|
PLATE DISTAL POST LAT 3H 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 POST LAT 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 POST LAT 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 POST LAT LEFT
|
Facility
|
OP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem Medicaid |
$3,159.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Humana KY Medicaid |
$3,159.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
PLATE DISTAL POST LAT LEFT
|
Facility
|
IP
|
$9,186.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,756.03 |
| Max. Negotiated Rate |
$8,819.28 |
| Rate for Payer: Aetna Commercial |
$7,073.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,165.66
|
| Rate for Payer: Cash Price |
$4,593.38
|
| Rate for Payer: Cigna Commercial |
$7,625.00
|
| Rate for Payer: First Health Commercial |
$8,727.41
|
| Rate for Payer: Humana Commercial |
$7,808.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,779.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,084.34
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,349.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,992.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,338.86
|
| Rate for Payer: PHCS Commercial |
$8,819.28
|
| Rate for Payer: United Healthcare All Payer |
$8,084.34
|
|
|
PLATE DISTAL POST MEDIAL 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 POST MEDIAL 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 RADIUS 26MM LEFT
|
Facility
|
IP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE DISTAL RADIUS 26MM LEFT
|
Facility
|
OP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem Medicaid |
$1,073.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Humana KY Medicaid |
$1,073.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE DISTAL RADIUS 26MM RIGHT
|
Facility
|
OP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem Medicaid |
$1,073.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Humana KY Medicaid |
$1,073.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,084.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,094.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE DISTAL RADIUS 26MM RIGHT
|
Facility
|
IP
|
$3,121.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$936.38 |
| Max. Negotiated Rate |
$2,996.40 |
| Rate for Payer: Aetna Commercial |
$2,403.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,434.57
|
| Rate for Payer: Cash Price |
$1,560.62
|
| Rate for Payer: Cigna Commercial |
$2,590.64
|
| Rate for Payer: First Health Commercial |
$2,965.19
|
| Rate for Payer: Humana Commercial |
$2,653.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,559.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,303.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$936.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,746.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,340.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,497.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,715.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,153.66
|
| Rate for Payer: PHCS Commercial |
$2,996.40
|
| Rate for Payer: United Healthcare All Payer |
$2,746.70
|
|
|
PLATE DIST ANTERLAT TIB 6H R
|
Facility
|
OP
|
$14,315.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,294.65 |
| Max. Negotiated Rate |
$13,742.87 |
| Rate for Payer: Aetna Commercial |
$11,022.93
|
| Rate for Payer: Anthem Medicaid |
$4,923.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,166.08
|
| Rate for Payer: Cash Price |
$7,157.74
|
| Rate for Payer: Cigna Commercial |
$11,881.86
|
| Rate for Payer: First Health Commercial |
$13,599.72
|
| Rate for Payer: Humana Commercial |
$12,168.17
|
| Rate for Payer: Humana KY Medicaid |
$4,923.10
|
| Rate for Payer: Kentucky WC Medicaid |
$4,973.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,738.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,564.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,294.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,021.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,597.63
|
| Rate for Payer: Ohio Health Group HMO |
$10,736.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,452.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,454.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,877.69
|
| Rate for Payer: PHCS Commercial |
$13,742.87
|
| Rate for Payer: United Healthcare All Payer |
$12,597.63
|
|
|
PLATE DIST ANTERLAT TIB 6H R
|
Facility
|
IP
|
$14,315.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,294.65 |
| Max. Negotiated Rate |
$13,742.87 |
| Rate for Payer: Aetna Commercial |
$11,022.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,166.08
|
| Rate for Payer: Cash Price |
$7,157.74
|
| Rate for Payer: Cigna Commercial |
$11,881.86
|
| Rate for Payer: First Health Commercial |
$13,599.72
|
| Rate for Payer: Humana Commercial |
$12,168.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,738.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,564.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,294.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,597.63
|
| Rate for Payer: Ohio Health Group HMO |
$10,736.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,452.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,454.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,877.69
|
| Rate for Payer: PHCS Commercial |
$13,742.87
|
| Rate for Payer: United Healthcare All Payer |
$12,597.63
|
|
|
PLATE DIST ANTEROLATERAL L 10H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL L 10H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL L 12H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL L 12H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL L 14H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL L 14H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL L 16H
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem Medicaid |
$2,638.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Humana KY Medicaid |
$2,638.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,665.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,691.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
PLATE DIST ANTEROLATERAL L 16H
|
Facility
|
IP
|
$7,672.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,301.60 |
| Max. Negotiated Rate |
$7,365.12 |
| Rate for Payer: Aetna Commercial |
$5,907.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,984.16
|
| Rate for Payer: Cash Price |
$3,836.00
|
| Rate for Payer: Cigna Commercial |
$6,367.76
|
| Rate for Payer: First Health Commercial |
$7,288.40
|
| Rate for Payer: Humana Commercial |
$6,521.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,291.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,661.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,301.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,751.36
|
| Rate for Payer: Ohio Health Group HMO |
$5,754.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,137.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,674.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,293.68
|
| Rate for Payer: PHCS Commercial |
$7,365.12
|
| Rate for Payer: United Healthcare All Payer |
$6,751.36
|
|
|
PLATE DIST ANTEROLATERAL R 10H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL R 10H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL R 12H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST ANTEROLATERAL R 12H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
