|
PLATE DISTAL FEM LAT R 9H 227M
|
Facility
|
IP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DISTAL FEM LAT R 9H 227M
|
Facility
|
OP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem Medicaid |
$2,895.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Humana KY Medicaid |
$2,895.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,953.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DISTAL FIB 10H LT
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
PLATE DISTAL FIB 10H LT
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
PLATE DISTAL FIB 10H RT
|
Facility
|
IP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
PLATE DISTAL FIB 10H RT
|
Facility
|
OP
|
$5,487.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,646.25 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$4,225.38
|
| Rate for Payer: Anthem Medicaid |
$1,887.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,280.25
|
| Rate for Payer: Cash Price |
$2,743.75
|
| Rate for Payer: Cigna Commercial |
$4,554.62
|
| Rate for Payer: First Health Commercial |
$5,213.12
|
| Rate for Payer: Humana Commercial |
$4,664.38
|
| Rate for Payer: Humana KY Medicaid |
$1,887.15
|
| Rate for Payer: Kentucky WC Medicaid |
$1,906.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,499.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,049.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,646.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,925.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,829.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,115.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,390.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,774.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,786.38
|
| Rate for Payer: PHCS Commercial |
$5,268.00
|
| Rate for Payer: United Healthcare All Payer |
$4,829.00
|
|
|
PLATE DISTAL FIB 12H LT
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PLATE DISTAL FIB 12H LT
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PLATE DISTAL FIB 12H RT
|
Facility
|
OP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem Medicaid |
$1,900.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Humana KY Medicaid |
$1,900.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,919.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,938.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PLATE DISTAL FIB 12H RT
|
Facility
|
IP
|
$5,525.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$4,254.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,309.50
|
| Rate for Payer: Cash Price |
$2,762.50
|
| Rate for Payer: Cigna Commercial |
$4,585.75
|
| Rate for Payer: First Health Commercial |
$5,248.75
|
| Rate for Payer: Humana Commercial |
$4,696.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,530.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,077.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,657.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,862.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,143.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,420.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,806.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,812.25
|
| Rate for Payer: PHCS Commercial |
$5,304.00
|
| Rate for Payer: United Healthcare All Payer |
$4,862.00
|
|
|
PLATE DISTAL FIB 14H LT
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PLATE DISTAL FIB 14H LT
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PLATE DISTAL FIB 14H RT
|
Facility
|
IP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PLATE DISTAL FIB 14H RT
|
Facility
|
OP
|
$5,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,668.75 |
| Max. Negotiated Rate |
$5,340.00 |
| Rate for Payer: Aetna Commercial |
$4,283.12
|
| Rate for Payer: Anthem Medicaid |
$1,912.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,338.75
|
| Rate for Payer: Cash Price |
$2,781.25
|
| Rate for Payer: Cigna Commercial |
$4,616.88
|
| Rate for Payer: First Health Commercial |
$5,284.38
|
| Rate for Payer: Humana Commercial |
$4,728.12
|
| Rate for Payer: Humana KY Medicaid |
$1,912.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,932.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,561.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,105.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,668.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,951.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,895.00
|
| Rate for Payer: Ohio Health Group HMO |
$4,171.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,450.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,839.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,838.12
|
| Rate for Payer: PHCS Commercial |
$5,340.00
|
| Rate for Payer: United Healthcare All Payer |
$4,895.00
|
|
|
PLATE DISTAL FIB 4H LT
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
PLATE DISTAL FIB 4H LT
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
PLATE DISTAL FIB 4H RT
|
Facility
|
OP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem Medicaid |
$1,461.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Humana KY Medicaid |
$1,461.58
|
| Rate for Payer: Kentucky WC Medicaid |
$1,476.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,490.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
PLATE DISTAL FIB 4H RT
|
Facility
|
IP
|
$4,250.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.00 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$3,272.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,315.00
|
| Rate for Payer: Cash Price |
$2,125.00
|
| Rate for Payer: Cigna Commercial |
$3,527.50
|
| Rate for Payer: First Health Commercial |
$4,037.50
|
| Rate for Payer: Humana Commercial |
$3,612.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,485.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,136.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,275.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,740.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,187.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,400.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,697.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,932.50
|
| Rate for Payer: PHCS Commercial |
$4,080.00
|
| Rate for Payer: United Healthcare All Payer |
$3,740.00
|
|
|
PLATE DISTAL FIB 5H LT
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem Medicaid |
$1,590.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Humana KY Medicaid |
$1,590.54
|
| Rate for Payer: Kentucky WC Medicaid |
$1,606.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,622.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
PLATE DISTAL FIB 5H LT
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,387.50 |
| Max. Negotiated Rate |
$4,440.00 |
| Rate for Payer: Aetna Commercial |
$3,561.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,607.50
|
| Rate for Payer: Cash Price |
$2,312.50
|
| Rate for Payer: Cigna Commercial |
$3,838.75
|
| Rate for Payer: First Health Commercial |
$4,393.75
|
| Rate for Payer: Humana Commercial |
$3,931.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,792.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,413.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,387.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,070.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,468.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,700.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,023.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,191.25
|
| Rate for Payer: PHCS Commercial |
$4,440.00
|
| Rate for Payer: United Healthcare All Payer |
$4,070.00
|
|
|
PLATE DISTAL FIB 5H RT
|
Facility
|
OP
|
$4,756.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.88 |
| Max. Negotiated Rate |
$4,566.00 |
| Rate for Payer: Aetna Commercial |
$3,662.31
|
| Rate for Payer: Anthem Medicaid |
$1,635.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,709.88
|
| Rate for Payer: Cash Price |
$2,378.12
|
| Rate for Payer: Cigna Commercial |
$3,947.69
|
| Rate for Payer: First Health Commercial |
$4,518.44
|
| Rate for Payer: Humana Commercial |
$4,042.81
|
| Rate for Payer: Humana KY Medicaid |
$1,635.67
|
| Rate for Payer: Kentucky WC Medicaid |
$1,652.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,900.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,510.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,426.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,668.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,185.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,567.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,805.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,137.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,281.81
|
| Rate for Payer: PHCS Commercial |
$4,566.00
|
| Rate for Payer: United Healthcare All Payer |
$4,185.50
|
|
|
PLATE DISTAL FIB 5H RT
|
Facility
|
IP
|
$4,756.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,426.88 |
| Max. Negotiated Rate |
$4,566.00 |
| Rate for Payer: Aetna Commercial |
$3,662.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,709.88
|
| Rate for Payer: Cash Price |
$2,378.12
|
| Rate for Payer: Cigna Commercial |
$3,947.69
|
| Rate for Payer: First Health Commercial |
$4,518.44
|
| Rate for Payer: Humana Commercial |
$4,042.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,900.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,510.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,426.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,185.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,567.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,805.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,137.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,281.81
|
| Rate for Payer: PHCS Commercial |
$4,566.00
|
| Rate for Payer: United Healthcare All Payer |
$4,185.50
|
|
|
PLATE DISTAL FIB 6H LT
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PLATE DISTAL FIB 6H LT
|
Facility
|
OP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem Medicaid |
$1,687.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Humana KY Medicaid |
$1,687.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,704.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,721.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
|
PLATE DISTAL FIB 6H RT
|
Facility
|
IP
|
$4,906.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,471.88 |
| Max. Negotiated Rate |
$4,710.00 |
| Rate for Payer: Aetna Commercial |
$3,777.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,826.88
|
| Rate for Payer: Cash Price |
$2,453.12
|
| Rate for Payer: Cigna Commercial |
$4,072.19
|
| Rate for Payer: First Health Commercial |
$4,660.94
|
| Rate for Payer: Humana Commercial |
$4,170.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,023.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,620.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,471.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,317.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,679.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,925.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,268.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,385.31
|
| Rate for Payer: PHCS Commercial |
$4,710.00
|
| Rate for Payer: United Healthcare All Payer |
$4,317.50
|
|
