|
PLATE FIBLUA COMP 7 HOLE
|
Facility
|
IP
|
$2,071.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.42 |
| Max. Negotiated Rate |
$1,988.54 |
| Rate for Payer: Aetna Commercial |
$1,594.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.69
|
| Rate for Payer: Cash Price |
$1,035.70
|
| Rate for Payer: Cigna Commercial |
$1,719.26
|
| Rate for Payer: First Health Commercial |
$1,967.83
|
| Rate for Payer: Humana Commercial |
$1,760.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,657.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,802.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.27
|
| Rate for Payer: PHCS Commercial |
$1,988.54
|
| Rate for Payer: United Healthcare All Payer |
$1,822.83
|
|
|
PLATE FIBLUA COMP 7 HOLE
|
Facility
|
OP
|
$2,071.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$621.42 |
| Max. Negotiated Rate |
$1,988.54 |
| Rate for Payer: Aetna Commercial |
$1,594.98
|
| Rate for Payer: Anthem Medicaid |
$712.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,615.69
|
| Rate for Payer: Cash Price |
$1,035.70
|
| Rate for Payer: Cigna Commercial |
$1,719.26
|
| Rate for Payer: First Health Commercial |
$1,967.83
|
| Rate for Payer: Humana Commercial |
$1,760.69
|
| Rate for Payer: Humana KY Medicaid |
$712.35
|
| Rate for Payer: Kentucky WC Medicaid |
$719.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,698.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,528.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$621.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$726.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,822.83
|
| Rate for Payer: Ohio Health Group HMO |
$1,553.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,657.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,802.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,429.27
|
| Rate for Payer: PHCS Commercial |
$1,988.54
|
| Rate for Payer: United Healthcare All Payer |
$1,822.83
|
|
|
PLATE FIBULA COMP 10H
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE FIBULA COMP 10H
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE FIBULA COMP 11H
|
Facility
|
IP
|
$2,162.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.78 |
| Max. Negotiated Rate |
$2,076.10 |
| Rate for Payer: Aetna Commercial |
$1,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,686.83
|
| Rate for Payer: Cash Price |
$1,081.30
|
| Rate for Payer: Cigna Commercial |
$1,794.96
|
| Rate for Payer: First Health Commercial |
$2,054.47
|
| Rate for Payer: Humana Commercial |
$1,838.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,621.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,730.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,881.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.19
|
| Rate for Payer: PHCS Commercial |
$2,076.10
|
| Rate for Payer: United Healthcare All Payer |
$1,903.09
|
|
|
PLATE FIBULA COMP 11H
|
Facility
|
OP
|
$2,162.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.78 |
| Max. Negotiated Rate |
$2,076.10 |
| Rate for Payer: Aetna Commercial |
$1,665.20
|
| Rate for Payer: Anthem Medicaid |
$743.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,686.83
|
| Rate for Payer: Cash Price |
$1,081.30
|
| Rate for Payer: Cigna Commercial |
$1,794.96
|
| Rate for Payer: First Health Commercial |
$2,054.47
|
| Rate for Payer: Humana Commercial |
$1,838.21
|
| Rate for Payer: Humana KY Medicaid |
$743.72
|
| Rate for Payer: Kentucky WC Medicaid |
$751.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,621.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,730.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,881.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.19
|
| Rate for Payer: PHCS Commercial |
$2,076.10
|
| Rate for Payer: United Healthcare All Payer |
$1,903.09
|
|
|
PLATE FIBULA COMP 12H
|
Facility
|
IP
|
$2,162.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.78 |
| Max. Negotiated Rate |
$2,076.10 |
| Rate for Payer: Aetna Commercial |
$1,665.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,686.83
|
| Rate for Payer: Cash Price |
$1,081.30
|
| Rate for Payer: Cigna Commercial |
$1,794.96
|
| Rate for Payer: First Health Commercial |
$2,054.47
|
| Rate for Payer: Humana Commercial |
$1,838.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,621.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,730.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,881.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.19
|
| Rate for Payer: PHCS Commercial |
$2,076.10
|
| Rate for Payer: United Healthcare All Payer |
$1,903.09
|
|
|
PLATE FIBULA COMP 12H
|
Facility
|
OP
|
$2,162.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.78 |
| Max. Negotiated Rate |
$2,076.10 |
| Rate for Payer: Aetna Commercial |
$1,665.20
|
| Rate for Payer: Anthem Medicaid |
$743.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,686.83
|
| Rate for Payer: Cash Price |
$1,081.30
|
| Rate for Payer: Cigna Commercial |
$1,794.96
|
| Rate for Payer: First Health Commercial |
$2,054.47
|
| Rate for Payer: Humana Commercial |
$1,838.21
|
| Rate for Payer: Humana KY Medicaid |
$743.72
|
| Rate for Payer: Kentucky WC Medicaid |
$751.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,773.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,596.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$648.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$758.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,903.09
|
| Rate for Payer: Ohio Health Group HMO |
$1,621.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,730.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,881.46
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,492.19
|
| Rate for Payer: PHCS Commercial |
$2,076.10
|
| Rate for Payer: United Healthcare All Payer |
$1,903.09
|
|
|
PLATE FIBULA COMP 13H
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE FIBULA COMP 13H
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE FIBULA COMP 14H
|
Facility
|
OP
|
$2,941.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.38 |
| Max. Negotiated Rate |
$2,823.60 |
| Rate for Payer: Aetna Commercial |
$2,264.76
|
| Rate for Payer: Anthem Medicaid |
$1,011.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,294.18
|
| Rate for Payer: Cash Price |
$1,470.62
|
| Rate for Payer: Cigna Commercial |
$2,441.24
|
| Rate for Payer: First Health Commercial |
$2,794.19
|
| Rate for Payer: Humana Commercial |
$2,500.06
|
| Rate for Payer: Humana KY Medicaid |
$1,011.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,021.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,031.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,353.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.46
|
| Rate for Payer: PHCS Commercial |
$2,823.60
|
| Rate for Payer: United Healthcare All Payer |
$2,588.30
|
|
|
PLATE FIBULA COMP 14H
|
Facility
|
IP
|
$2,941.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$882.38 |
| Max. Negotiated Rate |
$2,823.60 |
| Rate for Payer: Aetna Commercial |
$2,264.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,294.18
|
| Rate for Payer: Cash Price |
$1,470.62
|
| Rate for Payer: Cigna Commercial |
$2,441.24
|
| Rate for Payer: First Health Commercial |
$2,794.19
|
| Rate for Payer: Humana Commercial |
$2,500.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,411.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,170.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$882.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,588.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,205.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,353.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,558.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,029.46
|
| Rate for Payer: PHCS Commercial |
$2,823.60
|
| Rate for Payer: United Healthcare All Payer |
$2,588.30
|
|
|
PLATE FIBULA COMP 5 HOLE
|
Facility
|
IP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
PLATE FIBULA COMP 5 HOLE
|
Facility
|
OP
|
$1,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$504.00 |
| Max. Negotiated Rate |
$1,612.80 |
| Rate for Payer: Aetna Commercial |
$1,293.60
|
| Rate for Payer: Anthem Medicaid |
$577.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,310.40
|
| Rate for Payer: Cash Price |
$840.00
|
| Rate for Payer: Cigna Commercial |
$1,394.40
|
| Rate for Payer: First Health Commercial |
$1,596.00
|
| Rate for Payer: Humana Commercial |
$1,428.00
|
| Rate for Payer: Humana KY Medicaid |
$577.75
|
| Rate for Payer: Kentucky WC Medicaid |
$583.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,377.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,239.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$504.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,478.40
|
| Rate for Payer: Ohio Health Group HMO |
$1,260.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,344.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,461.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,159.20
|
| Rate for Payer: PHCS Commercial |
$1,612.80
|
| Rate for Payer: United Healthcare All Payer |
$1,478.40
|
|
|
PLATE FIBULA COMP 6H
|
Facility
|
OP
|
$2,025.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.74 |
| Max. Negotiated Rate |
$1,944.77 |
| Rate for Payer: Aetna Commercial |
$1,559.87
|
| Rate for Payer: Anthem Medicaid |
$696.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.12
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: Cigna Commercial |
$1,681.41
|
| Rate for Payer: First Health Commercial |
$1,924.51
|
| Rate for Payer: Humana Commercial |
$1,721.93
|
| Rate for Payer: Humana KY Medicaid |
$696.67
|
| Rate for Payer: Kentucky WC Medicaid |
$703.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$710.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.80
|
| Rate for Payer: PHCS Commercial |
$1,944.77
|
| Rate for Payer: United Healthcare All Payer |
$1,782.70
|
|
|
PLATE FIBULA COMP 6H
|
Facility
|
IP
|
$2,025.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$607.74 |
| Max. Negotiated Rate |
$1,944.77 |
| Rate for Payer: Aetna Commercial |
$1,559.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,580.12
|
| Rate for Payer: Cash Price |
$1,012.90
|
| Rate for Payer: Cigna Commercial |
$1,681.41
|
| Rate for Payer: First Health Commercial |
$1,924.51
|
| Rate for Payer: Humana Commercial |
$1,721.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,661.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,495.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$607.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,782.70
|
| Rate for Payer: Ohio Health Group HMO |
$1,519.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,620.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,762.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,397.80
|
| Rate for Payer: PHCS Commercial |
$1,944.77
|
| Rate for Payer: United Healthcare All Payer |
$1,782.70
|
|
|
PLATE FIBULA COMP 8H
|
Facility
|
IP
|
$2,029.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.72 |
| Max. Negotiated Rate |
$1,947.91 |
| Rate for Payer: Aetna Commercial |
$1,562.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.67
|
| Rate for Payer: Cash Price |
$1,014.53
|
| Rate for Payer: Cigna Commercial |
$1,684.13
|
| Rate for Payer: First Health Commercial |
$1,927.62
|
| Rate for Payer: Humana Commercial |
$1,724.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,400.06
|
| Rate for Payer: PHCS Commercial |
$1,947.91
|
| Rate for Payer: United Healthcare All Payer |
$1,785.58
|
|
|
PLATE FIBULA COMP 8H
|
Facility
|
OP
|
$2,029.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.72 |
| Max. Negotiated Rate |
$1,947.91 |
| Rate for Payer: Aetna Commercial |
$1,562.38
|
| Rate for Payer: Anthem Medicaid |
$697.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,582.67
|
| Rate for Payer: Cash Price |
$1,014.53
|
| Rate for Payer: Cigna Commercial |
$1,684.13
|
| Rate for Payer: First Health Commercial |
$1,927.62
|
| Rate for Payer: Humana Commercial |
$1,724.71
|
| Rate for Payer: Humana KY Medicaid |
$697.80
|
| Rate for Payer: Kentucky WC Medicaid |
$704.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,663.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,497.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$608.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$711.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,785.58
|
| Rate for Payer: Ohio Health Group HMO |
$1,521.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,623.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,765.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,400.06
|
| Rate for Payer: PHCS Commercial |
$1,947.91
|
| Rate for Payer: United Healthcare All Payer |
$1,785.58
|
|
|
PLATE FIBULA COMP 9H
|
Facility
|
IP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE FIBULA COMP 9H
|
Facility
|
OP
|
$2,117.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$635.10 |
| Max. Negotiated Rate |
$2,032.32 |
| Rate for Payer: Aetna Commercial |
$1,630.09
|
| Rate for Payer: Anthem Medicaid |
$728.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,651.26
|
| Rate for Payer: Cash Price |
$1,058.50
|
| Rate for Payer: Cigna Commercial |
$1,757.11
|
| Rate for Payer: First Health Commercial |
$2,011.15
|
| Rate for Payer: Humana Commercial |
$1,799.45
|
| Rate for Payer: Humana KY Medicaid |
$728.04
|
| Rate for Payer: Kentucky WC Medicaid |
$735.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,735.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,562.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$635.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$742.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,862.96
|
| Rate for Payer: Ohio Health Group HMO |
$1,587.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,693.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,841.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,460.73
|
| Rate for Payer: PHCS Commercial |
$2,032.32
|
| Rate for Payer: United Healthcare All Payer |
$1,862.96
|
|
|
PLATE FIBULA X-SMALL
|
Facility
|
IP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
PLATE FIBULA X-SMALL
|
Facility
|
OP
|
$7,015.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,104.50 |
| Max. Negotiated Rate |
$6,734.40 |
| Rate for Payer: Aetna Commercial |
$5,401.55
|
| Rate for Payer: Anthem Medicaid |
$2,412.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,471.70
|
| Rate for Payer: Cash Price |
$3,507.50
|
| Rate for Payer: Cigna Commercial |
$5,822.45
|
| Rate for Payer: First Health Commercial |
$6,664.25
|
| Rate for Payer: Humana Commercial |
$5,962.75
|
| Rate for Payer: Humana KY Medicaid |
$2,412.46
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,460.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,612.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,103.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,840.35
|
| Rate for Payer: PHCS Commercial |
$6,734.40
|
| Rate for Payer: United Healthcare All Payer |
$6,173.20
|
|
|
PLATE FLAT T 4H
|
Facility
|
IP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
|
PLATE FLAT T 4H
|
Facility
|
OP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem Medicaid |
$1,398.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Humana KY Medicaid |
$1,398.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,412.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,426.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
|
PLATE FLAT T 5H
|
Facility
|
IP
|
$4,066.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.88 |
| Max. Negotiated Rate |
$3,903.60 |
| Rate for Payer: Aetna Commercial |
$3,131.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,171.68
|
| Rate for Payer: Cash Price |
$2,033.12
|
| Rate for Payer: Cigna Commercial |
$3,374.99
|
| Rate for Payer: First Health Commercial |
$3,862.94
|
| Rate for Payer: Humana Commercial |
$3,456.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,334.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,000.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,219.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,578.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,049.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,253.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,537.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,805.71
|
| Rate for Payer: PHCS Commercial |
$3,903.60
|
| Rate for Payer: United Healthcare All Payer |
$3,578.30
|
|
