|
PLATE MED DST HUM LK 13 174M R
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE MED DST HUM LK 13 174M R
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE MED DST HUM LK 9 127M L
|
Facility
|
IP
|
$7,652.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.74 |
| Max. Negotiated Rate |
$7,346.37 |
| Rate for Payer: Aetna Commercial |
$5,892.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,968.93
|
| Rate for Payer: Cash Price |
$3,826.24
|
| Rate for Payer: Cigna Commercial |
$6,351.55
|
| Rate for Payer: First Health Commercial |
$7,269.85
|
| Rate for Payer: Humana Commercial |
$6,504.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,275.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,647.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,295.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,734.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,739.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,121.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,657.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,280.20
|
| Rate for Payer: PHCS Commercial |
$7,346.37
|
| Rate for Payer: United Healthcare All Payer |
$6,734.17
|
|
|
PLATE MED DST HUM LK 9 127M L
|
Facility
|
OP
|
$7,652.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.74 |
| Max. Negotiated Rate |
$7,346.37 |
| Rate for Payer: Aetna Commercial |
$5,892.40
|
| Rate for Payer: Anthem Medicaid |
$2,631.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,968.93
|
| Rate for Payer: Cash Price |
$3,826.24
|
| Rate for Payer: Cigna Commercial |
$6,351.55
|
| Rate for Payer: First Health Commercial |
$7,269.85
|
| Rate for Payer: Humana Commercial |
$6,504.60
|
| Rate for Payer: Humana KY Medicaid |
$2,631.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,658.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,275.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,647.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,295.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,684.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,734.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,739.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,121.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,657.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,280.20
|
| Rate for Payer: PHCS Commercial |
$7,346.37
|
| Rate for Payer: United Healthcare All Payer |
$6,734.17
|
|
|
PLATE MEDIAL ANT CLAVICLE 6H
|
Facility
|
OP
|
$7,383.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.09 |
| Max. Negotiated Rate |
$7,088.30 |
| Rate for Payer: Aetna Commercial |
$5,685.41
|
| Rate for Payer: Anthem Medicaid |
$2,539.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.25
|
| Rate for Payer: Cash Price |
$3,691.82
|
| Rate for Payer: Cigna Commercial |
$6,128.43
|
| Rate for Payer: First Health Commercial |
$7,014.47
|
| Rate for Payer: Humana Commercial |
$6,276.10
|
| Rate for Payer: Humana KY Medicaid |
$2,539.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,565.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,054.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,590.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,497.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,537.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,906.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,423.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,094.72
|
| Rate for Payer: PHCS Commercial |
$7,088.30
|
| Rate for Payer: United Healthcare All Payer |
$6,497.61
|
|
|
PLATE MEDIAL ANT CLAVICLE 6H
|
Facility
|
IP
|
$7,383.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.09 |
| Max. Negotiated Rate |
$7,088.30 |
| Rate for Payer: Aetna Commercial |
$5,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.25
|
| Rate for Payer: Cash Price |
$3,691.82
|
| Rate for Payer: Cigna Commercial |
$6,128.43
|
| Rate for Payer: First Health Commercial |
$7,014.47
|
| Rate for Payer: Humana Commercial |
$6,276.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,054.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,497.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,537.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,906.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,423.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,094.72
|
| Rate for Payer: PHCS Commercial |
$7,088.30
|
| Rate for Payer: United Healthcare All Payer |
$6,497.61
|
|
|
PLATE MEDIAL ANT CLAVICLE 8H
|
Facility
|
IP
|
$7,383.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.09 |
| Max. Negotiated Rate |
$7,088.30 |
| Rate for Payer: Aetna Commercial |
$5,685.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.25
|
| Rate for Payer: Cash Price |
$3,691.82
|
| Rate for Payer: Cigna Commercial |
$6,128.43
|
| Rate for Payer: First Health Commercial |
$7,014.47
|
| Rate for Payer: Humana Commercial |
$6,276.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,054.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,497.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,537.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,906.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,423.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,094.72
|
| Rate for Payer: PHCS Commercial |
$7,088.30
|
| Rate for Payer: United Healthcare All Payer |
$6,497.61
|
|
|
PLATE MEDIAL ANT CLAVICLE 8H
|
Facility
|
OP
|
$7,383.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,215.09 |
| Max. Negotiated Rate |
$7,088.30 |
| Rate for Payer: Aetna Commercial |
$5,685.41
|
| Rate for Payer: Anthem Medicaid |
$2,539.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,759.25
|
| Rate for Payer: Cash Price |
$3,691.82
|
| Rate for Payer: Cigna Commercial |
$6,128.43
|
| Rate for Payer: First Health Commercial |
$7,014.47
|
| Rate for Payer: Humana Commercial |
$6,276.10
|
| Rate for Payer: Humana KY Medicaid |
$2,539.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,565.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,054.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,449.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,215.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,590.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,497.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,537.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,906.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,423.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,094.72
|
| Rate for Payer: PHCS Commercial |
$7,088.30
|
| Rate for Payer: United Healthcare All Payer |
$6,497.61
|
|
|
PLATE MEDIAL ANTI-GLIDE 4H
|
Facility
|
OP
|
$3,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.00 |
| Max. Negotiated Rate |
$3,417.60 |
| Rate for Payer: Aetna Commercial |
$2,741.20
|
| Rate for Payer: Anthem Medicaid |
$1,224.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,776.80
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cigna Commercial |
$2,954.80
|
| Rate for Payer: First Health Commercial |
$3,382.00
|
| Rate for Payer: Humana Commercial |
$3,026.00
|
| Rate for Payer: Humana KY Medicaid |
$1,224.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,236.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,919.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,627.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,068.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,248.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,132.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,670.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,097.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,456.40
|
| Rate for Payer: PHCS Commercial |
$3,417.60
|
| Rate for Payer: United Healthcare All Payer |
$3,132.80
|
|
|
PLATE MEDIAL ANTI-GLIDE 4H
|
Facility
|
IP
|
$3,560.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.00 |
| Max. Negotiated Rate |
$3,417.60 |
| Rate for Payer: Aetna Commercial |
$2,741.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,776.80
|
| Rate for Payer: Cash Price |
$1,780.00
|
| Rate for Payer: Cigna Commercial |
$2,954.80
|
| Rate for Payer: First Health Commercial |
$3,382.00
|
| Rate for Payer: Humana Commercial |
$3,026.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,919.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,627.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,068.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,132.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,670.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,848.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,097.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,456.40
|
| Rate for Payer: PHCS Commercial |
$3,417.60
|
| Rate for Payer: United Healthcare All Payer |
$3,132.80
|
|
|
PLATE MEDIAL EPICONDYAL 10H
|
Facility
|
IP
|
$4,377.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,313.25 |
| Max. Negotiated Rate |
$4,202.40 |
| Rate for Payer: Aetna Commercial |
$3,370.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,414.45
|
| Rate for Payer: Cash Price |
$2,188.75
|
| Rate for Payer: Cigna Commercial |
$3,633.32
|
| Rate for Payer: First Health Commercial |
$4,158.62
|
| Rate for Payer: Humana Commercial |
$3,720.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,589.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,230.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,852.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,283.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,502.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,808.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,020.47
|
| Rate for Payer: PHCS Commercial |
$4,202.40
|
| Rate for Payer: United Healthcare All Payer |
$3,852.20
|
|
|
PLATE MEDIAL EPICONDYAL 10H
|
Facility
|
OP
|
$4,377.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,313.25 |
| Max. Negotiated Rate |
$4,202.40 |
| Rate for Payer: Aetna Commercial |
$3,370.68
|
| Rate for Payer: Anthem Medicaid |
$1,505.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,414.45
|
| Rate for Payer: Cash Price |
$2,188.75
|
| Rate for Payer: Cigna Commercial |
$3,633.32
|
| Rate for Payer: First Health Commercial |
$4,158.62
|
| Rate for Payer: Humana Commercial |
$3,720.88
|
| Rate for Payer: Humana KY Medicaid |
$1,505.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,520.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,589.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,230.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,313.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,535.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,852.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,283.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,502.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,808.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,020.47
|
| Rate for Payer: PHCS Commercial |
$4,202.40
|
| Rate for Payer: United Healthcare All Payer |
$3,852.20
|
|
|
PLATE MEDIAL EPICONDYAL LONG
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE MEDIAL EPICONDYAL LONG
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE MEDIAL EPICONDYAL MED
|
Facility
|
IP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE MEDIAL EPICONDYAL MED
|
Facility
|
OP
|
$5,093.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.12 |
| Max. Negotiated Rate |
$4,890.00 |
| Rate for Payer: Aetna Commercial |
$3,922.19
|
| Rate for Payer: Anthem Medicaid |
$1,751.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,973.12
|
| Rate for Payer: Cash Price |
$2,546.88
|
| Rate for Payer: Cigna Commercial |
$4,227.81
|
| Rate for Payer: First Health Commercial |
$4,839.06
|
| Rate for Payer: Humana Commercial |
$4,329.69
|
| Rate for Payer: Humana KY Medicaid |
$1,751.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,769.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,176.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,759.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,528.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,786.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,482.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,820.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,075.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,431.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,514.69
|
| Rate for Payer: PHCS Commercial |
$4,890.00
|
| Rate for Payer: United Healthcare All Payer |
$4,482.50
|
|
|
PLATE MEDIAL EPICONDYAL SM
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE MEDIAL EPICONDYAL SM
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE MEDIAL EPICONDYAL XLG
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE MEDIAL EPICONDYAL XLG
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE MEDIAL MALLEOLAR
|
Facility
|
OP
|
$3,293.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem Medicaid |
$1,132.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Humana KY Medicaid |
$1,132.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,144.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,155.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
PLATE MEDIAL MALLEOLAR
|
Facility
|
IP
|
$3,293.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$988.12 |
| Max. Negotiated Rate |
$3,162.00 |
| Rate for Payer: Aetna Commercial |
$2,536.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,569.12
|
| Rate for Payer: Cash Price |
$1,646.88
|
| Rate for Payer: Cigna Commercial |
$2,733.81
|
| Rate for Payer: First Health Commercial |
$3,129.06
|
| Rate for Payer: Humana Commercial |
$2,799.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,700.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,430.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$988.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,898.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,470.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,635.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,865.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,272.69
|
| Rate for Payer: PHCS Commercial |
$3,162.00
|
| Rate for Payer: United Healthcare All Payer |
$2,898.50
|
|
|
PLATE MEDIAL PILON 3H
|
Facility
|
IP
|
$3,307.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.33 |
| Max. Negotiated Rate |
$3,175.47 |
| Rate for Payer: Aetna Commercial |
$2,546.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.07
|
| Rate for Payer: Cash Price |
$1,653.89
|
| Rate for Payer: Cigna Commercial |
$2,745.46
|
| Rate for Payer: First Health Commercial |
$3,142.39
|
| Rate for Payer: Humana Commercial |
$2,811.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,910.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,646.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.37
|
| Rate for Payer: PHCS Commercial |
$3,175.47
|
| Rate for Payer: United Healthcare All Payer |
$2,910.85
|
|
|
PLATE MEDIAL PILON 3H
|
Facility
|
OP
|
$3,307.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.33 |
| Max. Negotiated Rate |
$3,175.47 |
| Rate for Payer: Aetna Commercial |
$2,546.99
|
| Rate for Payer: Anthem Medicaid |
$1,137.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.07
|
| Rate for Payer: Cash Price |
$1,653.89
|
| Rate for Payer: Cigna Commercial |
$2,745.46
|
| Rate for Payer: First Health Commercial |
$3,142.39
|
| Rate for Payer: Humana Commercial |
$2,811.61
|
| Rate for Payer: Humana KY Medicaid |
$1,137.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,160.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,910.85
|
| Rate for Payer: Ohio Health Group HMO |
$2,480.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,646.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,877.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,282.37
|
| Rate for Payer: PHCS Commercial |
$3,175.47
|
| Rate for Payer: United Healthcare All Payer |
$2,910.85
|
|
|
PLATE MEDIAL PILON 5H
|
Facility
|
OP
|
$2,204.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.32 |
| Max. Negotiated Rate |
$2,116.22 |
| Rate for Payer: Aetna Commercial |
$1,697.39
|
| Rate for Payer: Anthem Medicaid |
$758.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,719.43
|
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: Cigna Commercial |
$1,829.65
|
| Rate for Payer: First Health Commercial |
$2,094.18
|
| Rate for Payer: Humana Commercial |
$1,873.74
|
| Rate for Payer: Humana KY Medicaid |
$758.09
|
| Rate for Payer: Kentucky WC Medicaid |
$765.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$773.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,653.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,763.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,917.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.04
|
| Rate for Payer: PHCS Commercial |
$2,116.22
|
| Rate for Payer: United Healthcare All Payer |
$1,939.87
|
|
