|
PLATE PROX LAT TIBIA 8H R
|
Facility
|
IP
|
$8,576.29
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,572.89 |
| Max. Negotiated Rate |
$8,233.24 |
| Rate for Payer: Aetna Commercial |
$6,603.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,689.51
|
| Rate for Payer: Cash Price |
$4,288.14
|
| Rate for Payer: Cigna Commercial |
$7,118.32
|
| Rate for Payer: First Health Commercial |
$8,147.48
|
| Rate for Payer: Humana Commercial |
$7,289.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,032.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,329.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,572.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,547.14
|
| Rate for Payer: Ohio Health Group HMO |
$6,432.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,861.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,461.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,917.64
|
| Rate for Payer: PHCS Commercial |
$8,233.24
|
| Rate for Payer: United Healthcare All Payer |
$7,547.14
|
|
|
PLATE PROX METATARSAL WEDGE L
|
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 PROX METATARSAL WEDGE L
|
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 PROX METATARSAL WEDGE R
|
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 PROX METATARSAL WEDGE R
|
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 PROX METATATARSAL L
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE PROX METATATARSAL L
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE PROX METATATARSAL R
|
Facility
|
OP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem Medicaid |
$1,197.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Humana KY Medicaid |
$1,197.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,209.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,221.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE PROX METATATARSAL R
|
Facility
|
IP
|
$3,481.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,044.38 |
| Max. Negotiated Rate |
$3,342.00 |
| Rate for Payer: Aetna Commercial |
$2,680.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,715.38
|
| Rate for Payer: Cash Price |
$1,740.62
|
| Rate for Payer: Cigna Commercial |
$2,889.44
|
| Rate for Payer: First Health Commercial |
$3,307.19
|
| Rate for Payer: Humana Commercial |
$2,959.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,854.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,569.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,044.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,063.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,610.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,785.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,028.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,402.06
|
| Rate for Payer: PHCS Commercial |
$3,342.00
|
| Rate for Payer: United Healthcare All Payer |
$3,063.50
|
|
|
PLATE PROX RADIUS LARGE
|
Facility
|
IP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE PROX RADIUS LARGE
|
Facility
|
OP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem Medicaid |
$1,774.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Humana KY Medicaid |
$1,774.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,793.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE PROX RADIUS SMALL
|
Facility
|
OP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem Medicaid |
$1,774.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Humana KY Medicaid |
$1,774.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,793.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE PROX RADIUS SMALL
|
Facility
|
IP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE PROX TIB 3.5 6H 107MM R
|
Facility
|
IP
|
$9,021.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,706.48 |
| Max. Negotiated Rate |
$8,660.73 |
| Rate for Payer: Aetna Commercial |
$6,946.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,036.84
|
| Rate for Payer: Cash Price |
$4,510.79
|
| Rate for Payer: Cigna Commercial |
$7,487.92
|
| Rate for Payer: First Health Commercial |
$8,570.51
|
| Rate for Payer: Humana Commercial |
$7,668.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,397.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,657.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,706.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,766.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,217.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,848.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,224.90
|
| Rate for Payer: PHCS Commercial |
$8,660.73
|
| Rate for Payer: United Healthcare All Payer |
$7,939.00
|
|
|
PLATE PROX TIB 3.5 6H 107MM R
|
Facility
|
OP
|
$9,021.59
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,706.48 |
| Max. Negotiated Rate |
$8,660.73 |
| Rate for Payer: Aetna Commercial |
$6,946.62
|
| Rate for Payer: Anthem Medicaid |
$3,102.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,036.84
|
| Rate for Payer: Cash Price |
$4,510.79
|
| Rate for Payer: Cigna Commercial |
$7,487.92
|
| Rate for Payer: First Health Commercial |
$8,570.51
|
| Rate for Payer: Humana Commercial |
$7,668.35
|
| Rate for Payer: Humana KY Medicaid |
$3,102.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3,134.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,397.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,657.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,706.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,164.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,939.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,766.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,217.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,848.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,224.90
|
| Rate for Payer: PHCS Commercial |
$8,660.73
|
| Rate for Payer: United Healthcare All Payer |
$7,939.00
|
|
|
PLATE PROX TIBIAL LOCKNG 10H L
|
Facility
|
IP
|
$8,472.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.71 |
| Max. Negotiated Rate |
$8,133.48 |
| Rate for Payer: Aetna Commercial |
$6,523.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,608.45
|
| Rate for Payer: Cash Price |
$4,236.19
|
| Rate for Payer: Cigna Commercial |
$7,032.07
|
| Rate for Payer: First Health Commercial |
$8,048.75
|
| Rate for Payer: Humana Commercial |
$7,201.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,947.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,252.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,455.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,354.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.94
|
| Rate for Payer: PHCS Commercial |
$8,133.48
|
| Rate for Payer: United Healthcare All Payer |
$7,455.69
|
|
|
PLATE PROX TIBIAL LOCKNG 10H L
|
Facility
|
OP
|
$8,472.37
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,541.71 |
| Max. Negotiated Rate |
$8,133.48 |
| Rate for Payer: Aetna Commercial |
$6,523.72
|
| Rate for Payer: Anthem Medicaid |
$2,913.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,608.45
|
| Rate for Payer: Cash Price |
$4,236.19
|
| Rate for Payer: Cigna Commercial |
$7,032.07
|
| Rate for Payer: First Health Commercial |
$8,048.75
|
| Rate for Payer: Humana Commercial |
$7,201.51
|
| Rate for Payer: Humana KY Medicaid |
$2,913.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,943.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,947.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,252.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,541.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,972.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,455.69
|
| Rate for Payer: Ohio Health Group HMO |
$6,354.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,777.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,370.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,845.94
|
| Rate for Payer: PHCS Commercial |
$8,133.48
|
| Rate for Payer: United Healthcare All Payer |
$7,455.69
|
|
|
PLATE PROX TIBIAL LOCKNG 10H R
|
Facility
|
OP
|
$7,103.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.20 |
| Max. Negotiated Rate |
$6,819.83 |
| Rate for Payer: Aetna Commercial |
$5,470.07
|
| Rate for Payer: Anthem Medicaid |
$2,443.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.11
|
| Rate for Payer: Cash Price |
$3,551.99
|
| Rate for Payer: Cigna Commercial |
$5,896.31
|
| Rate for Payer: First Health Commercial |
$6,748.79
|
| Rate for Payer: Humana Commercial |
$6,038.39
|
| Rate for Payer: Humana KY Medicaid |
$2,443.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.75
|
| Rate for Payer: PHCS Commercial |
$6,819.83
|
| Rate for Payer: United Healthcare All Payer |
$6,251.51
|
|
|
PLATE PROX TIBIAL LOCKNG 10H R
|
Facility
|
IP
|
$7,103.99
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.20 |
| Max. Negotiated Rate |
$6,819.83 |
| Rate for Payer: Aetna Commercial |
$5,470.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.11
|
| Rate for Payer: Cash Price |
$3,551.99
|
| Rate for Payer: Cigna Commercial |
$5,896.31
|
| Rate for Payer: First Health Commercial |
$6,748.79
|
| Rate for Payer: Humana Commercial |
$6,038.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.19
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.75
|
| Rate for Payer: PHCS Commercial |
$6,819.83
|
| Rate for Payer: United Healthcare All Payer |
$6,251.51
|
|
|
PLATE PROX TIBIAL LOCKNG 12H L
|
Facility
|
OP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem Medicaid |
$2,474.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Humana KY Medicaid |
$2,474.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,499.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE PROX TIBIAL LOCKNG 12H L
|
Facility
|
IP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE PROX TIBIAL LOCKNG 12H R
|
Facility
|
IP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE PROX TIBIAL LOCKNG 12H R
|
Facility
|
OP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem Medicaid |
$2,474.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Humana KY Medicaid |
$2,474.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,499.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE PROX TIBIAL LOCKNG 14H L
|
Facility
|
OP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem Medicaid |
$2,490.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Humana KY Medicaid |
$2,490.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
|
PLATE PROX TIBIAL LOCKNG 14H L
|
Facility
|
IP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
