|
PLATE MED PROX TIB 6H R
|
Facility
|
IP
|
$7,303.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.01 |
| Max. Negotiated Rate |
$7,011.22 |
| Rate for Payer: Aetna Commercial |
$5,623.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,696.61
|
| Rate for Payer: Cash Price |
$3,651.68
|
| Rate for Payer: Cigna Commercial |
$6,061.78
|
| Rate for Payer: First Health Commercial |
$6,938.18
|
| Rate for Payer: Humana Commercial |
$6,207.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,988.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,389.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,426.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,477.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,842.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,353.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,039.31
|
| Rate for Payer: PHCS Commercial |
$7,011.22
|
| Rate for Payer: United Healthcare All Payer |
$6,426.95
|
|
|
PLATE MED PROX TIB 6H R
|
Facility
|
OP
|
$7,303.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,191.01 |
| Max. Negotiated Rate |
$7,011.22 |
| Rate for Payer: Aetna Commercial |
$5,623.58
|
| Rate for Payer: Anthem Medicaid |
$2,511.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,696.61
|
| Rate for Payer: Cash Price |
$3,651.68
|
| Rate for Payer: Cigna Commercial |
$6,061.78
|
| Rate for Payer: First Health Commercial |
$6,938.18
|
| Rate for Payer: Humana Commercial |
$6,207.85
|
| Rate for Payer: Humana KY Medicaid |
$2,511.62
|
| Rate for Payer: Kentucky WC Medicaid |
$2,537.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,988.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,389.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,191.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,562.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,426.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,477.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,842.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,353.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,039.31
|
| Rate for Payer: PHCS Commercial |
$7,011.22
|
| Rate for Payer: United Healthcare All Payer |
$6,426.95
|
|
|
PLATE MED PROX TIB 8H R
|
Facility
|
OP
|
$7,921.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.40 |
| Max. Negotiated Rate |
$7,604.48 |
| Rate for Payer: Aetna Commercial |
$6,099.42
|
| Rate for Payer: Anthem Medicaid |
$2,724.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,178.64
|
| Rate for Payer: Cash Price |
$3,960.67
|
| Rate for Payer: Cigna Commercial |
$6,574.70
|
| Rate for Payer: First Health Commercial |
$7,525.26
|
| Rate for Payer: Humana Commercial |
$6,733.13
|
| Rate for Payer: Humana KY Medicaid |
$2,724.15
|
| Rate for Payer: Kentucky WC Medicaid |
$2,751.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,495.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,845.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,376.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,778.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,970.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,941.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,337.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,891.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,465.72
|
| Rate for Payer: PHCS Commercial |
$7,604.48
|
| Rate for Payer: United Healthcare All Payer |
$6,970.77
|
|
|
PLATE MED PROX TIB 8H R
|
Facility
|
IP
|
$7,921.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,376.40 |
| Max. Negotiated Rate |
$7,604.48 |
| Rate for Payer: Aetna Commercial |
$6,099.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,178.64
|
| Rate for Payer: Cash Price |
$3,960.67
|
| Rate for Payer: Cigna Commercial |
$6,574.70
|
| Rate for Payer: First Health Commercial |
$7,525.26
|
| Rate for Payer: Humana Commercial |
$6,733.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,495.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,845.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,376.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,970.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,941.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,337.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,891.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,465.72
|
| Rate for Payer: PHCS Commercial |
$7,604.48
|
| Rate for Payer: United Healthcare All Payer |
$6,970.77
|
|
|
PLATE META LARGE 3H
|
Facility
|
IP
|
$2,948.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.62 |
| Max. Negotiated Rate |
$2,830.80 |
| Rate for Payer: Aetna Commercial |
$2,270.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,300.03
|
| Rate for Payer: Cash Price |
$1,474.38
|
| Rate for Payer: Cigna Commercial |
$2,447.46
|
| Rate for Payer: First Health Commercial |
$2,801.31
|
| Rate for Payer: Humana Commercial |
$2,506.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,417.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,176.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$884.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,594.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,211.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,359.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,565.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.64
|
| Rate for Payer: PHCS Commercial |
$2,830.80
|
| Rate for Payer: United Healthcare All Payer |
$2,594.90
|
|
|
PLATE META LARGE 3H
|
Facility
|
OP
|
$2,948.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.62 |
| Max. Negotiated Rate |
$2,830.80 |
| Rate for Payer: Aetna Commercial |
$2,270.54
|
| Rate for Payer: Anthem Medicaid |
$1,014.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,300.03
|
| Rate for Payer: Cash Price |
$1,474.38
|
| Rate for Payer: Cigna Commercial |
$2,447.46
|
| Rate for Payer: First Health Commercial |
$2,801.31
|
| Rate for Payer: Humana Commercial |
$2,506.44
|
| Rate for Payer: Humana KY Medicaid |
$1,014.08
|
| Rate for Payer: Kentucky WC Medicaid |
$1,024.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,417.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,176.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$884.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,034.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,594.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,211.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,359.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,565.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,034.64
|
| Rate for Payer: PHCS Commercial |
$2,830.80
|
| Rate for Payer: United Healthcare All Payer |
$2,594.90
|
|
|
PLATE META LARGE 5H
|
Facility
|
OP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem Medicaid |
$1,023.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Humana KY Medicaid |
$1,023.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,033.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,043.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE META LARGE 5H
|
Facility
|
IP
|
$2,975.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$892.50 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$2,290.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,320.50
|
| Rate for Payer: Cash Price |
$1,487.50
|
| Rate for Payer: Cigna Commercial |
$2,469.25
|
| Rate for Payer: First Health Commercial |
$2,826.25
|
| Rate for Payer: Humana Commercial |
$2,528.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,439.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,195.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$892.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,618.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,231.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,380.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,588.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,052.75
|
| Rate for Payer: PHCS Commercial |
$2,856.00
|
| Rate for Payer: United Healthcare All Payer |
$2,618.00
|
|
|
PLATE META LARGE 7H
|
Facility
|
IP
|
$3,053.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.12 |
| Max. Negotiated Rate |
$2,931.60 |
| Rate for Payer: Aetna Commercial |
$2,351.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,381.93
|
| Rate for Payer: Cash Price |
$1,526.88
|
| Rate for Payer: Cigna Commercial |
$2,534.61
|
| Rate for Payer: First Health Commercial |
$2,901.06
|
| Rate for Payer: Humana Commercial |
$2,595.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,504.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,253.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$916.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,687.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,290.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,443.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,656.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,107.09
|
| Rate for Payer: PHCS Commercial |
$2,931.60
|
| Rate for Payer: United Healthcare All Payer |
$2,687.30
|
|
|
PLATE META LARGE 7H
|
Facility
|
OP
|
$3,053.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$916.12 |
| Max. Negotiated Rate |
$2,931.60 |
| Rate for Payer: Aetna Commercial |
$2,351.39
|
| Rate for Payer: Anthem Medicaid |
$1,050.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,381.93
|
| Rate for Payer: Cash Price |
$1,526.88
|
| Rate for Payer: Cigna Commercial |
$2,534.61
|
| Rate for Payer: First Health Commercial |
$2,901.06
|
| Rate for Payer: Humana Commercial |
$2,595.69
|
| Rate for Payer: Humana KY Medicaid |
$1,050.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,060.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,504.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,253.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$916.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,071.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,687.30
|
| Rate for Payer: Ohio Health Group HMO |
$2,290.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,443.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,656.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,107.09
|
| Rate for Payer: PHCS Commercial |
$2,931.60
|
| Rate for Payer: United Healthcare All Payer |
$2,687.30
|
|
|
PLATE META SMALL 3H
|
Facility
|
OP
|
$3,180.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.17 |
| Max. Negotiated Rate |
$3,053.35 |
| Rate for Payer: Aetna Commercial |
$2,449.04
|
| Rate for Payer: Anthem Medicaid |
$1,093.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.84
|
| Rate for Payer: Cash Price |
$1,590.29
|
| Rate for Payer: Cigna Commercial |
$2,639.87
|
| Rate for Payer: First Health Commercial |
$3,021.54
|
| Rate for Payer: Humana Commercial |
$2,703.48
|
| Rate for Payer: Humana KY Medicaid |
$1,093.80
|
| Rate for Payer: Kentucky WC Medicaid |
$1,104.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,115.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,544.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,194.59
|
| Rate for Payer: PHCS Commercial |
$3,053.35
|
| Rate for Payer: United Healthcare All Payer |
$2,798.90
|
|
|
PLATE META SMALL 3H
|
Facility
|
IP
|
$3,180.57
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$954.17 |
| Max. Negotiated Rate |
$3,053.35 |
| Rate for Payer: Aetna Commercial |
$2,449.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,480.84
|
| Rate for Payer: Cash Price |
$1,590.29
|
| Rate for Payer: Cigna Commercial |
$2,639.87
|
| Rate for Payer: First Health Commercial |
$3,021.54
|
| Rate for Payer: Humana Commercial |
$2,703.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,608.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,347.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$954.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,798.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,385.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,544.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,767.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,194.59
|
| Rate for Payer: PHCS Commercial |
$3,053.35
|
| Rate for Payer: United Healthcare All Payer |
$2,798.90
|
|
|
PLATE META SMALL 5H
|
Facility
|
IP
|
$2,124.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.38 |
| Max. Negotiated Rate |
$2,039.62 |
| Rate for Payer: Aetna Commercial |
$1,635.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.19
|
| Rate for Payer: Cash Price |
$1,062.30
|
| Rate for Payer: Cigna Commercial |
$1,763.42
|
| Rate for Payer: First Health Commercial |
$2,018.37
|
| Rate for Payer: Humana Commercial |
$1,805.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.97
|
| Rate for Payer: PHCS Commercial |
$2,039.62
|
| Rate for Payer: United Healthcare All Payer |
$1,869.65
|
|
|
PLATE META SMALL 5H
|
Facility
|
OP
|
$2,124.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$637.38 |
| Max. Negotiated Rate |
$2,039.62 |
| Rate for Payer: Aetna Commercial |
$1,635.94
|
| Rate for Payer: Anthem Medicaid |
$730.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,657.19
|
| Rate for Payer: Cash Price |
$1,062.30
|
| Rate for Payer: Cigna Commercial |
$1,763.42
|
| Rate for Payer: First Health Commercial |
$2,018.37
|
| Rate for Payer: Humana Commercial |
$1,805.91
|
| Rate for Payer: Humana KY Medicaid |
$730.65
|
| Rate for Payer: Kentucky WC Medicaid |
$738.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,742.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,567.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$637.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$745.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,869.65
|
| Rate for Payer: Ohio Health Group HMO |
$1,593.45
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,699.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,848.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,465.97
|
| Rate for Payer: PHCS Commercial |
$2,039.62
|
| Rate for Payer: United Healthcare All Payer |
$1,869.65
|
|
|
PLATE META SMALL 7H
|
Facility
|
OP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem Medicaid |
$1,126.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Humana KY Medicaid |
$1,126.27
|
| Rate for Payer: Kentucky WC Medicaid |
$1,137.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,148.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
PLATE META SMALL 7H
|
Facility
|
IP
|
$3,275.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$982.50 |
| Max. Negotiated Rate |
$3,144.00 |
| Rate for Payer: Aetna Commercial |
$2,521.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,554.50
|
| Rate for Payer: Cash Price |
$1,637.50
|
| Rate for Payer: Cigna Commercial |
$2,718.25
|
| Rate for Payer: First Health Commercial |
$3,111.25
|
| Rate for Payer: Humana Commercial |
$2,783.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,685.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,416.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$982.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,882.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,456.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,620.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,849.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,259.75
|
| Rate for Payer: PHCS Commercial |
$3,144.00
|
| Rate for Payer: United Healthcare All Payer |
$2,882.00
|
|
|
PLATE METATARSAL 5TH LEFT
|
Facility
|
OP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem Medicaid |
$2,531.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Humana KY Medicaid |
$2,531.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,557.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,582.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE METATARSAL 5TH LEFT
|
Facility
|
IP
|
$7,361.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,208.53 |
| Max. Negotiated Rate |
$7,067.28 |
| Rate for Payer: Aetna Commercial |
$5,668.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,742.16
|
| Rate for Payer: Cash Price |
$3,680.88
|
| Rate for Payer: Cigna Commercial |
$6,110.25
|
| Rate for Payer: First Health Commercial |
$6,993.66
|
| Rate for Payer: Humana Commercial |
$6,257.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,036.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,432.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,208.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,478.34
|
| Rate for Payer: Ohio Health Group HMO |
$5,521.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,889.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,404.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,079.61
|
| Rate for Payer: PHCS Commercial |
$7,067.28
|
| Rate for Payer: United Healthcare All Payer |
$6,478.34
|
|
|
PLATE METATARSALPHALENGEAL-MTP
|
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 METATARSALPHALENGEAL-MTP
|
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 METATARSALPHALENGEL-MTPL
|
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 METATARSALPHALENGEL-MTPL
|
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 METTARSALPHALENGEL L REV
|
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 METTARSALPHALENGEL L REV
|
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 METTARSALPHALENGEL R REV
|
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
|
|
