|
PLATE DISTL ANTEROLATERAL R 6H
|
Facility
|
OP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem Medicaid |
$2,368.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Humana KY Medicaid |
$2,368.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DISTL ANTEROLATERAL R 8H
|
Facility
|
IP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DISTL ANTEROLATERAL R 8H
|
Facility
|
OP
|
$6,888.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$895.44 |
| Max. Negotiated Rate |
$6,612.48 |
| Rate for Payer: Aetna Commercial |
$5,303.76
|
| Rate for Payer: Anthem Medicaid |
$2,368.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,372.64
|
| Rate for Payer: Cash Price |
$3,444.00
|
| Rate for Payer: Cigna Commercial |
$5,717.04
|
| Rate for Payer: First Health Commercial |
$6,543.60
|
| Rate for Payer: Humana Commercial |
$5,854.80
|
| Rate for Payer: Humana KY Medicaid |
$2,368.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,392.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,648.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,083.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,066.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,416.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,061.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,166.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,377.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$895.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,135.28
|
| Rate for Payer: PHCS Commercial |
$6,612.48
|
| Rate for Payer: United Healthcare All Payer |
$6,061.44
|
|
|
PLATE DIST LAT FEM 10 HOLE L
|
Facility
|
OP
|
$17,732.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.21 |
| Max. Negotiated Rate |
$17,023.10 |
| Rate for Payer: Aetna Commercial |
$13,653.95
|
| Rate for Payer: Anthem Medicaid |
$6,098.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,831.27
|
| Rate for Payer: Cash Price |
$8,866.20
|
| Rate for Payer: Cigna Commercial |
$14,717.89
|
| Rate for Payer: First Health Commercial |
$16,845.78
|
| Rate for Payer: Humana Commercial |
$15,072.54
|
| Rate for Payer: Humana KY Medicaid |
$6,098.17
|
| Rate for Payer: Kentucky WC Medicaid |
$6,160.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,540.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,086.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,319.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,220.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,604.51
|
| Rate for Payer: Ohio Health Group HMO |
$13,299.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,546.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,305.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,497.04
|
| Rate for Payer: PHCS Commercial |
$17,023.10
|
| Rate for Payer: United Healthcare All Payer |
$15,604.51
|
|
|
PLATE DIST LAT FEM 10 HOLE L
|
Facility
|
IP
|
$17,732.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,305.21 |
| Max. Negotiated Rate |
$17,023.10 |
| Rate for Payer: Aetna Commercial |
$13,653.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,831.27
|
| Rate for Payer: Cash Price |
$8,866.20
|
| Rate for Payer: Cigna Commercial |
$14,717.89
|
| Rate for Payer: First Health Commercial |
$16,845.78
|
| Rate for Payer: Humana Commercial |
$15,072.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,540.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,086.51
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,319.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,604.51
|
| Rate for Payer: Ohio Health Group HMO |
$13,299.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,546.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,305.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,497.04
|
| Rate for Payer: PHCS Commercial |
$17,023.10
|
| Rate for Payer: United Healthcare All Payer |
$15,604.51
|
|
|
PLATE DIST LAT FEM 10 HOLE R
|
Facility
|
OP
|
$12,206.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,586.83 |
| Max. Negotiated Rate |
$11,718.11 |
| Rate for Payer: Aetna Commercial |
$9,398.90
|
| Rate for Payer: Anthem Medicaid |
$4,197.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,520.96
|
| Rate for Payer: Cash Price |
$6,103.18
|
| Rate for Payer: Cigna Commercial |
$10,131.28
|
| Rate for Payer: First Health Commercial |
$11,596.04
|
| Rate for Payer: Humana Commercial |
$10,375.41
|
| Rate for Payer: Humana KY Medicaid |
$4,197.77
|
| Rate for Payer: Kentucky WC Medicaid |
$4,240.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,009.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,008.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,661.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,281.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,741.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,154.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,441.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,783.97
|
| Rate for Payer: PHCS Commercial |
$11,718.11
|
| Rate for Payer: United Healthcare All Payer |
$10,741.60
|
|
|
PLATE DIST LAT FEM 10 HOLE R
|
Facility
|
IP
|
$12,206.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,586.83 |
| Max. Negotiated Rate |
$11,718.11 |
| Rate for Payer: Aetna Commercial |
$9,398.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,520.96
|
| Rate for Payer: Cash Price |
$6,103.18
|
| Rate for Payer: Cigna Commercial |
$10,131.28
|
| Rate for Payer: First Health Commercial |
$11,596.04
|
| Rate for Payer: Humana Commercial |
$10,375.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,009.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,008.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,661.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,741.60
|
| Rate for Payer: Ohio Health Group HMO |
$9,154.77
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,441.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,586.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,783.97
|
| Rate for Payer: PHCS Commercial |
$11,718.11
|
| Rate for Payer: United Healthcare All Payer |
$10,741.60
|
|
|
PLATE DIST LAT FEM 12 HOLE L
|
Facility
|
IP
|
$9,739.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.12 |
| Max. Negotiated Rate |
$9,349.80 |
| Rate for Payer: Aetna Commercial |
$7,499.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.72
|
| Rate for Payer: Cash Price |
$4,869.69
|
| Rate for Payer: Cigna Commercial |
$8,083.69
|
| Rate for Payer: First Health Commercial |
$9,252.41
|
| Rate for Payer: Humana Commercial |
$8,278.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,986.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,570.65
|
| Rate for Payer: Ohio Health Group HMO |
$7,304.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,266.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.21
|
| Rate for Payer: PHCS Commercial |
$9,349.80
|
| Rate for Payer: United Healthcare All Payer |
$8,570.65
|
|
|
PLATE DIST LAT FEM 12 HOLE L
|
Facility
|
OP
|
$9,739.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.12 |
| Max. Negotiated Rate |
$9,349.80 |
| Rate for Payer: Aetna Commercial |
$7,499.32
|
| Rate for Payer: Anthem Medicaid |
$3,349.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.72
|
| Rate for Payer: Cash Price |
$4,869.69
|
| Rate for Payer: Cigna Commercial |
$8,083.69
|
| Rate for Payer: First Health Commercial |
$9,252.41
|
| Rate for Payer: Humana Commercial |
$8,278.47
|
| Rate for Payer: Humana KY Medicaid |
$3,349.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,383.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,986.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,570.65
|
| Rate for Payer: Ohio Health Group HMO |
$7,304.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,266.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.21
|
| Rate for Payer: PHCS Commercial |
$9,349.80
|
| Rate for Payer: United Healthcare All Payer |
$8,570.65
|
|
|
PLATE DIST LAT FEM 12 HOLE R
|
Facility
|
IP
|
$9,739.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.12 |
| Max. Negotiated Rate |
$9,349.80 |
| Rate for Payer: Aetna Commercial |
$7,499.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.72
|
| Rate for Payer: Cash Price |
$4,869.69
|
| Rate for Payer: Cigna Commercial |
$8,083.69
|
| Rate for Payer: First Health Commercial |
$9,252.41
|
| Rate for Payer: Humana Commercial |
$8,278.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,986.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,570.65
|
| Rate for Payer: Ohio Health Group HMO |
$7,304.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,266.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.21
|
| Rate for Payer: PHCS Commercial |
$9,349.80
|
| Rate for Payer: United Healthcare All Payer |
$8,570.65
|
|
|
PLATE DIST LAT FEM 12 HOLE R
|
Facility
|
OP
|
$9,739.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.12 |
| Max. Negotiated Rate |
$9,349.80 |
| Rate for Payer: Aetna Commercial |
$7,499.32
|
| Rate for Payer: Anthem Medicaid |
$3,349.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,596.72
|
| Rate for Payer: Cash Price |
$4,869.69
|
| Rate for Payer: Cigna Commercial |
$8,083.69
|
| Rate for Payer: First Health Commercial |
$9,252.41
|
| Rate for Payer: Humana Commercial |
$8,278.47
|
| Rate for Payer: Humana KY Medicaid |
$3,349.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,383.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,986.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,187.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,921.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,416.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,570.65
|
| Rate for Payer: Ohio Health Group HMO |
$7,304.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,947.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,266.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.21
|
| Rate for Payer: PHCS Commercial |
$9,349.80
|
| Rate for Payer: United Healthcare All Payer |
$8,570.65
|
|
|
PLATE DIST LAT FEM 14 HOLE L
|
Facility
|
IP
|
$11,757.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.52 |
| Max. Negotiated Rate |
$11,287.51 |
| Rate for Payer: Aetna Commercial |
$9,053.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,171.10
|
| Rate for Payer: Cash Price |
$5,878.91
|
| Rate for Payer: Cigna Commercial |
$9,758.99
|
| Rate for Payer: First Health Commercial |
$11,169.93
|
| Rate for Payer: Humana Commercial |
$9,994.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,351.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.92
|
| Rate for Payer: PHCS Commercial |
$11,287.51
|
| Rate for Payer: United Healthcare All Payer |
$10,346.88
|
|
|
PLATE DIST LAT FEM 14 HOLE L
|
Facility
|
OP
|
$11,757.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,528.52 |
| Max. Negotiated Rate |
$11,287.51 |
| Rate for Payer: Aetna Commercial |
$9,053.52
|
| Rate for Payer: Anthem Medicaid |
$4,043.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,171.10
|
| Rate for Payer: Cash Price |
$5,878.91
|
| Rate for Payer: Cigna Commercial |
$9,758.99
|
| Rate for Payer: First Health Commercial |
$11,169.93
|
| Rate for Payer: Humana Commercial |
$9,994.15
|
| Rate for Payer: Humana KY Medicaid |
$4,043.51
|
| Rate for Payer: Kentucky WC Medicaid |
$4,084.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,641.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,677.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,527.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,124.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,346.88
|
| Rate for Payer: Ohio Health Group HMO |
$8,818.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,351.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,528.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,644.92
|
| Rate for Payer: PHCS Commercial |
$11,287.51
|
| Rate for Payer: United Healthcare All Payer |
$10,346.88
|
|
|
PLATE DIST LAT FEM 14 HOLE R
|
Facility
|
OP
|
$9,888.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.45 |
| Max. Negotiated Rate |
$9,492.56 |
| Rate for Payer: Aetna Commercial |
$7,613.82
|
| Rate for Payer: Anthem Medicaid |
$3,400.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.70
|
| Rate for Payer: Cash Price |
$4,944.04
|
| Rate for Payer: Cigna Commercial |
$8,207.11
|
| Rate for Payer: First Health Commercial |
$9,393.68
|
| Rate for Payer: Humana Commercial |
$8,404.87
|
| Rate for Payer: Humana KY Medicaid |
$3,400.51
|
| Rate for Payer: Kentucky WC Medicaid |
$3,435.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,108.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,468.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.51
|
| Rate for Payer: Ohio Health Group HMO |
$7,416.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,977.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,285.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,065.30
|
| Rate for Payer: PHCS Commercial |
$9,492.56
|
| Rate for Payer: United Healthcare All Payer |
$8,701.51
|
|
|
PLATE DIST LAT FEM 14 HOLE R
|
Facility
|
IP
|
$9,888.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,285.45 |
| Max. Negotiated Rate |
$9,492.56 |
| Rate for Payer: Aetna Commercial |
$7,613.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,712.70
|
| Rate for Payer: Cash Price |
$4,944.04
|
| Rate for Payer: Cigna Commercial |
$8,207.11
|
| Rate for Payer: First Health Commercial |
$9,393.68
|
| Rate for Payer: Humana Commercial |
$8,404.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,108.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,297.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,966.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,701.51
|
| Rate for Payer: Ohio Health Group HMO |
$7,416.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,977.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,285.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,065.30
|
| Rate for Payer: PHCS Commercial |
$9,492.56
|
| Rate for Payer: United Healthcare All Payer |
$8,701.51
|
|
|
PLATE DIST LAT FEM 16 HOLE L
|
Facility
|
IP
|
$16,965.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.53 |
| Max. Negotiated Rate |
$16,286.98 |
| Rate for Payer: Aetna Commercial |
$13,063.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,233.17
|
| Rate for Payer: Cash Price |
$8,482.80
|
| Rate for Payer: Cigna Commercial |
$14,081.45
|
| Rate for Payer: First Health Commercial |
$16,117.32
|
| Rate for Payer: Humana Commercial |
$14,420.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,911.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,520.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,089.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,929.73
|
| Rate for Payer: Ohio Health Group HMO |
$12,724.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,205.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,259.34
|
| Rate for Payer: PHCS Commercial |
$16,286.98
|
| Rate for Payer: United Healthcare All Payer |
$14,929.73
|
|
|
PLATE DIST LAT FEM 16 HOLE L
|
Facility
|
OP
|
$16,965.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,205.53 |
| Max. Negotiated Rate |
$16,286.98 |
| Rate for Payer: Aetna Commercial |
$13,063.51
|
| Rate for Payer: Anthem Medicaid |
$5,834.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,233.17
|
| Rate for Payer: Cash Price |
$8,482.80
|
| Rate for Payer: Cigna Commercial |
$14,081.45
|
| Rate for Payer: First Health Commercial |
$16,117.32
|
| Rate for Payer: Humana Commercial |
$14,420.76
|
| Rate for Payer: Humana KY Medicaid |
$5,834.47
|
| Rate for Payer: Kentucky WC Medicaid |
$5,893.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,911.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,520.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,089.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,951.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,929.73
|
| Rate for Payer: Ohio Health Group HMO |
$12,724.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,393.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,205.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,259.34
|
| Rate for Payer: PHCS Commercial |
$16,286.98
|
| Rate for Payer: United Healthcare All Payer |
$14,929.73
|
|
|
PLATE DIST LAT FEM 16 HOLE R
|
Facility
|
OP
|
$18,322.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,381.96 |
| Max. Negotiated Rate |
$17,589.89 |
| Rate for Payer: Aetna Commercial |
$14,108.56
|
| Rate for Payer: Anthem Medicaid |
$6,301.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,291.78
|
| Rate for Payer: Cash Price |
$9,161.40
|
| Rate for Payer: Cigna Commercial |
$15,207.92
|
| Rate for Payer: First Health Commercial |
$17,406.66
|
| Rate for Payer: Humana Commercial |
$15,574.38
|
| Rate for Payer: Humana KY Medicaid |
$6,301.21
|
| Rate for Payer: Kentucky WC Medicaid |
$6,365.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,024.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,522.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,496.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,427.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,124.06
|
| Rate for Payer: Ohio Health Group HMO |
$13,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,664.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,381.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,680.07
|
| Rate for Payer: PHCS Commercial |
$17,589.89
|
| Rate for Payer: United Healthcare All Payer |
$16,124.06
|
|
|
PLATE DIST LAT FEM 16 HOLE R
|
Facility
|
IP
|
$18,322.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,381.96 |
| Max. Negotiated Rate |
$17,589.89 |
| Rate for Payer: Aetna Commercial |
$14,108.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,291.78
|
| Rate for Payer: Cash Price |
$9,161.40
|
| Rate for Payer: Cigna Commercial |
$15,207.92
|
| Rate for Payer: First Health Commercial |
$17,406.66
|
| Rate for Payer: Humana Commercial |
$15,574.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,024.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,522.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,496.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,124.06
|
| Rate for Payer: Ohio Health Group HMO |
$13,742.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,664.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,381.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,680.07
|
| Rate for Payer: PHCS Commercial |
$17,589.89
|
| Rate for Payer: United Healthcare All Payer |
$16,124.06
|
|
|
PLATE DIST LAT FEM 4 HOLE L
|
Facility
|
OP
|
$11,625.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.36 |
| Max. Negotiated Rate |
$11,160.84 |
| Rate for Payer: Aetna Commercial |
$8,951.92
|
| Rate for Payer: Anthem Medicaid |
$3,998.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,068.18
|
| Rate for Payer: Cash Price |
$5,812.93
|
| Rate for Payer: Cigna Commercial |
$9,649.47
|
| Rate for Payer: First Health Commercial |
$11,044.58
|
| Rate for Payer: Humana Commercial |
$9,881.99
|
| Rate for Payer: Humana KY Medicaid |
$3,998.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,038.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,533.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,579.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,487.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,078.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,230.77
|
| Rate for Payer: Ohio Health Group HMO |
$8,719.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,325.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,604.02
|
| Rate for Payer: PHCS Commercial |
$11,160.84
|
| Rate for Payer: United Healthcare All Payer |
$10,230.77
|
|
|
PLATE DIST LAT FEM 4 HOLE L
|
Facility
|
IP
|
$11,625.87
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,511.36 |
| Max. Negotiated Rate |
$11,160.84 |
| Rate for Payer: Aetna Commercial |
$8,951.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,068.18
|
| Rate for Payer: Cash Price |
$5,812.93
|
| Rate for Payer: Cigna Commercial |
$9,649.47
|
| Rate for Payer: First Health Commercial |
$11,044.58
|
| Rate for Payer: Humana Commercial |
$9,881.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,533.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,579.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,487.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,230.77
|
| Rate for Payer: Ohio Health Group HMO |
$8,719.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,325.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,511.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,604.02
|
| Rate for Payer: PHCS Commercial |
$11,160.84
|
| Rate for Payer: United Healthcare All Payer |
$10,230.77
|
|
|
PLATE DIST LAT FEM 4 HOLE R
|
Facility
|
OP
|
$10,739.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.09 |
| Max. Negotiated Rate |
$10,309.57 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,376.53
|
| Rate for Payer: Cash Price |
$5,369.57
|
| Rate for Payer: Cigna Commercial |
$8,913.49
|
| Rate for Payer: First Health Commercial |
$10,202.18
|
| Rate for Payer: Humana Commercial |
$9,128.27
|
| Rate for Payer: Humana KY Medicaid |
$3,693.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,730.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.09
|
| Rate for Payer: Aetna Commercial |
$8,269.14
|
| Rate for Payer: Anthem Medicaid |
$3,693.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,221.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,767.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,450.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,054.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.13
|
| Rate for Payer: PHCS Commercial |
$10,309.57
|
| Rate for Payer: United Healthcare All Payer |
$9,450.44
|
|
|
PLATE DIST LAT FEM 4 HOLE R
|
Facility
|
IP
|
$10,739.14
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,396.09 |
| Max. Negotiated Rate |
$10,309.57 |
| Rate for Payer: Aetna Commercial |
$8,269.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,376.53
|
| Rate for Payer: Cash Price |
$5,369.57
|
| Rate for Payer: Cigna Commercial |
$8,913.49
|
| Rate for Payer: First Health Commercial |
$10,202.18
|
| Rate for Payer: Humana Commercial |
$9,128.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,806.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,925.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,221.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,450.44
|
| Rate for Payer: Ohio Health Group HMO |
$8,054.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,147.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,396.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,329.13
|
| Rate for Payer: PHCS Commercial |
$10,309.57
|
| Rate for Payer: United Healthcare All Payer |
$9,450.44
|
|
|
PLATE DIST LAT FEM 6 HOLE L
|
Facility
|
IP
|
$11,820.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.62 |
| Max. Negotiated Rate |
$11,347.35 |
| Rate for Payer: Aetna Commercial |
$9,101.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.72
|
| Rate for Payer: Cash Price |
$5,910.08
|
| Rate for Payer: Cigna Commercial |
$9,810.73
|
| Rate for Payer: First Health Commercial |
$11,229.15
|
| Rate for Payer: Humana Commercial |
$10,047.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,723.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,546.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.74
|
| Rate for Payer: Ohio Health Group HMO |
$8,865.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,364.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.25
|
| Rate for Payer: PHCS Commercial |
$11,347.35
|
| Rate for Payer: United Healthcare All Payer |
$10,401.74
|
|
|
PLATE DIST LAT FEM 6 HOLE L
|
Facility
|
OP
|
$11,820.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,536.62 |
| Max. Negotiated Rate |
$11,347.35 |
| Rate for Payer: Aetna Commercial |
$9,101.52
|
| Rate for Payer: Anthem Medicaid |
$4,064.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,219.72
|
| Rate for Payer: Cash Price |
$5,910.08
|
| Rate for Payer: Cigna Commercial |
$9,810.73
|
| Rate for Payer: First Health Commercial |
$11,229.15
|
| Rate for Payer: Humana Commercial |
$10,047.14
|
| Rate for Payer: Humana KY Medicaid |
$4,064.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,106.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,692.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,723.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,546.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,146.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,401.74
|
| Rate for Payer: Ohio Health Group HMO |
$8,865.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,364.03
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,536.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,664.25
|
| Rate for Payer: PHCS Commercial |
$11,347.35
|
| Rate for Payer: United Healthcare All Payer |
$10,401.74
|
|
