|
PLATE DVRANSL NAR SHORT L
|
Facility
|
IP
|
$6,935.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.61 |
| Max. Negotiated Rate |
$6,658.03 |
| Rate for Payer: Aetna Commercial |
$5,340.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.65
|
| Rate for Payer: Cash Price |
$3,467.72
|
| Rate for Payer: Cigna Commercial |
$5,756.42
|
| Rate for Payer: First Health Commercial |
$6,588.68
|
| Rate for Payer: Humana Commercial |
$5,895.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,687.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,118.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,080.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.99
|
| Rate for Payer: PHCS Commercial |
$6,658.03
|
| Rate for Payer: United Healthcare All Payer |
$6,103.20
|
|
|
PLATE DVRANSL NAR SHORT L
|
Facility
|
OP
|
$6,935.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.61 |
| Max. Negotiated Rate |
$6,658.03 |
| Rate for Payer: Aetna Commercial |
$5,340.30
|
| Rate for Payer: Anthem Medicaid |
$2,385.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.65
|
| Rate for Payer: Cash Price |
$3,467.72
|
| Rate for Payer: Cigna Commercial |
$5,756.42
|
| Rate for Payer: First Health Commercial |
$6,588.68
|
| Rate for Payer: Humana Commercial |
$5,895.13
|
| Rate for Payer: Humana KY Medicaid |
$2,385.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,687.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,118.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,080.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,432.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.99
|
| Rate for Payer: PHCS Commercial |
$6,658.03
|
| Rate for Payer: United Healthcare All Payer |
$6,103.20
|
|
|
PLATE DVRANSL NAR SHORT R
|
Facility
|
IP
|
$7,143.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.66 |
| Max. Negotiated Rate |
$6,857.76 |
| Rate for Payer: Aetna Commercial |
$5,500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,571.93
|
| Rate for Payer: Cash Price |
$3,571.75
|
| Rate for Payer: Cigna Commercial |
$5,929.10
|
| Rate for Payer: First Health Commercial |
$6,786.32
|
| Rate for Payer: Humana Commercial |
$6,071.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,857.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,271.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,143.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,286.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,357.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$928.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.48
|
| Rate for Payer: PHCS Commercial |
$6,857.76
|
| Rate for Payer: United Healthcare All Payer |
$6,286.28
|
|
|
PLATE DVRANSL NAR SHORT R
|
Facility
|
OP
|
$7,143.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.66 |
| Max. Negotiated Rate |
$6,857.76 |
| Rate for Payer: Aetna Commercial |
$5,500.50
|
| Rate for Payer: Anthem Medicaid |
$2,456.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,571.93
|
| Rate for Payer: Cash Price |
$3,571.75
|
| Rate for Payer: Cigna Commercial |
$5,929.10
|
| Rate for Payer: First Health Commercial |
$6,786.32
|
| Rate for Payer: Humana Commercial |
$6,071.98
|
| Rate for Payer: Humana KY Medicaid |
$2,456.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,481.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,857.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,271.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,143.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,505.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,286.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,357.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$928.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.48
|
| Rate for Payer: PHCS Commercial |
$6,857.76
|
| Rate for Payer: United Healthcare All Payer |
$6,286.28
|
|
|
PLATE DVRAS SHORT LEFT
|
Facility
|
IP
|
$7,143.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.66 |
| Max. Negotiated Rate |
$6,857.76 |
| Rate for Payer: Aetna Commercial |
$5,500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,571.93
|
| Rate for Payer: Cash Price |
$3,571.75
|
| Rate for Payer: Cigna Commercial |
$5,929.10
|
| Rate for Payer: First Health Commercial |
$6,786.32
|
| Rate for Payer: Humana Commercial |
$6,071.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,857.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,271.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,143.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,286.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,357.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$928.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.48
|
| Rate for Payer: PHCS Commercial |
$6,857.76
|
| Rate for Payer: United Healthcare All Payer |
$6,286.28
|
|
|
PLATE DVRAS SHORT LEFT
|
Facility
|
OP
|
$7,143.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.66 |
| Max. Negotiated Rate |
$6,857.76 |
| Rate for Payer: Aetna Commercial |
$5,500.50
|
| Rate for Payer: Anthem Medicaid |
$2,456.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,571.93
|
| Rate for Payer: Cash Price |
$3,571.75
|
| Rate for Payer: Cigna Commercial |
$5,929.10
|
| Rate for Payer: First Health Commercial |
$6,786.32
|
| Rate for Payer: Humana Commercial |
$6,071.98
|
| Rate for Payer: Humana KY Medicaid |
$2,456.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,481.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,857.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,271.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,143.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,505.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,286.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,357.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$928.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.48
|
| Rate for Payer: PHCS Commercial |
$6,857.76
|
| Rate for Payer: United Healthcare All Payer |
$6,286.28
|
|
|
PLATE DVRAS SHORT RIGHT
|
Facility
|
IP
|
$7,143.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.66 |
| Max. Negotiated Rate |
$6,857.76 |
| Rate for Payer: Aetna Commercial |
$5,500.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,571.93
|
| Rate for Payer: Cash Price |
$3,571.75
|
| Rate for Payer: Cigna Commercial |
$5,929.10
|
| Rate for Payer: First Health Commercial |
$6,786.32
|
| Rate for Payer: Humana Commercial |
$6,071.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,857.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,271.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,143.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,286.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,357.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$928.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.48
|
| Rate for Payer: PHCS Commercial |
$6,857.76
|
| Rate for Payer: United Healthcare All Payer |
$6,286.28
|
|
|
PLATE DVRAS SHORT RIGHT
|
Facility
|
OP
|
$7,143.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$928.66 |
| Max. Negotiated Rate |
$6,857.76 |
| Rate for Payer: Anthem Medicaid |
$2,456.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,571.93
|
| Rate for Payer: Cash Price |
$3,571.75
|
| Rate for Payer: Cigna Commercial |
$5,929.10
|
| Rate for Payer: First Health Commercial |
$6,786.32
|
| Rate for Payer: Humana Commercial |
$6,071.98
|
| Rate for Payer: Humana KY Medicaid |
$2,456.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,481.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,857.67
|
| Rate for Payer: Aetna Commercial |
$5,500.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,271.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,143.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,505.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,286.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,357.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,428.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$928.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,214.48
|
| Rate for Payer: PHCS Commercial |
$6,857.76
|
| Rate for Payer: United Healthcare All Payer |
$6,286.28
|
|
|
PLATE DVRAW WIDE LEFT
|
Facility
|
OP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem Medicaid |
$2,317.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Humana KY Medicaid |
$2,317.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE DVRAW WIDE LEFT
|
Facility
|
IP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE DVRAW WIDE RIGHT
|
Facility
|
OP
|
$6,658.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.55 |
| Max. Negotiated Rate |
$6,391.73 |
| Rate for Payer: Aetna Commercial |
$5,126.70
|
| Rate for Payer: Anthem Medicaid |
$2,289.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,193.28
|
| Rate for Payer: Cash Price |
$3,329.02
|
| Rate for Payer: Cigna Commercial |
$5,526.18
|
| Rate for Payer: First Health Commercial |
$6,325.15
|
| Rate for Payer: Humana Commercial |
$5,659.34
|
| Rate for Payer: Humana KY Medicaid |
$2,289.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,313.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,459.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,335.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,993.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.00
|
| Rate for Payer: PHCS Commercial |
$6,391.73
|
| Rate for Payer: United Healthcare All Payer |
$5,859.08
|
|
|
PLATE DVRAW WIDE RIGHT
|
Facility
|
IP
|
$6,658.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.55 |
| Max. Negotiated Rate |
$6,391.73 |
| Rate for Payer: Aetna Commercial |
$5,126.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,193.28
|
| Rate for Payer: Cash Price |
$3,329.02
|
| Rate for Payer: Cigna Commercial |
$5,526.18
|
| Rate for Payer: First Health Commercial |
$6,325.15
|
| Rate for Payer: Humana Commercial |
$5,659.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,459.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,993.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.00
|
| Rate for Payer: PHCS Commercial |
$6,391.73
|
| Rate for Payer: United Healthcare All Payer |
$5,859.08
|
|
|
PLATE DVRAX EXTENDED LEFT
|
Facility
|
OP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem Medicaid |
$2,317.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Humana KY Medicaid |
$2,317.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,340.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE DVRAX EXTENDED LEFT
|
Facility
|
IP
|
$6,738.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$875.99 |
| Max. Negotiated Rate |
$6,468.82 |
| Rate for Payer: Aetna Commercial |
$5,188.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,255.91
|
| Rate for Payer: Cash Price |
$3,369.18
|
| Rate for Payer: Cigna Commercial |
$5,592.83
|
| Rate for Payer: First Health Commercial |
$6,401.43
|
| Rate for Payer: Humana Commercial |
$5,727.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,525.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,972.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,021.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,929.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,053.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,347.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$875.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,088.89
|
| Rate for Payer: PHCS Commercial |
$6,468.82
|
| Rate for Payer: United Healthcare All Payer |
$5,929.75
|
|
|
PLATE DVRAX EXTENDED RIGHT
|
Facility
|
IP
|
$5,318.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$5,105.76 |
| Rate for Payer: Aetna Commercial |
$4,095.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.43
|
| Rate for Payer: Cash Price |
$2,659.25
|
| Rate for Payer: Cigna Commercial |
$4,414.36
|
| Rate for Payer: First Health Commercial |
$5,052.58
|
| Rate for Payer: Humana Commercial |
$4,520.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,988.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.74
|
| Rate for Payer: PHCS Commercial |
$5,105.76
|
| Rate for Payer: United Healthcare All Payer |
$4,680.28
|
|
|
PLATE DVRAX EXTENDED RIGHT
|
Facility
|
OP
|
$5,318.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$691.40 |
| Max. Negotiated Rate |
$5,105.76 |
| Rate for Payer: Aetna Commercial |
$4,095.24
|
| Rate for Payer: Anthem Medicaid |
$1,829.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,148.43
|
| Rate for Payer: Cash Price |
$2,659.25
|
| Rate for Payer: Cigna Commercial |
$4,414.36
|
| Rate for Payer: First Health Commercial |
$5,052.58
|
| Rate for Payer: Humana Commercial |
$4,520.72
|
| Rate for Payer: Humana KY Medicaid |
$1,829.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,847.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,361.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,925.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,595.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,865.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,680.28
|
| Rate for Payer: Ohio Health Group HMO |
$3,988.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,063.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$691.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,648.74
|
| Rate for Payer: PHCS Commercial |
$5,105.76
|
| Rate for Payer: United Healthcare All Payer |
$4,680.28
|
|
|
PLATE DVRAXXL EX EXT LEFT
|
Facility
|
IP
|
$6,658.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.55 |
| Max. Negotiated Rate |
$6,391.73 |
| Rate for Payer: Aetna Commercial |
$5,126.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,193.28
|
| Rate for Payer: Cash Price |
$3,329.02
|
| Rate for Payer: Cigna Commercial |
$5,526.18
|
| Rate for Payer: First Health Commercial |
$6,325.15
|
| Rate for Payer: Humana Commercial |
$5,659.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,459.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,993.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.00
|
| Rate for Payer: PHCS Commercial |
$6,391.73
|
| Rate for Payer: United Healthcare All Payer |
$5,859.08
|
|
|
PLATE DVRAXXL EX EXT LEFT
|
Facility
|
OP
|
$6,658.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.55 |
| Max. Negotiated Rate |
$6,391.73 |
| Rate for Payer: Anthem Medicaid |
$2,289.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,193.28
|
| Rate for Payer: Cash Price |
$3,329.02
|
| Rate for Payer: Cigna Commercial |
$5,526.18
|
| Rate for Payer: First Health Commercial |
$6,325.15
|
| Rate for Payer: Humana Commercial |
$5,659.34
|
| Rate for Payer: Humana KY Medicaid |
$2,289.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,313.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,459.60
|
| Rate for Payer: Aetna Commercial |
$5,126.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,335.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,993.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.00
|
| Rate for Payer: PHCS Commercial |
$6,391.73
|
| Rate for Payer: United Healthcare All Payer |
$5,859.08
|
|
|
PLATE DVRAXXR EX EXT RIGHT
|
Facility
|
IP
|
$6,658.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.55 |
| Max. Negotiated Rate |
$6,391.73 |
| Rate for Payer: Aetna Commercial |
$5,126.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,193.28
|
| Rate for Payer: Cash Price |
$3,329.02
|
| Rate for Payer: Cigna Commercial |
$5,526.18
|
| Rate for Payer: First Health Commercial |
$6,325.15
|
| Rate for Payer: Humana Commercial |
$5,659.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,459.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,993.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.00
|
| Rate for Payer: PHCS Commercial |
$6,391.73
|
| Rate for Payer: United Healthcare All Payer |
$5,859.08
|
|
|
PLATE DVRAXXR EX EXT RIGHT
|
Facility
|
OP
|
$6,658.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.55 |
| Max. Negotiated Rate |
$6,391.73 |
| Rate for Payer: Aetna Commercial |
$5,126.70
|
| Rate for Payer: Anthem Medicaid |
$2,289.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,193.28
|
| Rate for Payer: Cash Price |
$3,329.02
|
| Rate for Payer: Cigna Commercial |
$5,526.18
|
| Rate for Payer: First Health Commercial |
$6,325.15
|
| Rate for Payer: Humana Commercial |
$5,659.34
|
| Rate for Payer: Humana KY Medicaid |
$2,289.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,313.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,459.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,913.64
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,335.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,859.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,993.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.00
|
| Rate for Payer: PHCS Commercial |
$6,391.73
|
| Rate for Payer: United Healthcare All Payer |
$5,859.08
|
|
|
PLATE DVSR STD LEFT
|
Facility
|
IP
|
$6,935.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.61 |
| Max. Negotiated Rate |
$6,658.03 |
| Rate for Payer: Aetna Commercial |
$5,340.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.65
|
| Rate for Payer: Cash Price |
$3,467.72
|
| Rate for Payer: Cigna Commercial |
$5,756.42
|
| Rate for Payer: First Health Commercial |
$6,588.68
|
| Rate for Payer: Humana Commercial |
$5,895.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,687.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,118.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,080.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.99
|
| Rate for Payer: PHCS Commercial |
$6,658.03
|
| Rate for Payer: United Healthcare All Payer |
$6,103.20
|
|
|
PLATE DVSR STD LEFT
|
Facility
|
OP
|
$6,935.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.61 |
| Max. Negotiated Rate |
$6,658.03 |
| Rate for Payer: Aetna Commercial |
$5,340.30
|
| Rate for Payer: Anthem Medicaid |
$2,385.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.65
|
| Rate for Payer: Cash Price |
$3,467.72
|
| Rate for Payer: Cigna Commercial |
$5,756.42
|
| Rate for Payer: First Health Commercial |
$6,588.68
|
| Rate for Payer: Humana Commercial |
$5,895.13
|
| Rate for Payer: Humana KY Medicaid |
$2,385.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,687.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,118.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,080.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,432.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.99
|
| Rate for Payer: PHCS Commercial |
$6,658.03
|
| Rate for Payer: United Healthcare All Payer |
$6,103.20
|
|
|
PLATE DVSR STD RIGHT
|
Facility
|
OP
|
$6,935.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.61 |
| Max. Negotiated Rate |
$6,658.03 |
| Rate for Payer: Aetna Commercial |
$5,340.30
|
| Rate for Payer: Anthem Medicaid |
$2,385.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.65
|
| Rate for Payer: Cash Price |
$3,467.72
|
| Rate for Payer: Cigna Commercial |
$5,756.42
|
| Rate for Payer: First Health Commercial |
$6,588.68
|
| Rate for Payer: Humana Commercial |
$5,895.13
|
| Rate for Payer: Humana KY Medicaid |
$2,385.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,409.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,687.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,118.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,080.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,432.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.99
|
| Rate for Payer: PHCS Commercial |
$6,658.03
|
| Rate for Payer: United Healthcare All Payer |
$6,103.20
|
|
|
PLATE DVSR STD RIGHT
|
Facility
|
IP
|
$6,935.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$901.61 |
| Max. Negotiated Rate |
$6,658.03 |
| Rate for Payer: Aetna Commercial |
$5,340.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,409.65
|
| Rate for Payer: Cash Price |
$3,467.72
|
| Rate for Payer: Cigna Commercial |
$5,756.42
|
| Rate for Payer: First Health Commercial |
$6,588.68
|
| Rate for Payer: Humana Commercial |
$5,895.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,687.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,118.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,080.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,103.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,201.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,387.09
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$901.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,149.99
|
| Rate for Payer: PHCS Commercial |
$6,658.03
|
| Rate for Payer: United Healthcare All Payer |
$6,103.20
|
|
|
PLATE ELBOW POSTERIOR
|
Facility
|
OP
|
$4,825.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$627.25 |
| Max. Negotiated Rate |
$4,632.00 |
| Rate for Payer: Aetna Commercial |
$3,715.25
|
| Rate for Payer: Anthem Medicaid |
$1,659.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,763.50
|
| Rate for Payer: Cash Price |
$2,412.50
|
| Rate for Payer: Cigna Commercial |
$4,004.75
|
| Rate for Payer: First Health Commercial |
$4,583.75
|
| Rate for Payer: Humana Commercial |
$4,101.25
|
| Rate for Payer: Humana KY Medicaid |
$1,659.32
|
| Rate for Payer: Kentucky WC Medicaid |
$1,676.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,956.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,560.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,447.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,692.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,246.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,618.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$965.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$627.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,495.75
|
| Rate for Payer: PHCS Commercial |
$4,632.00
|
| Rate for Payer: United Healthcare All Payer |
$4,246.00
|
|
