|
PLATE DISTAL FIB 6H RT
|
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 8H LT
|
Facility
|
OP
|
$5,168.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.62 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$3,979.94
|
| Rate for Payer: Anthem Medicaid |
$1,777.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.62
|
| Rate for Payer: Cash Price |
$2,584.38
|
| Rate for Payer: Cigna Commercial |
$4,290.06
|
| Rate for Payer: First Health Commercial |
$4,910.31
|
| Rate for Payer: Humana Commercial |
$4,393.44
|
| Rate for Payer: Humana KY Medicaid |
$1,777.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,795.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,813.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,566.44
|
| Rate for Payer: PHCS Commercial |
$4,962.00
|
| Rate for Payer: United Healthcare All Payer |
$4,548.50
|
|
|
PLATE DISTAL FIB 8H LT
|
Facility
|
IP
|
$5,168.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.62 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$3,979.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.62
|
| Rate for Payer: Cash Price |
$2,584.38
|
| Rate for Payer: Cigna Commercial |
$4,290.06
|
| Rate for Payer: First Health Commercial |
$4,910.31
|
| Rate for Payer: Humana Commercial |
$4,393.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,566.44
|
| Rate for Payer: PHCS Commercial |
$4,962.00
|
| Rate for Payer: United Healthcare All Payer |
$4,548.50
|
|
|
PLATE DISTAL FIB 8H RT
|
Facility
|
IP
|
$5,168.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.62 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$3,979.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.62
|
| Rate for Payer: Cash Price |
$2,584.38
|
| Rate for Payer: Cigna Commercial |
$4,290.06
|
| Rate for Payer: First Health Commercial |
$4,910.31
|
| Rate for Payer: Humana Commercial |
$4,393.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,566.44
|
| Rate for Payer: PHCS Commercial |
$4,962.00
|
| Rate for Payer: United Healthcare All Payer |
$4,548.50
|
|
|
PLATE DISTAL FIB 8H RT
|
Facility
|
OP
|
$5,168.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,550.62 |
| Max. Negotiated Rate |
$4,962.00 |
| Rate for Payer: Aetna Commercial |
$3,979.94
|
| Rate for Payer: Anthem Medicaid |
$1,777.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,031.62
|
| Rate for Payer: Cash Price |
$2,584.38
|
| Rate for Payer: Cigna Commercial |
$4,290.06
|
| Rate for Payer: First Health Commercial |
$4,910.31
|
| Rate for Payer: Humana Commercial |
$4,393.44
|
| Rate for Payer: Humana KY Medicaid |
$1,777.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,795.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,238.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,814.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,550.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,813.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,548.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,876.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,135.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,496.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,566.44
|
| Rate for Payer: PHCS Commercial |
$4,962.00
|
| Rate for Payer: United Healthcare All Payer |
$4,548.50
|
|
|
PLATE DISTAL LAT FEM 4.5 8H R
|
Facility
|
OP
|
$8,556.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.03 |
| Max. Negotiated Rate |
$8,214.49 |
| Rate for Payer: Aetna Commercial |
$6,588.71
|
| Rate for Payer: Anthem Medicaid |
$2,942.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,674.27
|
| Rate for Payer: Cash Price |
$4,278.38
|
| Rate for Payer: Cigna Commercial |
$7,102.11
|
| Rate for Payer: First Health Commercial |
$8,128.92
|
| Rate for Payer: Humana Commercial |
$7,273.25
|
| Rate for Payer: Humana KY Medicaid |
$2,942.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,972.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,314.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,001.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,529.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,845.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,444.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,904.16
|
| Rate for Payer: PHCS Commercial |
$8,214.49
|
| Rate for Payer: United Healthcare All Payer |
$7,529.95
|
|
|
PLATE DISTAL LAT FEM 4.5 8H R
|
Facility
|
IP
|
$8,556.76
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.03 |
| Max. Negotiated Rate |
$8,214.49 |
| Rate for Payer: Aetna Commercial |
$6,588.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,674.27
|
| Rate for Payer: Cash Price |
$4,278.38
|
| Rate for Payer: Cigna Commercial |
$7,102.11
|
| Rate for Payer: First Health Commercial |
$8,128.92
|
| Rate for Payer: Humana Commercial |
$7,273.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,016.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,314.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,567.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,529.95
|
| Rate for Payer: Ohio Health Group HMO |
$6,417.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,845.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,444.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,904.16
|
| Rate for Payer: PHCS Commercial |
$8,214.49
|
| Rate for Payer: United Healthcare All Payer |
$7,529.95
|
|
|
PLATE DISTAL LAT HUM 10H R
|
Facility
|
IP
|
$12,249.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,674.78 |
| Max. Negotiated Rate |
$11,759.31 |
| Rate for Payer: Aetna Commercial |
$9,431.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,554.44
|
| Rate for Payer: Cash Price |
$6,124.64
|
| Rate for Payer: Cigna Commercial |
$10,166.90
|
| Rate for Payer: First Health Commercial |
$11,636.82
|
| Rate for Payer: Humana Commercial |
$10,411.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,044.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,039.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,779.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,186.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,799.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,656.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.00
|
| Rate for Payer: PHCS Commercial |
$11,759.31
|
| Rate for Payer: United Healthcare All Payer |
$10,779.37
|
|
|
PLATE DISTAL LAT HUM 10H R
|
Facility
|
OP
|
$12,249.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,674.78 |
| Max. Negotiated Rate |
$11,759.31 |
| Rate for Payer: Aetna Commercial |
$9,431.95
|
| Rate for Payer: Anthem Medicaid |
$4,212.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,554.44
|
| Rate for Payer: Cash Price |
$6,124.64
|
| Rate for Payer: Cigna Commercial |
$10,166.90
|
| Rate for Payer: First Health Commercial |
$11,636.82
|
| Rate for Payer: Humana Commercial |
$10,411.89
|
| Rate for Payer: Humana KY Medicaid |
$4,212.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,255.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,044.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,039.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,297.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,779.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,186.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,799.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,656.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.00
|
| Rate for Payer: PHCS Commercial |
$11,759.31
|
| Rate for Payer: United Healthcare All Payer |
$10,779.37
|
|
|
PLATE DISTAL LAT HUM 3H R
|
Facility
|
IP
|
$7,148.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$6,862.09 |
| Rate for Payer: Aetna Commercial |
$5,503.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,575.45
|
| Rate for Payer: Cash Price |
$3,574.00
|
| Rate for Payer: Cigna Commercial |
$5,932.85
|
| Rate for Payer: First Health Commercial |
$6,790.61
|
| Rate for Payer: Humana Commercial |
$6,075.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,861.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,290.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,718.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,218.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,932.13
|
| Rate for Payer: PHCS Commercial |
$6,862.09
|
| Rate for Payer: United Healthcare All Payer |
$6,290.25
|
|
|
PLATE DISTAL LAT HUM 3H R
|
Facility
|
OP
|
$7,148.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.40 |
| Max. Negotiated Rate |
$6,862.09 |
| Rate for Payer: Aetna Commercial |
$5,503.97
|
| Rate for Payer: Anthem Medicaid |
$2,458.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,575.45
|
| Rate for Payer: Cash Price |
$3,574.00
|
| Rate for Payer: Cigna Commercial |
$5,932.85
|
| Rate for Payer: First Health Commercial |
$6,790.61
|
| Rate for Payer: Humana Commercial |
$6,075.81
|
| Rate for Payer: Humana KY Medicaid |
$2,458.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,483.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,861.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,507.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,290.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,718.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,218.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,932.13
|
| Rate for Payer: PHCS Commercial |
$6,862.09
|
| Rate for Payer: United Healthcare All Payer |
$6,290.25
|
|
|
PLATE DISTAL LAT HUM 4H R
|
Facility
|
OP
|
$9,821.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,946.55 |
| Max. Negotiated Rate |
$9,428.98 |
| Rate for Payer: Aetna Commercial |
$7,562.82
|
| Rate for Payer: Anthem Medicaid |
$3,377.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,661.04
|
| Rate for Payer: Cash Price |
$4,910.92
|
| Rate for Payer: Cigna Commercial |
$8,152.14
|
| Rate for Payer: First Health Commercial |
$9,330.76
|
| Rate for Payer: Humana Commercial |
$8,348.57
|
| Rate for Payer: Humana KY Medicaid |
$3,377.73
|
| Rate for Payer: Kentucky WC Medicaid |
$3,412.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,053.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,248.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,946.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,445.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,643.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,366.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,857.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,545.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.08
|
| Rate for Payer: PHCS Commercial |
$9,428.98
|
| Rate for Payer: United Healthcare All Payer |
$8,643.23
|
|
|
PLATE DISTAL LAT HUM 4H R
|
Facility
|
IP
|
$9,821.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,946.55 |
| Max. Negotiated Rate |
$9,428.98 |
| Rate for Payer: Aetna Commercial |
$7,562.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,661.04
|
| Rate for Payer: Cash Price |
$4,910.92
|
| Rate for Payer: Cigna Commercial |
$8,152.14
|
| Rate for Payer: First Health Commercial |
$9,330.76
|
| Rate for Payer: Humana Commercial |
$8,348.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,053.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,248.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,946.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,643.23
|
| Rate for Payer: Ohio Health Group HMO |
$7,366.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,857.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,545.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,777.08
|
| Rate for Payer: PHCS Commercial |
$9,428.98
|
| Rate for Payer: United Healthcare All Payer |
$8,643.23
|
|
|
PLATE DISTAL MED HUM EXT L/R
|
Facility
|
OP
|
$4,713.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$3,629.46
|
| Rate for Payer: Anthem Medicaid |
$1,621.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.59
|
| Rate for Payer: Cash Price |
$2,356.79
|
| Rate for Payer: Cigna Commercial |
$3,912.27
|
| Rate for Payer: First Health Commercial |
$4,477.90
|
| Rate for Payer: Humana Commercial |
$4,006.54
|
| Rate for Payer: Humana KY Medicaid |
$1,621.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,653.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.37
|
| Rate for Payer: PHCS Commercial |
$4,525.04
|
| Rate for Payer: United Healthcare All Payer |
$4,147.95
|
|
|
PLATE DISTAL MED HUM EXT L/R
|
Facility
|
IP
|
$4,713.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$3,629.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.59
|
| Rate for Payer: Cash Price |
$2,356.79
|
| Rate for Payer: Cigna Commercial |
$3,912.27
|
| Rate for Payer: First Health Commercial |
$4,477.90
|
| Rate for Payer: Humana Commercial |
$4,006.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.37
|
| Rate for Payer: PHCS Commercial |
$4,525.04
|
| Rate for Payer: United Healthcare All Payer |
$4,147.95
|
|
|
PLATE DISTAL MEDIAL HUM 10H
|
Facility
|
IP
|
$12,249.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,674.78 |
| Max. Negotiated Rate |
$11,759.31 |
| Rate for Payer: Aetna Commercial |
$9,431.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,554.44
|
| Rate for Payer: Cash Price |
$6,124.64
|
| Rate for Payer: Cigna Commercial |
$10,166.90
|
| Rate for Payer: First Health Commercial |
$11,636.82
|
| Rate for Payer: Humana Commercial |
$10,411.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,044.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,039.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,779.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,186.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,799.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,656.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.00
|
| Rate for Payer: PHCS Commercial |
$11,759.31
|
| Rate for Payer: United Healthcare All Payer |
$10,779.37
|
|
|
PLATE DISTAL MEDIAL HUM 10H
|
Facility
|
OP
|
$12,249.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,674.78 |
| Max. Negotiated Rate |
$11,759.31 |
| Rate for Payer: Aetna Commercial |
$9,431.95
|
| Rate for Payer: Anthem Medicaid |
$4,212.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,554.44
|
| Rate for Payer: Cash Price |
$6,124.64
|
| Rate for Payer: Cigna Commercial |
$10,166.90
|
| Rate for Payer: First Health Commercial |
$11,636.82
|
| Rate for Payer: Humana Commercial |
$10,411.89
|
| Rate for Payer: Humana KY Medicaid |
$4,212.53
|
| Rate for Payer: Kentucky WC Medicaid |
$4,255.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,044.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,039.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,674.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,297.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,779.37
|
| Rate for Payer: Ohio Health Group HMO |
$9,186.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,799.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,656.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,452.00
|
| Rate for Payer: PHCS Commercial |
$11,759.31
|
| Rate for Payer: United Healthcare All Payer |
$10,779.37
|
|
|
PLATE DISTAL MEDIAL HUMERUS 3H
|
Facility
|
OP
|
$4,713.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$3,629.46
|
| Rate for Payer: Anthem Medicaid |
$1,621.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.59
|
| Rate for Payer: Cash Price |
$2,356.79
|
| Rate for Payer: Cigna Commercial |
$3,912.27
|
| Rate for Payer: First Health Commercial |
$4,477.90
|
| Rate for Payer: Humana Commercial |
$4,006.54
|
| Rate for Payer: Humana KY Medicaid |
$1,621.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,637.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,653.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.37
|
| Rate for Payer: PHCS Commercial |
$4,525.04
|
| Rate for Payer: United Healthcare All Payer |
$4,147.95
|
|
|
PLATE DISTAL MEDIAL HUMERUS 3H
|
Facility
|
IP
|
$4,713.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,414.07 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$3,629.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,676.59
|
| Rate for Payer: Cash Price |
$2,356.79
|
| Rate for Payer: Cigna Commercial |
$3,912.27
|
| Rate for Payer: First Health Commercial |
$4,477.90
|
| Rate for Payer: Humana Commercial |
$4,006.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,865.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,478.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,414.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,147.95
|
| Rate for Payer: Ohio Health Group HMO |
$3,535.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,770.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,100.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,252.37
|
| Rate for Payer: PHCS Commercial |
$4,525.04
|
| Rate for Payer: United Healthcare All Payer |
$4,147.95
|
|
|
PLATE DISTAL MEDIAL HUMERUS 4H
|
Facility
|
OP
|
$7,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,272.14 |
| Max. Negotiated Rate |
$7,270.86 |
| Rate for Payer: Aetna Commercial |
$5,831.83
|
| Rate for Payer: Anthem Medicaid |
$2,604.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.57
|
| Rate for Payer: Cash Price |
$3,786.91
|
| Rate for Payer: Cigna Commercial |
$6,286.26
|
| Rate for Payer: First Health Commercial |
$7,195.12
|
| Rate for Payer: Humana Commercial |
$6,437.74
|
| Rate for Payer: Humana KY Medicaid |
$2,604.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,631.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,656.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,664.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,059.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,589.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,225.93
|
| Rate for Payer: PHCS Commercial |
$7,270.86
|
| Rate for Payer: United Healthcare All Payer |
$6,664.95
|
|
|
PLATE DISTAL MEDIAL HUMERUS 4H
|
Facility
|
IP
|
$7,573.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,272.14 |
| Max. Negotiated Rate |
$7,270.86 |
| Rate for Payer: Aetna Commercial |
$5,831.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,907.57
|
| Rate for Payer: Cash Price |
$3,786.91
|
| Rate for Payer: Cigna Commercial |
$6,286.26
|
| Rate for Payer: First Health Commercial |
$7,195.12
|
| Rate for Payer: Humana Commercial |
$6,437.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,210.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,589.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,272.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,664.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,680.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,059.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,589.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,225.93
|
| Rate for Payer: PHCS Commercial |
$7,270.86
|
| Rate for Payer: United Healthcare All Payer |
$6,664.95
|
|
|
PLATE DISTAL MEDIAL TIB L 10H
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE DISTAL MEDIAL TIB L 10H
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE DISTAL MEDIAL TIB L 12H
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE DISTAL MEDIAL TIB L 12H
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
