|
PLATE LATERAL FIBULA 5H L
|
Facility
|
IP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
|
PLATE LATERAL FIBULA 5H L
|
Facility
|
OP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem Medicaid |
$1,648.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Humana KY Medicaid |
$1,648.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
|
PLATE LATERAL FIBULA 5H R
|
Facility
|
IP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
|
PLATE LATERAL FIBULA 5H R
|
Facility
|
OP
|
$4,793.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.16 |
| Max. Negotiated Rate |
$4,601.76 |
| Rate for Payer: Aetna Commercial |
$3,691.00
|
| Rate for Payer: Anthem Medicaid |
$1,648.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,738.93
|
| Rate for Payer: Cash Price |
$2,396.75
|
| Rate for Payer: Cigna Commercial |
$3,978.60
|
| Rate for Payer: First Health Commercial |
$4,553.82
|
| Rate for Payer: Humana Commercial |
$4,074.48
|
| Rate for Payer: Humana KY Medicaid |
$1,648.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$958.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$623.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,485.98
|
| Rate for Payer: PHCS Commercial |
$4,601.76
|
| Rate for Payer: United Healthcare All Payer |
$4,218.28
|
|
|
PLATE LATERAL FIBULA 6H L
|
Facility
|
OP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Anthem Medicaid |
$1,664.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Humana KY Medicaid |
$1,664.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,697.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE LATERAL FIBULA 6H L
|
Facility
|
IP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE LATERAL FIBULA 6H R
|
Facility
|
IP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE LATERAL FIBULA 6H R
|
Facility
|
OP
|
$4,839.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$629.07 |
| Max. Negotiated Rate |
$4,645.44 |
| Rate for Payer: Aetna Commercial |
$3,726.03
|
| Rate for Payer: Anthem Medicaid |
$1,664.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,774.42
|
| Rate for Payer: Cash Price |
$2,419.50
|
| Rate for Payer: Cigna Commercial |
$4,016.37
|
| Rate for Payer: First Health Commercial |
$4,597.05
|
| Rate for Payer: Humana Commercial |
$4,113.15
|
| Rate for Payer: Humana KY Medicaid |
$1,664.13
|
| Rate for Payer: Kentucky WC Medicaid |
$1,681.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,967.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,571.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,451.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,697.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,258.32
|
| Rate for Payer: Ohio Health Group HMO |
$3,629.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$967.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$629.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,500.09
|
| Rate for Payer: PHCS Commercial |
$4,645.44
|
| Rate for Payer: United Healthcare All Payer |
$4,258.32
|
|
|
PLATE LATERAL FIBULA 7H L
|
Facility
|
OP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem Medicaid |
$1,679.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Humana KY Medicaid |
$1,679.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,696.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,713.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
|
|
PLATE LATERAL FIBULA 7H L
|
Facility
|
IP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
|
|
PLATE LATERAL FIBULA 7H R
|
Facility
|
IP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
|
|
PLATE LATERAL FIBULA 7H R
|
Facility
|
OP
|
$4,884.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$634.98 |
| Max. Negotiated Rate |
$4,689.12 |
| Rate for Payer: Aetna Commercial |
$3,761.06
|
| Rate for Payer: Anthem Medicaid |
$1,679.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,809.91
|
| Rate for Payer: Cash Price |
$2,442.25
|
| Rate for Payer: Cigna Commercial |
$4,054.14
|
| Rate for Payer: First Health Commercial |
$4,640.28
|
| Rate for Payer: Humana Commercial |
$4,151.82
|
| Rate for Payer: Humana KY Medicaid |
$1,679.78
|
| Rate for Payer: Kentucky WC Medicaid |
$1,696.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,005.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,604.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,465.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,713.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,298.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,663.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$976.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$634.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,514.20
|
| Rate for Payer: PHCS Commercial |
$4,689.12
|
| Rate for Payer: United Healthcare All Payer |
$4,298.36
|
|
|
PLATE LATERAL FIBULA 9H L
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE LATERAL FIBULA 9H L
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE LATERAL FIBULA 9H R
|
Facility
|
OP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem Medicaid |
$1,695.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Humana KY Medicaid |
$1,695.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,712.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,729.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE LATERAL FIBULA 9H R
|
Facility
|
IP
|
$4,930.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$640.90 |
| Max. Negotiated Rate |
$4,732.80 |
| Rate for Payer: Aetna Commercial |
$3,796.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,845.40
|
| Rate for Payer: Cash Price |
$2,465.00
|
| Rate for Payer: Cigna Commercial |
$4,091.90
|
| Rate for Payer: First Health Commercial |
$4,683.50
|
| Rate for Payer: Humana Commercial |
$4,190.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,042.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,638.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,479.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,338.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$986.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$640.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,528.30
|
| Rate for Payer: PHCS Commercial |
$4,732.80
|
| Rate for Payer: United Healthcare All Payer |
$4,338.40
|
|
|
PLATE LATERAL FIBULA RT 77MM
|
Facility
|
IP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
PLATE LATERAL FIBULA RT 77MM
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
|
|
PLATE LATL TTC 4.5MM 120MM L
|
Facility
|
IP
|
$6,968.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.95 |
| Max. Negotiated Rate |
$6,690.10 |
| Rate for Payer: Aetna Commercial |
$5,366.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,435.70
|
| Rate for Payer: Cash Price |
$3,484.42
|
| Rate for Payer: Cigna Commercial |
$5,784.15
|
| Rate for Payer: First Health Commercial |
$6,620.41
|
| Rate for Payer: Humana Commercial |
$5,923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,714.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,143.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,090.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,132.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,226.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,393.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$905.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,160.34
|
| Rate for Payer: PHCS Commercial |
$6,690.10
|
| Rate for Payer: United Healthcare All Payer |
$6,132.59
|
|
|
PLATE LATL TTC 4.5MM 120MM L
|
Facility
|
OP
|
$6,968.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.95 |
| Max. Negotiated Rate |
$6,690.10 |
| Rate for Payer: Aetna Commercial |
$5,366.01
|
| Rate for Payer: Anthem Medicaid |
$2,396.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,435.70
|
| Rate for Payer: Cash Price |
$3,484.42
|
| Rate for Payer: Cigna Commercial |
$5,784.15
|
| Rate for Payer: First Health Commercial |
$6,620.41
|
| Rate for Payer: Humana Commercial |
$5,923.52
|
| Rate for Payer: Humana KY Medicaid |
$2,396.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,420.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,714.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,143.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,090.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,444.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,132.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,226.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,393.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$905.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,160.34
|
| Rate for Payer: PHCS Commercial |
$6,690.10
|
| Rate for Payer: United Healthcare All Payer |
$6,132.59
|
|
|
PLATE LATL TTC 4.5MM 120MM R
|
Facility
|
IP
|
$6,968.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.95 |
| Max. Negotiated Rate |
$6,690.10 |
| Rate for Payer: Aetna Commercial |
$5,366.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,435.70
|
| Rate for Payer: Cash Price |
$3,484.42
|
| Rate for Payer: Cigna Commercial |
$5,784.15
|
| Rate for Payer: First Health Commercial |
$6,620.41
|
| Rate for Payer: Humana Commercial |
$5,923.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,714.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,143.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,090.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,132.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,226.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,393.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$905.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,160.34
|
| Rate for Payer: PHCS Commercial |
$6,690.10
|
| Rate for Payer: United Healthcare All Payer |
$6,132.59
|
|
|
PLATE LATL TTC 4.5MM 120MM R
|
Facility
|
OP
|
$6,968.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$905.95 |
| Max. Negotiated Rate |
$6,690.10 |
| Rate for Payer: Aetna Commercial |
$5,366.01
|
| Rate for Payer: Anthem Medicaid |
$2,396.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,435.70
|
| Rate for Payer: Cash Price |
$3,484.42
|
| Rate for Payer: Cigna Commercial |
$5,784.15
|
| Rate for Payer: First Health Commercial |
$6,620.41
|
| Rate for Payer: Humana Commercial |
$5,923.52
|
| Rate for Payer: Humana KY Medicaid |
$2,396.59
|
| Rate for Payer: Kentucky WC Medicaid |
$2,420.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,714.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,143.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,090.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,444.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,132.59
|
| Rate for Payer: Ohio Health Group HMO |
$5,226.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,393.77
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$905.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,160.34
|
| Rate for Payer: PHCS Commercial |
$6,690.10
|
| Rate for Payer: United Healthcare All Payer |
$6,132.59
|
|
|
PLATE L-BUTTRESS 4 HOLE
|
Facility
|
IP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
PLATE L-BUTTRESS 4 HOLE
|
Facility
|
OP
|
$1,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$239.20 |
| Max. Negotiated Rate |
$1,766.40 |
| Rate for Payer: Aetna Commercial |
$1,416.80
|
| Rate for Payer: Anthem Medicaid |
$632.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,435.20
|
| Rate for Payer: Cash Price |
$920.00
|
| Rate for Payer: Cigna Commercial |
$1,527.20
|
| Rate for Payer: First Health Commercial |
$1,748.00
|
| Rate for Payer: Humana Commercial |
$1,564.00
|
| Rate for Payer: Humana KY Medicaid |
$632.78
|
| Rate for Payer: Kentucky WC Medicaid |
$639.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,508.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,357.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$552.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$645.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,619.20
|
| Rate for Payer: Ohio Health Group HMO |
$1,380.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$368.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$239.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$570.40
|
| Rate for Payer: PHCS Commercial |
$1,766.40
|
| Rate for Payer: United Healthcare All Payer |
$1,619.20
|
|
|
PLATE L-BUTTRESS W/PF LT
|
Facility
|
OP
|
$3,591.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.95 |
| Max. Negotiated Rate |
$3,448.27 |
| Rate for Payer: Aetna Commercial |
$2,765.80
|
| Rate for Payer: Anthem Medicaid |
$1,235.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,801.72
|
| Rate for Payer: Cash Price |
$1,795.97
|
| Rate for Payer: Cigna Commercial |
$2,981.32
|
| Rate for Payer: First Health Commercial |
$3,412.35
|
| Rate for Payer: Humana Commercial |
$3,053.16
|
| Rate for Payer: Humana KY Medicaid |
$1,235.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,247.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,945.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,650.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,077.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,260.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,160.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,693.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$718.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$466.95
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,113.50
|
| Rate for Payer: PHCS Commercial |
$3,448.27
|
| Rate for Payer: United Healthcare All Payer |
$3,160.92
|
|
