|
PLATE DORSAL LEFT 4H
|
Facility
|
OP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem Medicaid |
$1,612.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Humana KY Medicaid |
$1,612.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE DORSAL LEFT 4H
|
Facility
|
IP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE DORSAL LUNATE LEFT
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSAL LUNATE LEFT
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSAL LUNATE RIGHT
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSAL LUNATE RIGHT
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSAL NAIL LEFT
|
Facility
|
OP
|
$7,091.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.49 |
| Max. Negotiated Rate |
$6,807.98 |
| Rate for Payer: Aetna Commercial |
$5,460.57
|
| Rate for Payer: Anthem Medicaid |
$2,438.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,531.49
|
| Rate for Payer: Cash Price |
$3,545.82
|
| Rate for Payer: Cigna Commercial |
$5,886.07
|
| Rate for Payer: First Health Commercial |
$6,737.07
|
| Rate for Payer: Humana Commercial |
$6,027.90
|
| Rate for Payer: Humana KY Medicaid |
$2,438.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,463.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,487.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,673.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.24
|
| Rate for Payer: PHCS Commercial |
$6,807.98
|
| Rate for Payer: United Healthcare All Payer |
$6,240.65
|
|
|
PLATE DORSAL NAIL LEFT
|
Facility
|
IP
|
$7,091.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,127.49 |
| Max. Negotiated Rate |
$6,807.98 |
| Rate for Payer: Aetna Commercial |
$5,460.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,531.49
|
| Rate for Payer: Cash Price |
$3,545.82
|
| Rate for Payer: Cigna Commercial |
$5,886.07
|
| Rate for Payer: First Health Commercial |
$6,737.07
|
| Rate for Payer: Humana Commercial |
$6,027.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,815.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,233.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,127.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,240.65
|
| Rate for Payer: Ohio Health Group HMO |
$5,318.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,673.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,169.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,893.24
|
| Rate for Payer: PHCS Commercial |
$6,807.98
|
| Rate for Payer: United Healthcare All Payer |
$6,240.65
|
|
|
PLATE DORSAL NAIL RIGHT
|
Facility
|
OP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem Medicaid |
$1,916.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Humana KY Medicaid |
$1,916.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,936.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,955.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
PLATE DORSAL NAIL RIGHT
|
Facility
|
IP
|
$5,573.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,672.12 |
| Max. Negotiated Rate |
$5,350.80 |
| Rate for Payer: Aetna Commercial |
$4,291.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,347.52
|
| Rate for Payer: Cash Price |
$2,786.88
|
| Rate for Payer: Cigna Commercial |
$4,626.21
|
| Rate for Payer: First Health Commercial |
$5,295.06
|
| Rate for Payer: Humana Commercial |
$4,737.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,570.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,113.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,672.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,904.90
|
| Rate for Payer: Ohio Health Group HMO |
$4,180.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,459.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,849.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,845.89
|
| Rate for Payer: PHCS Commercial |
$5,350.80
|
| Rate for Payer: United Healthcare All Payer |
$4,904.90
|
|
|
PLATE DORSAL RIGHT 3H
|
Facility
|
IP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE DORSAL RIGHT 3H
|
Facility
|
OP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem Medicaid |
$1,612.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Humana KY Medicaid |
$1,612.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE DORSAL RIGHT 4H
|
Facility
|
IP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE DORSAL RIGHT 4H
|
Facility
|
OP
|
$4,688.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,406.62 |
| Max. Negotiated Rate |
$4,501.20 |
| Rate for Payer: Aetna Commercial |
$3,610.34
|
| Rate for Payer: Anthem Medicaid |
$1,612.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,657.22
|
| Rate for Payer: Cash Price |
$2,344.38
|
| Rate for Payer: Cigna Commercial |
$3,891.66
|
| Rate for Payer: First Health Commercial |
$4,454.31
|
| Rate for Payer: Humana Commercial |
$3,985.44
|
| Rate for Payer: Humana KY Medicaid |
$1,612.46
|
| Rate for Payer: Kentucky WC Medicaid |
$1,628.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,844.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,460.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,406.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,644.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,126.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,516.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,751.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,079.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,235.24
|
| Rate for Payer: PHCS Commercial |
$4,501.20
|
| Rate for Payer: United Healthcare All Payer |
$4,126.10
|
|
|
PLATE DORSAL RIM BUTTRESS LEFT
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSAL RIM BUTTRESS LEFT
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSAL RIM BUTTRESS RT
|
Facility
|
OP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem Medicaid |
$1,446.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Humana KY Medicaid |
$1,446.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,460.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSAL RIM BUTTRESS RT
|
Facility
|
IP
|
$4,205.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.50 |
| Max. Negotiated Rate |
$4,036.80 |
| Rate for Payer: Aetna Commercial |
$3,237.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,279.90
|
| Rate for Payer: Cash Price |
$2,102.50
|
| Rate for Payer: Cigna Commercial |
$3,490.15
|
| Rate for Payer: First Health Commercial |
$3,994.75
|
| Rate for Payer: Humana Commercial |
$3,574.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,700.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,153.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,658.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,901.45
|
| Rate for Payer: PHCS Commercial |
$4,036.80
|
| Rate for Payer: United Healthcare All Payer |
$3,700.40
|
|
|
PLATE DORSOLATL MIDSHFT RAD 6H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLATL MIDSHFT RAD 6H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLATL MIDSHFT RAD 8H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLATL MIDSHFT RAD 8H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLAT MIDSHFT RAD 10H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLAT MIDSHFT RAD 10H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLAT MIDSHFT RAD 12H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
