|
PLATE PROX LAT TIBIA 2H L
|
Facility
|
OP
|
$9,058.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.61 |
| Max. Negotiated Rate |
$8,696.17 |
| Rate for Payer: Aetna Commercial |
$6,975.05
|
| Rate for Payer: Anthem Medicaid |
$3,115.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,065.64
|
| Rate for Payer: Cash Price |
$4,529.25
|
| Rate for Payer: Cigna Commercial |
$7,518.56
|
| Rate for Payer: First Health Commercial |
$8,605.58
|
| Rate for Payer: Humana Commercial |
$7,699.73
|
| Rate for Payer: Humana KY Medicaid |
$3,115.22
|
| Rate for Payer: Kentucky WC Medicaid |
$3,146.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,427.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,685.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,177.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,971.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,793.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.14
|
| Rate for Payer: PHCS Commercial |
$8,696.17
|
| Rate for Payer: United Healthcare All Payer |
$7,971.49
|
|
|
PLATE PROX LAT TIBIA 2H L
|
Facility
|
IP
|
$9,058.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,177.61 |
| Max. Negotiated Rate |
$8,696.17 |
| Rate for Payer: Aetna Commercial |
$6,975.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,065.64
|
| Rate for Payer: Cash Price |
$4,529.25
|
| Rate for Payer: Cigna Commercial |
$7,518.56
|
| Rate for Payer: First Health Commercial |
$8,605.58
|
| Rate for Payer: Humana Commercial |
$7,699.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,427.98
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,685.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,717.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,971.49
|
| Rate for Payer: Ohio Health Group HMO |
$6,793.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,811.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,177.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,808.14
|
| Rate for Payer: PHCS Commercial |
$8,696.17
|
| Rate for Payer: United Healthcare All Payer |
$7,971.49
|
|
|
PLATE PROX LAT TIBIA 2H R
|
Facility
|
IP
|
$8,047.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.11 |
| Max. Negotiated Rate |
$7,725.14 |
| Rate for Payer: Aetna Commercial |
$6,196.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,276.68
|
| Rate for Payer: Cash Price |
$4,023.51
|
| Rate for Payer: Cigna Commercial |
$6,679.03
|
| Rate for Payer: First Health Commercial |
$7,644.67
|
| Rate for Payer: Humana Commercial |
$6,839.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,598.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,938.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,414.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,081.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,035.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,609.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,494.58
|
| Rate for Payer: PHCS Commercial |
$7,725.14
|
| Rate for Payer: United Healthcare All Payer |
$7,081.38
|
|
|
PLATE PROX LAT TIBIA 2H R
|
Facility
|
OP
|
$8,047.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,046.11 |
| Max. Negotiated Rate |
$7,725.14 |
| Rate for Payer: Aetna Commercial |
$6,196.21
|
| Rate for Payer: Anthem Medicaid |
$2,767.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,276.68
|
| Rate for Payer: Cash Price |
$4,023.51
|
| Rate for Payer: Cigna Commercial |
$6,679.03
|
| Rate for Payer: First Health Commercial |
$7,644.67
|
| Rate for Payer: Humana Commercial |
$6,839.97
|
| Rate for Payer: Humana KY Medicaid |
$2,767.37
|
| Rate for Payer: Kentucky WC Medicaid |
$2,795.53
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,598.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,938.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,414.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,822.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,081.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,035.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,609.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,046.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,494.58
|
| Rate for Payer: PHCS Commercial |
$7,725.14
|
| Rate for Payer: United Healthcare All Payer |
$7,081.38
|
|
|
PLATE PROX LAT TIBIA 4H L
|
Facility
|
IP
|
$8,156.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.38 |
| Max. Negotiated Rate |
$7,830.51 |
| Rate for Payer: Aetna Commercial |
$6,280.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,362.29
|
| Rate for Payer: Cash Price |
$4,078.39
|
| Rate for Payer: Cigna Commercial |
$6,770.13
|
| Rate for Payer: First Health Commercial |
$7,748.94
|
| Rate for Payer: Humana Commercial |
$6,933.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,688.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,019.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,177.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,117.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,528.60
|
| Rate for Payer: PHCS Commercial |
$7,830.51
|
| Rate for Payer: United Healthcare All Payer |
$7,177.97
|
|
|
PLATE PROX LAT TIBIA 4H L
|
Facility
|
OP
|
$8,156.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.38 |
| Max. Negotiated Rate |
$7,830.51 |
| Rate for Payer: Aetna Commercial |
$6,280.72
|
| Rate for Payer: Anthem Medicaid |
$2,805.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,362.29
|
| Rate for Payer: Cash Price |
$4,078.39
|
| Rate for Payer: Cigna Commercial |
$6,770.13
|
| Rate for Payer: First Health Commercial |
$7,748.94
|
| Rate for Payer: Humana Commercial |
$6,933.26
|
| Rate for Payer: Humana KY Medicaid |
$2,805.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,833.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,688.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,019.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,177.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,117.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,528.60
|
| Rate for Payer: PHCS Commercial |
$7,830.51
|
| Rate for Payer: United Healthcare All Payer |
$7,177.97
|
|
|
PLATE PROX LAT TIBIA 4H R
|
Facility
|
OP
|
$8,156.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.38 |
| Max. Negotiated Rate |
$7,830.51 |
| Rate for Payer: Aetna Commercial |
$6,280.72
|
| Rate for Payer: Anthem Medicaid |
$2,805.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,362.29
|
| Rate for Payer: Cash Price |
$4,078.39
|
| Rate for Payer: Cigna Commercial |
$6,770.13
|
| Rate for Payer: First Health Commercial |
$7,748.94
|
| Rate for Payer: Humana Commercial |
$6,933.26
|
| Rate for Payer: Humana KY Medicaid |
$2,805.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,833.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,688.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,019.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,861.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,177.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,117.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,528.60
|
| Rate for Payer: PHCS Commercial |
$7,830.51
|
| Rate for Payer: United Healthcare All Payer |
$7,177.97
|
|
|
PLATE PROX LAT TIBIA 4H R
|
Facility
|
IP
|
$8,156.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,060.38 |
| Max. Negotiated Rate |
$7,830.51 |
| Rate for Payer: Aetna Commercial |
$6,280.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,362.29
|
| Rate for Payer: Cash Price |
$4,078.39
|
| Rate for Payer: Cigna Commercial |
$6,770.13
|
| Rate for Payer: First Health Commercial |
$7,748.94
|
| Rate for Payer: Humana Commercial |
$6,933.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,688.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,019.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,447.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,177.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,117.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,631.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,060.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,528.60
|
| Rate for Payer: PHCS Commercial |
$7,830.51
|
| Rate for Payer: United Healthcare All Payer |
$7,177.97
|
|
|
PLATE PROX LAT TIBIA 6H L
|
Facility
|
IP
|
$9,203.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.51 |
| Max. Negotiated Rate |
$8,835.76 |
| Rate for Payer: Aetna Commercial |
$7,087.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.06
|
| Rate for Payer: Cash Price |
$4,601.96
|
| Rate for Payer: Cigna Commercial |
$7,639.25
|
| Rate for Payer: First Health Commercial |
$8,743.72
|
| Rate for Payer: Humana Commercial |
$7,823.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,853.22
|
| Rate for Payer: PHCS Commercial |
$8,835.76
|
| Rate for Payer: United Healthcare All Payer |
$8,099.45
|
|
|
PLATE PROX LAT TIBIA 6H L
|
Facility
|
OP
|
$9,203.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.51 |
| Max. Negotiated Rate |
$8,835.76 |
| Rate for Payer: Aetna Commercial |
$7,087.02
|
| Rate for Payer: Anthem Medicaid |
$3,165.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.06
|
| Rate for Payer: Cash Price |
$4,601.96
|
| Rate for Payer: Cigna Commercial |
$7,639.25
|
| Rate for Payer: First Health Commercial |
$8,743.72
|
| Rate for Payer: Humana Commercial |
$7,823.33
|
| Rate for Payer: Humana KY Medicaid |
$3,165.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,197.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,228.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,853.22
|
| Rate for Payer: PHCS Commercial |
$8,835.76
|
| Rate for Payer: United Healthcare All Payer |
$8,099.45
|
|
|
PLATE PROX LAT TIBIA 6H R
|
Facility
|
IP
|
$15,090.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,961.70 |
| Max. Negotiated Rate |
$14,486.40 |
| Rate for Payer: Aetna Commercial |
$11,619.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,770.20
|
| Rate for Payer: Cash Price |
$7,545.00
|
| Rate for Payer: Cigna Commercial |
$12,524.70
|
| Rate for Payer: First Health Commercial |
$14,335.50
|
| Rate for Payer: Humana Commercial |
$12,826.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,373.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,136.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,527.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,279.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,317.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,018.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,961.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.90
|
| Rate for Payer: PHCS Commercial |
$14,486.40
|
| Rate for Payer: United Healthcare All Payer |
$13,279.20
|
|
|
PLATE PROX LAT TIBIA 6H R
|
Facility
|
OP
|
$15,090.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,961.70 |
| Max. Negotiated Rate |
$14,486.40 |
| Rate for Payer: Aetna Commercial |
$11,619.30
|
| Rate for Payer: Anthem Medicaid |
$5,189.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,770.20
|
| Rate for Payer: Cash Price |
$7,545.00
|
| Rate for Payer: Cigna Commercial |
$12,524.70
|
| Rate for Payer: First Health Commercial |
$14,335.50
|
| Rate for Payer: Humana Commercial |
$12,826.50
|
| Rate for Payer: Humana KY Medicaid |
$5,189.45
|
| Rate for Payer: Kentucky WC Medicaid |
$5,242.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,373.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,136.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,527.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,293.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,279.20
|
| Rate for Payer: Ohio Health Group HMO |
$11,317.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,018.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,961.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,677.90
|
| Rate for Payer: PHCS Commercial |
$14,486.40
|
| Rate for Payer: United Healthcare All Payer |
$13,279.20
|
|
|
PLATE PROX LAT TIBIA 8H L
|
Facility
|
OP
|
$15,309.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,990.25 |
| Max. Negotiated Rate |
$14,697.22 |
| Rate for Payer: Aetna Commercial |
$11,788.39
|
| Rate for Payer: Anthem Medicaid |
$5,264.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,941.49
|
| Rate for Payer: Cash Price |
$7,654.80
|
| Rate for Payer: Cigna Commercial |
$12,706.97
|
| Rate for Payer: First Health Commercial |
$14,544.12
|
| Rate for Payer: Humana Commercial |
$13,013.16
|
| Rate for Payer: Humana KY Medicaid |
$5,264.97
|
| Rate for Payer: Kentucky WC Medicaid |
$5,318.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,553.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,298.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,592.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,370.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,472.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,482.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,990.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,745.98
|
| Rate for Payer: PHCS Commercial |
$14,697.22
|
| Rate for Payer: United Healthcare All Payer |
$13,472.45
|
|
|
PLATE PROX LAT TIBIA 8H L
|
Facility
|
IP
|
$15,309.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,990.25 |
| Max. Negotiated Rate |
$14,697.22 |
| Rate for Payer: Aetna Commercial |
$11,788.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,941.49
|
| Rate for Payer: Cash Price |
$7,654.80
|
| Rate for Payer: Cigna Commercial |
$12,706.97
|
| Rate for Payer: First Health Commercial |
$14,544.12
|
| Rate for Payer: Humana Commercial |
$13,013.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,553.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,298.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,592.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,472.45
|
| Rate for Payer: Ohio Health Group HMO |
$11,482.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,061.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,990.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,745.98
|
| Rate for Payer: PHCS Commercial |
$14,697.22
|
| Rate for Payer: United Healthcare All Payer |
$13,472.45
|
|
|
PLATE PROX LAT TIBIA 8H R
|
Facility
|
OP
|
$8,376.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.92 |
| Max. Negotiated Rate |
$8,041.24 |
| Rate for Payer: Aetna Commercial |
$6,449.74
|
| Rate for Payer: Anthem Medicaid |
$2,880.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,533.51
|
| Rate for Payer: Cash Price |
$4,188.14
|
| Rate for Payer: Cigna Commercial |
$6,952.32
|
| Rate for Payer: First Health Commercial |
$7,957.48
|
| Rate for Payer: Humana Commercial |
$7,119.85
|
| Rate for Payer: Humana KY Medicaid |
$2,880.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,909.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,868.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,181.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,512.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,088.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.65
|
| Rate for Payer: PHCS Commercial |
$8,041.24
|
| Rate for Payer: United Healthcare All Payer |
$7,371.14
|
|
|
PLATE PROX LAT TIBIA 8H R
|
Facility
|
IP
|
$8,376.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,088.92 |
| Max. Negotiated Rate |
$8,041.24 |
| Rate for Payer: Aetna Commercial |
$6,449.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,533.51
|
| Rate for Payer: Cash Price |
$4,188.14
|
| Rate for Payer: Cigna Commercial |
$6,952.32
|
| Rate for Payer: First Health Commercial |
$7,957.48
|
| Rate for Payer: Humana Commercial |
$7,119.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,868.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,181.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,512.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,371.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,282.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,675.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,088.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,596.65
|
| Rate for Payer: PHCS Commercial |
$8,041.24
|
| Rate for Payer: United Healthcare All Payer |
$7,371.14
|
|
|
PLATE PROX METATARSAL WEDGE L
|
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 PROX METATARSAL WEDGE L
|
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 PROX METATARSAL WEDGE R
|
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 PROX METATARSAL WEDGE R
|
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 PROX METATATARSAL L
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE PROX METATATARSAL L
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE PROX METATATARSAL R
|
Facility
|
OP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem Medicaid |
$1,232.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Humana KY Medicaid |
$1,232.02
|
| Rate for Payer: Kentucky WC Medicaid |
$1,244.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,256.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE PROX METATATARSAL R
|
Facility
|
IP
|
$3,582.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.72 |
| Max. Negotiated Rate |
$3,439.20 |
| Rate for Payer: Aetna Commercial |
$2,758.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,794.35
|
| Rate for Payer: Cash Price |
$1,791.25
|
| Rate for Payer: Cigna Commercial |
$2,973.48
|
| Rate for Payer: First Health Commercial |
$3,403.38
|
| Rate for Payer: Humana Commercial |
$3,045.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,937.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,643.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,074.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,152.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,686.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$716.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$465.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,110.58
|
| Rate for Payer: PHCS Commercial |
$3,439.20
|
| Rate for Payer: United Healthcare All Payer |
$3,152.60
|
|
|
PLATE PROX RADIUS LARGE
|
Facility
|
OP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem Medicaid |
$1,771.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Humana KY Medicaid |
$1,771.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
