,048.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,399.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,020.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,130.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,473.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,951.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,720.50
|
| Rate for Payer: PHCS Commercial |
$6,567.65
|
| Rate for Payer: United Healthcare All Payer |
$6,020.34
|
|
|
PLATE CABLE 6HOLE 187MM
|
Facility
|
IP
|
$6,841.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,052.39 |
| Max. Negotiated Rate |
$6,567.65 |
| Rate for Payer: Aetna Commercial |
$5,267.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,336.21
|
| Rate for Payer: Cash Price |
$3,420.65
|
| Rate for Payer: Cigna Commercial |
$5,678.28
|
| Rate for Payer: First Health Commercial |
$6,499.23
|
| Rate for Payer: Humana Commercial |
$5,815.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,609.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,048.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,052.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,020.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,130.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,473.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,951.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,720.50
|
| Rate for Payer: PHCS Commercial |
$6,567.65
|
| Rate for Payer: United Healthcare All Payer |
$6,020.34
|
|
|
PLATE CALCANEAL LARGE
|
Facility
|
OP
|
$4,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.00 |
| Max. Negotiated Rate |
$4,022.40 |
| Rate for Payer: Aetna Commercial |
$3,226.30
|
| Rate for Payer: Anthem Medicaid |
$1,440.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.20
|
| Rate for Payer: Cash Price |
$2,095.00
|
| Rate for Payer: Cigna Commercial |
$3,477.70
|
| Rate for Payer: First Health Commercial |
$3,980.50
|
| Rate for Payer: Humana Commercial |
$3,561.50
|
| Rate for Payer: Humana KY Medicaid |
$1,440.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,455.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,435.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,469.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,645.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.10
|
| Rate for Payer: PHCS Commercial |
$4,022.40
|
| Rate for Payer: United Healthcare All Payer |
$3,687.20
|
|
|
PLATE CALCANEAL LARGE
|
Facility
|
IP
|
$4,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.00 |
| Max. Negotiated Rate |
$4,022.40 |
| Rate for Payer: Aetna Commercial |
$3,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.20
|
| Rate for Payer: Cash Price |
$2,095.00
|
| Rate for Payer: Cigna Commercial |
$3,477.70
|
| Rate for Payer: First Health Commercial |
$3,980.50
|
| Rate for Payer: Humana Commercial |
$3,561.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,435.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,645.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.10
|
| Rate for Payer: PHCS Commercial |
$4,022.40
|
| Rate for Payer: United Healthcare All Payer |
$3,687.20
|
|
|
PLATE CALCANEAL X-LARGE
|
Facility
|
OP
|
$4,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.00 |
| Max. Negotiated Rate |
$4,022.40 |
| Rate for Payer: Aetna Commercial |
$3,226.30
|
| Rate for Payer: Anthem Medicaid |
$1,440.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.20
|
| Rate for Payer: Cash Price |
$2,095.00
|
| Rate for Payer: Cigna Commercial |
$3,477.70
|
| Rate for Payer: First Health Commercial |
$3,980.50
|
| Rate for Payer: Humana Commercial |
$3,561.50
|
| Rate for Payer: Humana KY Medicaid |
$1,440.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,455.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,435.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,469.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,645.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.10
|
| Rate for Payer: PHCS Commercial |
$4,022.40
|
| Rate for Payer: United Healthcare All Payer |
$3,687.20
|
|
|
PLATE CALCANEAL X-LARGE
|
Facility
|
IP
|
$4,190.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,257.00 |
| Max. Negotiated Rate |
$4,022.40 |
| Rate for Payer: Aetna Commercial |
$3,226.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.20
|
| Rate for Payer: Cash Price |
$2,095.00
|
| Rate for Payer: Cigna Commercial |
$3,477.70
|
| Rate for Payer: First Health Commercial |
$3,980.50
|
| Rate for Payer: Humana Commercial |
$3,561.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,435.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,142.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,352.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,645.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,891.10
|
| Rate for Payer: PHCS Commercial |
$4,022.40
|
| Rate for Payer: United Healthcare All Payer |
$3,687.20
|
|
|
PLATE CALCANEAL X-SMALL
|
Facility
|
OP
|
$3,594.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.41 |
| Max. Negotiated Rate |
$3,450.90 |
| Rate for Payer: Aetna Commercial |
$2,767.91
|
| Rate for Payer: Anthem Medicaid |
$1,236.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.86
|
| Rate for Payer: Cash Price |
$1,797.34
|
| Rate for Payer: Cigna Commercial |
$2,983.59
|
| Rate for Payer: First Health Commercial |
$3,414.96
|
| Rate for Payer: Humana Commercial |
$3,055.49
|
| Rate for Payer: Humana KY Medicaid |
$1,236.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,248.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,947.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,261.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,163.33
|
| Rate for Payer: Ohio Health Group HMO |
$2,696.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,127.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.34
|
| Rate for Payer: PHCS Commercial |
$3,450.90
|
| Rate for Payer: United Healthcare All Payer |
$3,163.33
|
|
|
PLATE CALCANEAL X-SMALL
|
Facility
|
IP
|
$3,594.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,078.41 |
| Max. Negotiated Rate |
$3,450.90 |
| Rate for Payer: Aetna Commercial |
$2,767.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,803.86
|
| Rate for Payer: Cash Price |
$1,797.34
|
| Rate for Payer: Cigna Commercial |
$2,983.59
|
| Rate for Payer: First Health Commercial |
$3,414.96
|
| Rate for Payer: Humana Commercial |
$3,055.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,947.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,652.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,078.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,163.33
|
| Rate for Payer: Ohio Health Group HMO |
$2,696.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,875.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,127.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,480.34
|
| Rate for Payer: PHCS Commercial |
$3,450.90
|
| Rate for Payer: United Healthcare All Payer |
$3,163.33
|
|
|
PLATE CALCANEUS LG 3.5MM LT
|
Facility
|
IP
|
$5,666.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.08 |
| Max. Negotiated Rate |
$5,440.26 |
| Rate for Payer: Aetna Commercial |
$4,363.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,420.21
|
| Rate for Payer: Cash Price |
$2,833.47
|
| Rate for Payer: Cigna Commercial |
$4,703.56
|
| Rate for Payer: First Health Commercial |
$5,383.59
|
| Rate for Payer: Humana Commercial |
$4,816.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,646.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,182.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,986.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,250.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,533.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,930.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,910.19
|
| Rate for Payer: PHCS Commercial |
$5,440.26
|
| Rate for Payer: United Healthcare All Payer |
$4,986.91
|
|
|
PLATE CALCANEUS LG 3.5MM LT
|
Facility
|
OP
|
$5,666.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.08 |
| Max. Negotiated Rate |
$5,440.26 |
| Rate for Payer: Aetna Commercial |
$4,363.54
|
| Rate for Payer: Anthem Medicaid |
$1,948.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,420.21
|
| Rate for Payer: Cash Price |
$2,833.47
|
| Rate for Payer: Cigna Commercial |
$4,703.56
|
| Rate for Payer: First Health Commercial |
$5,383.59
|
| Rate for Payer: Humana Commercial |
$4,816.90
|
| Rate for Payer: Humana KY Medicaid |
$1,948.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,646.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,182.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,986.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,250.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,533.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,930.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,910.19
|
| Rate for Payer: PHCS Commercial |
$5,440.26
|
| Rate for Payer: United Healthcare All Payer |
$4,986.91
|
|
|
PLATE CALCANEUS LG 3.5MM RT
|
Facility
|
OP
|
$5,666.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.08 |
| Max. Negotiated Rate |
$5,440.26 |
| Rate for Payer: Aetna Commercial |
$4,363.54
|
| Rate for Payer: Anthem Medicaid |
$1,948.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,420.21
|
| Rate for Payer: Cash Price |
$2,833.47
|
| Rate for Payer: Cigna Commercial |
$4,703.56
|
| Rate for Payer: First Health Commercial |
$5,383.59
|
| Rate for Payer: Humana Commercial |
$4,816.90
|
| Rate for Payer: Humana KY Medicaid |
$1,948.86
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,646.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,182.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,986.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,250.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,533.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,930.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,910.19
|
| Rate for Payer: PHCS Commercial |
$5,440.26
|
| Rate for Payer: United Healthcare All Payer |
$4,986.91
|
|
|
PLATE CALCANEUS LG 3.5MM RT
|
Facility
|
IP
|
$5,666.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,700.08 |
| Max. Negotiated Rate |
$5,440.26 |
| Rate for Payer: Aetna Commercial |
$4,363.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,420.21
|
| Rate for Payer: Cash Price |
$2,833.47
|
| Rate for Payer: Cigna Commercial |
$4,703.56
|
| Rate for Payer: First Health Commercial |
$5,383.59
|
| Rate for Payer: Humana Commercial |
$4,816.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,646.89
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,182.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,700.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,986.91
|
| Rate for Payer: Ohio Health Group HMO |
$4,250.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,533.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,930.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,910.19
|
| Rate for Payer: PHCS Commercial |
$5,440.26
|
| Rate for Payer: United Healthcare All Payer |
$4,986.91
|
|
|
PLATE CALCANEUS MD LT 3.5MM
|
Facility
|
OP
|
$6,801.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.39 |
| Max. Negotiated Rate |
$6,529.24 |
| Rate for Payer: Aetna Commercial |
$5,236.99
|
| Rate for Payer: Anthem Medicaid |
$2,338.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,305.01
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Cigna Commercial |
$5,645.07
|
| Rate for Payer: First Health Commercial |
$6,461.23
|
| Rate for Payer: Humana Commercial |
$5,781.10
|
| Rate for Payer: Humana KY Medicaid |
$2,338.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,362.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,577.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,985.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,441.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,917.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,692.89
|
| Rate for Payer: PHCS Commercial |
$6,529.24
|
| Rate for Payer: United Healthcare All Payer |
$5,985.14
|
|
|
PLATE CALCANEUS MD LT 3.5MM
|
Facility
|
IP
|
$6,801.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.39 |
| Max. Negotiated Rate |
$6,529.24 |
| Rate for Payer: Aetna Commercial |
$5,236.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,305.01
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Cigna Commercial |
$5,645.07
|
| Rate for Payer: First Health Commercial |
$6,461.23
|
| Rate for Payer: Humana Commercial |
$5,781.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,577.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,985.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,441.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,917.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,692.89
|
| Rate for Payer: PHCS Commercial |
$6,529.24
|
| Rate for Payer: United Healthcare All Payer |
$5,985.14
|
|
|
PLATE CALCANEUS MD RT 3.5MM
|
Facility
|
OP
|
$6,801.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.39 |
| Max. Negotiated Rate |
$6,529.24 |
| Rate for Payer: Aetna Commercial |
$5,236.99
|
| Rate for Payer: Anthem Medicaid |
$2,338.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,305.01
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Cigna Commercial |
$5,645.07
|
| Rate for Payer: First Health Commercial |
$6,461.23
|
| Rate for Payer: Humana Commercial |
$5,781.10
|
| Rate for Payer: Humana KY Medicaid |
$2,338.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,362.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,577.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,385.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,985.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,441.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,917.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,692.89
|
| Rate for Payer: PHCS Commercial |
$6,529.24
|
| Rate for Payer: United Healthcare All Payer |
$5,985.14
|
|
|
PLATE CALCANEUS MD RT 3.5MM
|
Facility
|
IP
|
$6,801.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,040.39 |
| Max. Negotiated Rate |
$6,529.24 |
| Rate for Payer: Aetna Commercial |
$5,236.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,305.01
|
| Rate for Payer: Cash Price |
$3,400.65
|
| Rate for Payer: Cigna Commercial |
$5,645.07
|
| Rate for Payer: First Health Commercial |
$6,461.23
|
| Rate for Payer: Humana Commercial |
$5,781.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,577.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,019.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,040.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,985.14
|
| Rate for Payer: Ohio Health Group HMO |
$5,100.97
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,441.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,917.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,692.89
|
| Rate for Payer: PHCS Commercial |
$6,529.24
|
| Rate for Payer: United Healthcare All Payer |
$5,985.14
|
|
