|
PLATE L FRAGMENT 2.7*61 R
|
Facility
|
OP
|
$3,147.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$944.25 |
| Max. Negotiated Rate |
$3,021.60 |
| Rate for Payer: Aetna Commercial |
$2,423.57
|
| Rate for Payer: Anthem Medicaid |
$1,082.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,455.05
|
| Rate for Payer: Cash Price |
$1,573.75
|
| Rate for Payer: Cigna Commercial |
$2,612.43
|
| Rate for Payer: First Health Commercial |
$2,990.12
|
| Rate for Payer: Humana Commercial |
$2,675.38
|
| Rate for Payer: Humana KY Medicaid |
$1,082.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,093.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,580.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,322.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$944.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,104.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,769.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,360.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,518.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,738.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,171.78
|
| Rate for Payer: PHCS Commercial |
$3,021.60
|
| Rate for Payer: United Healthcare All Payer |
$2,769.80
|
|
|
PLATE LG FUSION TMT 2.7MM
|
Facility
|
IP
|
$6,656.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.86 |
| Max. Negotiated Rate |
$6,389.95 |
| Rate for Payer: Aetna Commercial |
$5,125.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,191.84
|
| Rate for Payer: Cash Price |
$3,328.10
|
| Rate for Payer: Cigna Commercial |
$5,524.65
|
| Rate for Payer: First Health Commercial |
$6,323.39
|
| Rate for Payer: Humana Commercial |
$5,657.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,458.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,912.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,996.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,857.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,992.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,324.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,790.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,592.78
|
| Rate for Payer: PHCS Commercial |
$6,389.95
|
| Rate for Payer: United Healthcare All Payer |
$5,857.46
|
|
|
PLATE LG FUSION TMT 2.7MM
|
Facility
|
OP
|
$6,656.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,996.86 |
| Max. Negotiated Rate |
$6,389.95 |
| Rate for Payer: Aetna Commercial |
$5,125.27
|
| Rate for Payer: Anthem Medicaid |
$2,289.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,191.84
|
| Rate for Payer: Cash Price |
$3,328.10
|
| Rate for Payer: Cigna Commercial |
$5,524.65
|
| Rate for Payer: First Health Commercial |
$6,323.39
|
| Rate for Payer: Humana Commercial |
$5,657.77
|
| Rate for Payer: Humana KY Medicaid |
$2,289.07
|
| Rate for Payer: Kentucky WC Medicaid |
$2,312.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,458.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,912.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,996.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,334.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,857.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,992.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,324.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,790.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,592.78
|
| Rate for Payer: PHCS Commercial |
$6,389.95
|
| Rate for Payer: United Healthcare All Payer |
$5,857.46
|
|
|
PLATE LG LT JONES FX
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLATE LG LT JONES FX
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLATE LG RT JONES FX
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLATE LG RT JONES FX
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
PLATE LG UTILITY 2.7MM
|
Facility
|
IP
|
$6,859.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,057.80 |
| Max. Negotiated Rate |
$6,584.96 |
| Rate for Payer: Aetna Commercial |
$5,281.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,350.28
|
| Rate for Payer: Cash Price |
$3,429.66
|
| Rate for Payer: Cigna Commercial |
$5,693.24
|
| Rate for Payer: First Health Commercial |
$6,516.36
|
| Rate for Payer: Humana Commercial |
$5,830.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,036.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,487.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,967.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,732.94
|
| Rate for Payer: PHCS Commercial |
$6,584.96
|
| Rate for Payer: United Healthcare All Payer |
$6,036.21
|
|
|
PLATE LG UTILITY 2.7MM
|
Facility
|
OP
|
$6,859.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,057.80 |
| Max. Negotiated Rate |
$6,584.96 |
| Rate for Payer: Aetna Commercial |
$5,281.68
|
| Rate for Payer: Anthem Medicaid |
$2,358.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,350.28
|
| Rate for Payer: Cash Price |
$3,429.66
|
| Rate for Payer: Cigna Commercial |
$5,693.24
|
| Rate for Payer: First Health Commercial |
$6,516.36
|
| Rate for Payer: Humana Commercial |
$5,830.43
|
| Rate for Payer: Humana KY Medicaid |
$2,358.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,382.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,036.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,487.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,967.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,732.94
|
| Rate for Payer: PHCS Commercial |
$6,584.96
|
| Rate for Payer: United Healthcare All Payer |
$6,036.21
|
|
|
PLATE LISFRANC TI LG LT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI LG LT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI LG RT
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI LG RT
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI MED L
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI MED L
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI MED R
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI MED R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM L
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM L
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM R
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem Medicaid |
$1,719.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Humana KY Medicaid |
$1,719.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,737.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,754.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LISFRANC TI SM R
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.00 |
| Max. Negotiated Rate |
$4,800.00 |
| Rate for Payer: Aetna Commercial |
$3,850.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,900.00
|
| Rate for Payer: Cash Price |
$2,500.00
|
| Rate for Payer: Cigna Commercial |
$4,150.00
|
| Rate for Payer: First Health Commercial |
$4,750.00
|
| Rate for Payer: Humana Commercial |
$4,250.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,100.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,690.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,500.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,400.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,750.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,000.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,350.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,450.00
|
| Rate for Payer: PHCS Commercial |
$4,800.00
|
| Rate for Payer: United Healthcare All Payer |
$4,400.00
|
|
|
PLATE LK CLAV INF MD 10H 117MM
|
Facility
|
OP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem Medicaid |
$1,596.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Humana KY Medicaid |
$1,596.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,613.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,628.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV INF MD 10H 117MM
|
Facility
|
IP
|
$4,643.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,392.96 |
| Max. Negotiated Rate |
$4,457.46 |
| Rate for Payer: Aetna Commercial |
$3,575.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,621.69
|
| Rate for Payer: Cash Price |
$2,321.59
|
| Rate for Payer: Cigna Commercial |
$3,853.85
|
| Rate for Payer: First Health Commercial |
$4,411.03
|
| Rate for Payer: Humana Commercial |
$3,946.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,807.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,426.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,392.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,086.01
|
| Rate for Payer: Ohio Health Group HMO |
$3,482.39
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,714.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,039.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,203.80
|
| Rate for Payer: PHCS Commercial |
$4,457.46
|
| Rate for Payer: United Healthcare All Payer |
$4,086.01
|
|
|
PLATE LK CLAV INF MD 8H 96MM
|
Facility
|
IP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
|
PLATE LK CLAV INF MD 8H 96MM
|
Facility
|
OP
|
$4,587.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,376.31 |
| Max. Negotiated Rate |
$4,404.18 |
| Rate for Payer: Aetna Commercial |
$3,532.52
|
| Rate for Payer: Anthem Medicaid |
$1,577.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,578.40
|
| Rate for Payer: Cash Price |
$2,293.84
|
| Rate for Payer: Cigna Commercial |
$3,807.78
|
| Rate for Payer: First Health Commercial |
$4,358.31
|
| Rate for Payer: Humana Commercial |
$3,899.54
|
| Rate for Payer: Humana KY Medicaid |
$1,577.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,593.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,761.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,385.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,376.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,609.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,037.17
|
| Rate for Payer: Ohio Health Group HMO |
$3,440.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,670.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,991.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,165.51
|
| Rate for Payer: PHCS Commercial |
$4,404.18
|
| Rate for Payer: United Healthcare All Payer |
$4,037.17
|
|
