|
PLATE DIST LAT FEM 6 HOLE R
|
Facility
|
IP
|
$10,912.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,418.65 |
| Max. Negotiated Rate |
$10,476.22 |
| Rate for Payer: Aetna Commercial |
$8,402.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.93
|
| Rate for Payer: Cash Price |
$5,456.37
|
| Rate for Payer: Cigna Commercial |
$9,057.57
|
| Rate for Payer: First Health Commercial |
$10,367.09
|
| Rate for Payer: Humana Commercial |
$9,275.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,948.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,184.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,182.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,418.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,382.95
|
| Rate for Payer: PHCS Commercial |
$10,476.22
|
| Rate for Payer: United Healthcare All Payer |
$9,603.20
|
|
|
PLATE DIST LAT FEM 6 HOLE R
|
Facility
|
OP
|
$10,912.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,418.65 |
| Max. Negotiated Rate |
$10,476.22 |
| Rate for Payer: United Healthcare All Payer |
$9,603.20
|
| Rate for Payer: Aetna Commercial |
$8,402.80
|
| Rate for Payer: Anthem Medicaid |
$3,752.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,511.93
|
| Rate for Payer: Cash Price |
$5,456.37
|
| Rate for Payer: Cigna Commercial |
$9,057.57
|
| Rate for Payer: First Health Commercial |
$10,367.09
|
| Rate for Payer: Humana Commercial |
$9,275.82
|
| Rate for Payer: Humana KY Medicaid |
$3,752.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,791.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,948.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,053.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,273.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,828.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$8,184.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,182.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,418.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,382.95
|
| Rate for Payer: PHCS Commercial |
$10,476.22
|
|
|
PLATE DIST LAT FEM 8 HOLE L
|
Facility
|
IP
|
$12,012.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.57 |
| Max. Negotiated Rate |
$11,531.60 |
| Rate for Payer: Aetna Commercial |
$9,249.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,369.42
|
| Rate for Payer: Cash Price |
$6,006.04
|
| Rate for Payer: Cigna Commercial |
$9,970.03
|
| Rate for Payer: First Health Commercial |
$11,411.48
|
| Rate for Payer: Humana Commercial |
$10,210.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,849.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,864.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,603.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,570.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,009.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,402.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,561.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,723.74
|
| Rate for Payer: PHCS Commercial |
$11,531.60
|
| Rate for Payer: United Healthcare All Payer |
$10,570.63
|
|
|
PLATE DIST LAT FEM 8 HOLE L
|
Facility
|
OP
|
$12,012.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.57 |
| Max. Negotiated Rate |
$11,531.60 |
| Rate for Payer: Aetna Commercial |
$9,249.30
|
| Rate for Payer: Anthem Medicaid |
$4,130.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,369.42
|
| Rate for Payer: Cash Price |
$6,006.04
|
| Rate for Payer: Cigna Commercial |
$9,970.03
|
| Rate for Payer: First Health Commercial |
$11,411.48
|
| Rate for Payer: Humana Commercial |
$10,210.27
|
| Rate for Payer: Humana KY Medicaid |
$4,130.95
|
| Rate for Payer: Kentucky WC Medicaid |
$4,173.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,849.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,864.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,603.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,213.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,570.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,009.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,402.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,561.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,723.74
|
| Rate for Payer: PHCS Commercial |
$11,531.60
|
| Rate for Payer: United Healthcare All Payer |
$10,570.63
|
|
|
PLATE DIST LAT FEM 8 HOLE R
|
Facility
|
IP
|
$9,445.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.92 |
| Max. Negotiated Rate |
$9,067.70 |
| Rate for Payer: Aetna Commercial |
$7,273.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.51
|
| Rate for Payer: Cash Price |
$4,722.76
|
| Rate for Payer: Cigna Commercial |
$7,839.78
|
| Rate for Payer: First Health Commercial |
$8,973.24
|
| Rate for Payer: Humana Commercial |
$8,028.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,970.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.11
|
| Rate for Payer: PHCS Commercial |
$9,067.70
|
| Rate for Payer: United Healthcare All Payer |
$8,312.06
|
|
|
PLATE DIST LAT FEM 8 HOLE R
|
Facility
|
OP
|
$9,445.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,227.92 |
| Max. Negotiated Rate |
$9,067.70 |
| Rate for Payer: Aetna Commercial |
$7,273.05
|
| Rate for Payer: Anthem Medicaid |
$3,248.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,367.51
|
| Rate for Payer: Cash Price |
$4,722.76
|
| Rate for Payer: Cigna Commercial |
$7,839.78
|
| Rate for Payer: First Health Commercial |
$8,973.24
|
| Rate for Payer: Humana Commercial |
$8,028.69
|
| Rate for Payer: Humana KY Medicaid |
$3,248.31
|
| Rate for Payer: Kentucky WC Medicaid |
$3,281.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,745.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,970.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,833.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,313.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,312.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,084.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,889.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,227.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,928.11
|
| Rate for Payer: PHCS Commercial |
$9,067.70
|
| Rate for Payer: United Healthcare All Payer |
$8,312.06
|
|
|
PLATE DISTL FEM LAT L 12H 281M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE DISTL FEM LAT L 12H 281M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE DISTL FEM LAT L 15H 333M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE DISTL FEM LAT L 15H 333M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE DISTL FEM LAT L 18H 386M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE DISTL FEM LAT L 18H 386M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE DISTL FEM LAT R 12H 281M
|
Facility
|
IP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DISTL FEM LAT R 12H 281M
|
Facility
|
OP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Anthem Medicaid |
$2,826.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Humana KY Medicaid |
$2,826.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DISTL FEM LAT R 15H 333M
|
Facility
|
IP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DISTL FEM LAT R 15H 333M
|
Facility
|
OP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Anthem Medicaid |
$2,826.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Humana KY Medicaid |
$2,826.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DISTL FEM LAT R 18H 386M
|
Facility
|
IP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DISTL FEM LAT R 18H 386M
|
Facility
|
OP
|
$8,220.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,068.63 |
| Max. Negotiated Rate |
$7,891.44 |
| Rate for Payer: Anthem Medicaid |
$2,826.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,411.80
|
| Rate for Payer: Cash Price |
$4,110.12
|
| Rate for Payer: Cigna Commercial |
$6,822.81
|
| Rate for Payer: First Health Commercial |
$7,809.24
|
| Rate for Payer: Humana Commercial |
$6,987.21
|
| Rate for Payer: Humana KY Medicaid |
$2,826.94
|
| Rate for Payer: Kentucky WC Medicaid |
$2,855.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,740.60
|
| Rate for Payer: Aetna Commercial |
$6,329.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,066.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,466.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,883.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,233.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,165.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,068.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,548.28
|
| Rate for Payer: PHCS Commercial |
$7,891.44
|
| Rate for Payer: United Healthcare All Payer |
$7,233.82
|
|
|
PLATE DIST MED TIB 10H L
|
Facility
|
IP
|
$9,967.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.74 |
| Max. Negotiated Rate |
$9,568.56 |
| Rate for Payer: Aetna Commercial |
$7,674.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,774.46
|
| Rate for Payer: Cash Price |
$4,983.62
|
| Rate for Payer: Cigna Commercial |
$8,272.82
|
| Rate for Payer: First Health Commercial |
$9,468.89
|
| Rate for Payer: Humana Commercial |
$8,472.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,173.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,355.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,990.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,771.18
|
| Rate for Payer: Ohio Health Group HMO |
$7,475.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,993.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,295.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,089.85
|
| Rate for Payer: PHCS Commercial |
$9,568.56
|
| Rate for Payer: United Healthcare All Payer |
$8,771.18
|
|
|
PLATE DIST MED TIB 10H L
|
Facility
|
OP
|
$9,967.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,295.74 |
| Max. Negotiated Rate |
$9,568.56 |
| Rate for Payer: Aetna Commercial |
$7,674.78
|
| Rate for Payer: Anthem Medicaid |
$3,427.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,774.46
|
| Rate for Payer: Cash Price |
$4,983.62
|
| Rate for Payer: Cigna Commercial |
$8,272.82
|
| Rate for Payer: First Health Commercial |
$9,468.89
|
| Rate for Payer: Humana Commercial |
$8,472.16
|
| Rate for Payer: Humana KY Medicaid |
$3,427.74
|
| Rate for Payer: Kentucky WC Medicaid |
$3,462.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,173.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,355.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,990.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,496.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,771.18
|
| Rate for Payer: Ohio Health Group HMO |
$7,475.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,993.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,295.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,089.85
|
| Rate for Payer: PHCS Commercial |
$9,568.56
|
| Rate for Payer: United Healthcare All Payer |
$8,771.18
|
|
|
PLATE DIST MED TIB 10H R
|
Facility
|
IP
|
$9,203.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.51 |
| Max. Negotiated Rate |
$8,835.76 |
| Rate for Payer: Aetna Commercial |
$7,087.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.06
|
| Rate for Payer: Cash Price |
$4,601.96
|
| Rate for Payer: Cigna Commercial |
$7,639.25
|
| Rate for Payer: First Health Commercial |
$8,743.72
|
| Rate for Payer: Humana Commercial |
$7,823.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,853.22
|
| Rate for Payer: PHCS Commercial |
$8,835.76
|
| Rate for Payer: United Healthcare All Payer |
$8,099.45
|
|
|
PLATE DIST MED TIB 10H R
|
Facility
|
OP
|
$9,203.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,196.51 |
| Max. Negotiated Rate |
$8,835.76 |
| Rate for Payer: Aetna Commercial |
$7,087.02
|
| Rate for Payer: Anthem Medicaid |
$3,165.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,179.06
|
| Rate for Payer: Cash Price |
$4,601.96
|
| Rate for Payer: Cigna Commercial |
$7,639.25
|
| Rate for Payer: First Health Commercial |
$8,743.72
|
| Rate for Payer: Humana Commercial |
$7,823.33
|
| Rate for Payer: Humana KY Medicaid |
$3,165.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,197.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,547.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,792.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,761.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,228.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,099.45
|
| Rate for Payer: Ohio Health Group HMO |
$6,902.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,840.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,196.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,853.22
|
| Rate for Payer: PHCS Commercial |
$8,835.76
|
| Rate for Payer: United Healthcare All Payer |
$8,099.45
|
|
|
PLATE DIST MED TIB 12H
|
Facility
|
OP
|
$8,415.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.98 |
| Max. Negotiated Rate |
$8,078.62 |
| Rate for Payer: Aetna Commercial |
$6,479.73
|
| Rate for Payer: Anthem Medicaid |
$2,894.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.88
|
| Rate for Payer: Cash Price |
$4,207.62
|
| Rate for Payer: Cigna Commercial |
$6,984.64
|
| Rate for Payer: First Health Commercial |
$7,994.47
|
| Rate for Payer: Humana Commercial |
$7,152.95
|
| Rate for Payer: Humana KY Medicaid |
$2,894.00
|
| Rate for Payer: Kentucky WC Medicaid |
$2,923.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,952.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.72
|
| Rate for Payer: PHCS Commercial |
$8,078.62
|
| Rate for Payer: United Healthcare All Payer |
$7,405.40
|
|
|
PLATE DIST MED TIB 12H
|
Facility
|
IP
|
$8,415.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,093.98 |
| Max. Negotiated Rate |
$8,078.62 |
| Rate for Payer: Aetna Commercial |
$6,479.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,563.88
|
| Rate for Payer: Cash Price |
$4,207.62
|
| Rate for Payer: Cigna Commercial |
$6,984.64
|
| Rate for Payer: First Health Commercial |
$7,994.47
|
| Rate for Payer: Humana Commercial |
$7,152.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,900.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,210.44
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,524.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,405.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,311.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,683.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,093.98
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,608.72
|
| Rate for Payer: PHCS Commercial |
$8,078.62
|
| Rate for Payer: United Healthcare All Payer |
$7,405.40
|
|
|
PLATE DIST MED TIB 14H R
|
Facility
|
OP
|
$10,855.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,411.26 |
| Max. Negotiated Rate |
$10,421.60 |
| Rate for Payer: Aetna Commercial |
$8,358.99
|
| Rate for Payer: Anthem Medicaid |
$3,733.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,467.55
|
| Rate for Payer: Cash Price |
$5,427.91
|
| Rate for Payer: Cigna Commercial |
$9,010.34
|
| Rate for Payer: First Health Commercial |
$10,313.04
|
| Rate for Payer: Humana Commercial |
$9,227.46
|
| Rate for Payer: Humana KY Medicaid |
$3,733.32
|
| Rate for Payer: Kentucky WC Medicaid |
$3,771.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,901.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,011.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,256.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,808.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,553.13
|
| Rate for Payer: Ohio Health Group HMO |
$8,141.87
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,171.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,411.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,365.31
|
| Rate for Payer: PHCS Commercial |
$10,421.60
|
| Rate for Payer: United Healthcare All Payer |
$9,553.13
|
|
