|
PLATE META SMALL 3H
|
Facility
|
OP
|
$3,301.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.24 |
| Max. Negotiated Rate |
$3,169.80 |
| Rate for Payer: Aetna Commercial |
$2,542.44
|
| Rate for Payer: Anthem Medicaid |
$1,135.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.46
|
| Rate for Payer: Cash Price |
$1,650.93
|
| Rate for Payer: Cigna Commercial |
$2,740.55
|
| Rate for Payer: First Health Commercial |
$3,136.78
|
| Rate for Payer: Humana Commercial |
$2,806.59
|
| Rate for Payer: Humana KY Medicaid |
$1,135.51
|
| Rate for Payer: Kentucky WC Medicaid |
$1,147.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,707.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,158.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,905.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.58
|
| Rate for Payer: PHCS Commercial |
$3,169.80
|
| Rate for Payer: United Healthcare All Payer |
$2,905.65
|
|
|
PLATE META SMALL 3H
|
Facility
|
IP
|
$3,301.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$429.24 |
| Max. Negotiated Rate |
$3,169.80 |
| Rate for Payer: Aetna Commercial |
$2,542.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,575.46
|
| Rate for Payer: Cash Price |
$1,650.93
|
| Rate for Payer: Cigna Commercial |
$2,740.55
|
| Rate for Payer: First Health Commercial |
$3,136.78
|
| Rate for Payer: Humana Commercial |
$2,806.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,707.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,436.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$990.56
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,905.65
|
| Rate for Payer: Ohio Health Group HMO |
$2,476.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$660.37
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$429.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,023.58
|
| Rate for Payer: PHCS Commercial |
$3,169.80
|
| Rate for Payer: United Healthcare All Payer |
$2,905.65
|
|
|
PLATE META SMALL 5H
|
Facility
|
OP
|
$2,109.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.24 |
| Max. Negotiated Rate |
$2,025.12 |
| Rate for Payer: Aetna Commercial |
$1,624.32
|
| Rate for Payer: Anthem Medicaid |
$725.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.41
|
| Rate for Payer: Cash Price |
$1,054.75
|
| Rate for Payer: Cigna Commercial |
$1,750.88
|
| Rate for Payer: First Health Commercial |
$2,004.02
|
| Rate for Payer: Humana Commercial |
$1,793.08
|
| Rate for Payer: Humana KY Medicaid |
$725.46
|
| Rate for Payer: Kentucky WC Medicaid |
$732.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$740.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.94
|
| Rate for Payer: PHCS Commercial |
$2,025.12
|
| Rate for Payer: United Healthcare All Payer |
$1,856.36
|
|
|
PLATE META SMALL 5H
|
Facility
|
IP
|
$2,109.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$274.24 |
| Max. Negotiated Rate |
$2,025.12 |
| Rate for Payer: Aetna Commercial |
$1,624.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,645.41
|
| Rate for Payer: Cash Price |
$1,054.75
|
| Rate for Payer: Cigna Commercial |
$1,750.88
|
| Rate for Payer: First Health Commercial |
$2,004.02
|
| Rate for Payer: Humana Commercial |
$1,793.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,729.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,556.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$632.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,856.36
|
| Rate for Payer: Ohio Health Group HMO |
$1,582.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$421.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$274.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$653.94
|
| Rate for Payer: PHCS Commercial |
$2,025.12
|
| Rate for Payer: United Healthcare All Payer |
$1,856.36
|
|
|
PLATE META SMALL 7H
|
Facility
|
OP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem Medicaid |
$1,165.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Humana KY Medicaid |
$1,165.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,177.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,189.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
PLATE META SMALL 7H
|
Facility
|
IP
|
$3,390.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.70 |
| Max. Negotiated Rate |
$3,254.40 |
| Rate for Payer: Aetna Commercial |
$2,610.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,644.20
|
| Rate for Payer: Cash Price |
$1,695.00
|
| Rate for Payer: Cigna Commercial |
$2,813.70
|
| Rate for Payer: First Health Commercial |
$3,220.50
|
| Rate for Payer: Humana Commercial |
$2,881.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,779.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,501.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,017.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,983.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,542.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$678.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$440.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,050.90
|
| Rate for Payer: PHCS Commercial |
$3,254.40
|
| Rate for Payer: United Healthcare All Payer |
$2,983.20
|
|
|
PLATE METATARSAL 5TH LEFT
|
Facility
|
OP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem Medicaid |
$2,462.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Humana KY Medicaid |
$2,462.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,487.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,512.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE METATARSAL 5TH LEFT
|
Facility
|
IP
|
$7,161.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$931.03 |
| Max. Negotiated Rate |
$6,875.28 |
| Rate for Payer: Aetna Commercial |
$5,514.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,586.16
|
| Rate for Payer: Cash Price |
$3,580.88
|
| Rate for Payer: Cigna Commercial |
$5,944.25
|
| Rate for Payer: First Health Commercial |
$6,803.66
|
| Rate for Payer: Humana Commercial |
$6,087.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,872.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,285.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,148.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,302.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,371.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,432.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$931.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,220.14
|
| Rate for Payer: PHCS Commercial |
$6,875.28
|
| Rate for Payer: United Healthcare All Payer |
$6,302.34
|
|
|
PLATE METATARSALPHALENGEAL-MTP
|
Facility
|
OP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem Medicaid |
$1,171.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Humana KY Medicaid |
$1,171.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE METATARSALPHALENGEAL-MTP
|
Facility
|
IP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE METATARSALPHALENGEL-MTPL
|
Facility
|
IP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE METATARSALPHALENGEL-MTPL
|
Facility
|
OP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem Medicaid |
$1,171.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Humana KY Medicaid |
$1,171.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE METTARSALPHALENGEL L REV
|
Facility
|
IP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE METTARSALPHALENGEL L REV
|
Facility
|
OP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem Medicaid |
$1,171.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Humana KY Medicaid |
$1,171.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE METTARSALPHALENGEL R REV
|
Facility
|
IP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
|
|
PLATE METTARSALPHALENGEL R REV
|
Facility
|
OP
|
$3,407.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$442.98 |
| Max. Negotiated Rate |
$3,271.20 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,657.85
|
| Rate for Payer: Cash Price |
$1,703.75
|
| Rate for Payer: Cigna Commercial |
$2,828.22
|
| Rate for Payer: First Health Commercial |
$3,237.12
|
| Rate for Payer: Humana Commercial |
$2,896.38
|
| Rate for Payer: Humana KY Medicaid |
$1,171.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,183.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,794.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,514.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,022.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,195.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,998.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,555.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$681.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$442.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,056.32
|
| Rate for Payer: PHCS Commercial |
$3,271.20
|
| Rate for Payer: United Healthcare All Payer |
$2,998.60
|
| Rate for Payer: Aetna Commercial |
$2,623.78
|
| Rate for Payer: Anthem Medicaid |
$1,171.84
|
|
|
PLATE MIDSHAFT 97MM 8H
|
Facility
|
IP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE MIDSHAFT 97MM 8H
|
Facility
|
OP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem Medicaid |
$1,807.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Humana KY Medicaid |
$1,807.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,825.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,843.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE MIDSHIFT COMPRESS 10H
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESS 10H
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESS 12H
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESS 12H
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESSION 4H
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESSION 4H
|
Facility
|
IP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
|
PLATE MIDSHIFT COMPRESSION 6H
|
Facility
|
OP
|
$1,931.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$251.03 |
| Max. Negotiated Rate |
$1,853.76 |
| Rate for Payer: Aetna Commercial |
$1,486.87
|
| Rate for Payer: Anthem Medicaid |
$664.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.18
|
| Rate for Payer: Cash Price |
$965.50
|
| Rate for Payer: Cigna Commercial |
$1,602.73
|
| Rate for Payer: First Health Commercial |
$1,834.45
|
| Rate for Payer: Humana Commercial |
$1,641.35
|
| Rate for Payer: Humana KY Medicaid |
$664.07
|
| Rate for Payer: Kentucky WC Medicaid |
$670.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,425.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.28
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$386.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$251.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$598.61
|
| Rate for Payer: PHCS Commercial |
$1,853.76
|
| Rate for Payer: United Healthcare All Payer |
$1,699.28
|
|
