|
PLATE L FRAGMENT 2.7*61 L
|
Facility
|
OP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem Medicaid |
$1,124.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Humana KY Medicaid |
$1,124.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
PLATE L FRAGMENT 2.7*61 R
|
Facility
|
IP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
PLATE L FRAGMENT 2.7*61 R
|
Facility
|
OP
|
$3,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$425.23 |
| Max. Negotiated Rate |
$3,140.16 |
| Rate for Payer: Aetna Commercial |
$2,518.67
|
| Rate for Payer: Anthem Medicaid |
$1,124.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,551.38
|
| Rate for Payer: Cash Price |
$1,635.50
|
| Rate for Payer: Cigna Commercial |
$2,714.93
|
| Rate for Payer: First Health Commercial |
$3,107.45
|
| Rate for Payer: Humana Commercial |
$2,780.35
|
| Rate for Payer: Humana KY Medicaid |
$1,124.90
|
| Rate for Payer: Kentucky WC Medicaid |
$1,136.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,682.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,414.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$981.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,147.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,878.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,453.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$654.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$425.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,014.01
|
| Rate for Payer: PHCS Commercial |
$3,140.16
|
| Rate for Payer: United Healthcare All Payer |
$2,878.48
|
|
|
PLATE LG FUSION TMT 2.7MM
|
Facility
|
IP
|
$6,456.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$6,197.95 |
| Rate for Payer: Aetna Commercial |
$4,971.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,035.84
|
| Rate for Payer: Cash Price |
$3,228.10
|
| Rate for Payer: Cigna Commercial |
$5,358.65
|
| Rate for Payer: First Health Commercial |
$6,133.39
|
| Rate for Payer: Humana Commercial |
$5,487.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,294.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,764.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,936.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,681.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,842.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,291.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,001.42
|
| Rate for Payer: PHCS Commercial |
$6,197.95
|
| Rate for Payer: United Healthcare All Payer |
$5,681.46
|
|
|
PLATE LG FUSION TMT 2.7MM
|
Facility
|
OP
|
$6,456.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$6,197.95 |
| Rate for Payer: Aetna Commercial |
$4,971.27
|
| Rate for Payer: Anthem Medicaid |
$2,220.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,035.84
|
| Rate for Payer: Cash Price |
$3,228.10
|
| Rate for Payer: Cigna Commercial |
$5,358.65
|
| Rate for Payer: First Health Commercial |
$6,133.39
|
| Rate for Payer: Humana Commercial |
$5,487.77
|
| Rate for Payer: Humana KY Medicaid |
$2,220.29
|
| Rate for Payer: Kentucky WC Medicaid |
$2,242.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,294.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,764.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,936.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,264.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,681.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,842.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,291.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$839.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,001.42
|
| Rate for Payer: PHCS Commercial |
$6,197.95
|
| Rate for Payer: United Healthcare All Payer |
$5,681.46
|
|
|
PLATE LG LT JONES FX
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLATE LG LT JONES FX
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLATE LG RT JONES FX
|
Facility
|
OP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem Medicaid |
$3,109.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
| Rate for Payer: Humana KY Medicaid |
$3,109.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,171.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
|
|
PLATE LG RT JONES FX
|
Facility
|
IP
|
$9,041.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,175.40 |
| Max. Negotiated Rate |
$8,679.84 |
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,414.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,672.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,956.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,781.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,808.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,175.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,802.86
|
| Rate for Payer: PHCS Commercial |
$8,679.84
|
| Rate for Payer: United Healthcare All Payer |
$7,956.52
|
| Rate for Payer: Aetna Commercial |
$6,961.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,052.37
|
| Rate for Payer: Cash Price |
$4,520.75
|
| Rate for Payer: Cigna Commercial |
$7,504.44
|
| Rate for Payer: First Health Commercial |
$8,589.42
|
| Rate for Payer: Humana Commercial |
$7,685.28
|
|
|
PLATE LG UTILITY 2.7MM
|
Facility
|
OP
|
$6,659.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.71 |
| Max. Negotiated Rate |
$6,392.96 |
| Rate for Payer: Aetna Commercial |
$5,127.68
|
| Rate for Payer: Anthem Medicaid |
$2,290.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,194.28
|
| Rate for Payer: Cash Price |
$3,329.66
|
| Rate for Payer: Cigna Commercial |
$5,527.24
|
| Rate for Payer: First Health Commercial |
$6,326.36
|
| Rate for Payer: Humana Commercial |
$5,660.43
|
| Rate for Payer: Humana KY Medicaid |
$2,290.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,313.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,460.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,336.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,860.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,994.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.39
|
| Rate for Payer: PHCS Commercial |
$6,392.96
|
| Rate for Payer: United Healthcare All Payer |
$5,860.21
|
|
|
PLATE LG UTILITY 2.7MM
|
Facility
|
IP
|
$6,659.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.71 |
| Max. Negotiated Rate |
$6,392.96 |
| Rate for Payer: Aetna Commercial |
$5,127.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,194.28
|
| Rate for Payer: Cash Price |
$3,329.66
|
| Rate for Payer: Cigna Commercial |
$5,527.24
|
| Rate for Payer: First Health Commercial |
$6,326.36
|
| Rate for Payer: Humana Commercial |
$5,660.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,460.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,860.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,994.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.39
|
| Rate for Payer: PHCS Commercial |
$6,392.96
|
| Rate for Payer: United Healthcare All Payer |
$5,860.21
|
|
|
PLATE LISFRANC TI LG LT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI LG LT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI LG RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI LG RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI MED L
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI MED L
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
|
|
PLATE LISFRANC TI MED R
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI MED R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM L
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM L
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM R
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$650.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$650.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,550.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LK CLAV INF MD 10H 117MM
|
Facility
|
IP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
|
PLATE LK CLAV INF MD 10H 117MM
|
Facility
|
OP
|
$4,666.98
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$606.71 |
| Max. Negotiated Rate |
$4,480.30 |
| Rate for Payer: Aetna Commercial |
$3,593.57
|
| Rate for Payer: Anthem Medicaid |
$1,604.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,640.24
|
| Rate for Payer: Cash Price |
$2,333.49
|
| Rate for Payer: Cigna Commercial |
$3,873.59
|
| Rate for Payer: First Health Commercial |
$4,433.63
|
| Rate for Payer: Humana Commercial |
$3,966.93
|
| Rate for Payer: Humana KY Medicaid |
$1,604.97
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,444.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,400.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,637.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.94
|
| Rate for Payer: Ohio Health Group HMO |
$3,500.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$606.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,446.76
|
| Rate for Payer: PHCS Commercial |
$4,480.30
|
| Rate for Payer: United Healthcare All Payer |
$4,106.94
|
|
