|
PLATE KEYED 135 DEG 12H
|
Facility
|
OP
|
$3,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.39 |
| Max. Negotiated Rate |
$3,650.88 |
| Rate for Payer: Aetna Commercial |
$2,928.31
|
| Rate for Payer: Anthem Medicaid |
$1,307.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.34
|
| Rate for Payer: Cash Price |
$1,901.50
|
| Rate for Payer: Cigna Commercial |
$3,156.49
|
| Rate for Payer: First Health Commercial |
$3,612.85
|
| Rate for Payer: Humana Commercial |
$3,232.55
|
| Rate for Payer: Humana KY Medicaid |
$1,307.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,321.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,334.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.93
|
| Rate for Payer: PHCS Commercial |
$3,650.88
|
| Rate for Payer: United Healthcare All Payer |
$3,346.64
|
|
|
PLATE KEYED 135 DEG 12H
|
Facility
|
IP
|
$3,803.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.39 |
| Max. Negotiated Rate |
$3,650.88 |
| Rate for Payer: Aetna Commercial |
$2,928.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,966.34
|
| Rate for Payer: Cash Price |
$1,901.50
|
| Rate for Payer: Cigna Commercial |
$3,156.49
|
| Rate for Payer: First Health Commercial |
$3,612.85
|
| Rate for Payer: Humana Commercial |
$3,232.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,118.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,806.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,140.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,346.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,852.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$760.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,178.93
|
| Rate for Payer: PHCS Commercial |
$3,650.88
|
| Rate for Payer: United Healthcare All Payer |
$3,346.64
|
|
|
PLATE L 2.4MM 2H TI 3H RT
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE L 2.4MM 2H TI 3H RT
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE L 2.4MM 2H TI 5H RT
|
Facility
|
OP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Anthem Medicaid |
$1,593.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Humana KY Medicaid |
$1,593.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,609.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,625.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
| Rate for Payer: Aetna Commercial |
$3,567.02
|
|
|
PLATE L 2.4MM 2H TI 5H RT
|
Facility
|
IP
|
$4,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$4,447.20 |
| Rate for Payer: Aetna Commercial |
$3,567.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,613.35
|
| Rate for Payer: Cash Price |
$2,316.25
|
| Rate for Payer: Cigna Commercial |
$3,844.98
|
| Rate for Payer: First Health Commercial |
$4,400.88
|
| Rate for Payer: Humana Commercial |
$3,937.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,798.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,418.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,389.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,076.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,474.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$926.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$602.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,436.08
|
| Rate for Payer: PHCS Commercial |
$4,447.20
|
| Rate for Payer: United Healthcare All Payer |
$4,076.60
|
|
|
PLATE L 2.7MM LT
|
Facility
|
OP
|
$3,869.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.04 |
| Max. Negotiated Rate |
$3,714.72 |
| Rate for Payer: Aetna Commercial |
$2,979.52
|
| Rate for Payer: Anthem Medicaid |
$1,330.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.21
|
| Rate for Payer: Cash Price |
$1,934.75
|
| Rate for Payer: Cigna Commercial |
$3,211.68
|
| Rate for Payer: First Health Commercial |
$3,676.02
|
| Rate for Payer: Humana Commercial |
$3,289.08
|
| Rate for Payer: Humana KY Medicaid |
$1,330.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,357.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.54
|
| Rate for Payer: PHCS Commercial |
$3,714.72
|
| Rate for Payer: United Healthcare All Payer |
$3,405.16
|
|
|
PLATE L 2.7MM LT
|
Facility
|
IP
|
$3,869.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.04 |
| Max. Negotiated Rate |
$3,714.72 |
| Rate for Payer: Aetna Commercial |
$2,979.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.21
|
| Rate for Payer: Cash Price |
$1,934.75
|
| Rate for Payer: Cigna Commercial |
$3,211.68
|
| Rate for Payer: First Health Commercial |
$3,676.02
|
| Rate for Payer: Humana Commercial |
$3,289.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.54
|
| Rate for Payer: PHCS Commercial |
$3,714.72
|
| Rate for Payer: United Healthcare All Payer |
$3,405.16
|
|
|
PLATE L 2.7MM RT
|
Facility
|
IP
|
$3,869.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.04 |
| Max. Negotiated Rate |
$3,714.72 |
| Rate for Payer: Aetna Commercial |
$2,979.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.21
|
| Rate for Payer: Cash Price |
$1,934.75
|
| Rate for Payer: Cigna Commercial |
$3,211.68
|
| Rate for Payer: First Health Commercial |
$3,676.02
|
| Rate for Payer: Humana Commercial |
$3,289.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.54
|
| Rate for Payer: PHCS Commercial |
$3,714.72
|
| Rate for Payer: United Healthcare All Payer |
$3,405.16
|
|
|
PLATE L 2.7MM RT
|
Facility
|
OP
|
$3,869.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$503.04 |
| Max. Negotiated Rate |
$3,714.72 |
| Rate for Payer: Aetna Commercial |
$2,979.52
|
| Rate for Payer: Anthem Medicaid |
$1,330.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,018.21
|
| Rate for Payer: Cash Price |
$1,934.75
|
| Rate for Payer: Cigna Commercial |
$3,211.68
|
| Rate for Payer: First Health Commercial |
$3,676.02
|
| Rate for Payer: Humana Commercial |
$3,289.08
|
| Rate for Payer: Humana KY Medicaid |
$1,330.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,344.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,172.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,855.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,160.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,357.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,405.16
|
| Rate for Payer: Ohio Health Group HMO |
$2,902.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$773.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$503.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,199.54
|
| Rate for Payer: PHCS Commercial |
$3,714.72
|
| Rate for Payer: United Healthcare All Payer |
$3,405.16
|
|
|
PLATE LAPDUS LOW PROF LONG
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
PLATE LAPDUS LOW PROF LONG
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
PLATE LAPDUS LOW PROF TITANIUM
|
Facility
|
OP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem Medicaid |
$1,833.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Humana KY Medicaid |
$1,833.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,852.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,870.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
PLATE LAPDUS LOW PROF TITANIUM
|
Facility
|
IP
|
$5,332.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$693.22 |
| Max. Negotiated Rate |
$5,119.20 |
| Rate for Payer: Aetna Commercial |
$4,106.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,159.35
|
| Rate for Payer: Cash Price |
$2,666.25
|
| Rate for Payer: Cigna Commercial |
$4,425.98
|
| Rate for Payer: First Health Commercial |
$5,065.88
|
| Rate for Payer: Humana Commercial |
$4,532.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,372.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,935.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,599.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,692.60
|
| Rate for Payer: Ohio Health Group HMO |
$3,999.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,066.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$693.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,653.08
|
| Rate for Payer: PHCS Commercial |
$5,119.20
|
| Rate for Payer: United Healthcare All Payer |
$4,692.60
|
|
|
PLATE LAPIDUS LEFT STD 626893
|
Facility
|
OP
|
$16,393.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.12 |
| Max. Negotiated Rate |
$15,737.47 |
| Rate for Payer: Aetna Commercial |
$12,622.76
|
| Rate for Payer: Anthem Medicaid |
$5,637.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,786.70
|
| Rate for Payer: Cash Price |
$8,196.60
|
| Rate for Payer: Cigna Commercial |
$13,606.36
|
| Rate for Payer: First Health Commercial |
$15,573.54
|
| Rate for Payer: Humana Commercial |
$13,934.22
|
| Rate for Payer: Humana KY Medicaid |
$5,637.62
|
| Rate for Payer: Kentucky WC Medicaid |
$5,695.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,442.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,098.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,917.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,750.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,426.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,294.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,081.89
|
| Rate for Payer: PHCS Commercial |
$15,737.47
|
| Rate for Payer: United Healthcare All Payer |
$14,426.02
|
|
|
PLATE LAPIDUS LEFT STD 626893
|
Facility
|
IP
|
$16,393.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.12 |
| Max. Negotiated Rate |
$15,737.47 |
| Rate for Payer: Aetna Commercial |
$12,622.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,786.70
|
| Rate for Payer: Cash Price |
$8,196.60
|
| Rate for Payer: Cigna Commercial |
$13,606.36
|
| Rate for Payer: First Health Commercial |
$15,573.54
|
| Rate for Payer: Humana Commercial |
$13,934.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,442.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,098.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,917.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,426.02
|
| Rate for Payer: Ohio Health Group HMO |
$12,294.90
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,278.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,131.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,081.89
|
| Rate for Payer: PHCS Commercial |
$15,737.47
|
| Rate for Payer: United Healthcare All Payer |
$14,426.02
|
|
|
PLATE LAT DIS HM LK 11H 153M L
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE LAT DIS HM LK 11H 153M L
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE LAT DIS HM LK 11H 153M R
|
Facility
|
OP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem Medicaid |
$2,641.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Humana KY Medicaid |
$2,641.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
|
|
PLATE LAT DIS HM LK 11H 153M R
|
Facility
|
IP
|
$7,682.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$998.67 |
| Max. Negotiated Rate |
$7,374.78 |
| Rate for Payer: Humana Commercial |
$6,529.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,299.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,669.36
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,760.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,761.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,536.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$998.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,381.44
|
| Rate for Payer: PHCS Commercial |
$7,374.78
|
| Rate for Payer: United Healthcare All Payer |
$6,760.21
|
| Rate for Payer: Aetna Commercial |
$5,915.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,992.01
|
| Rate for Payer: Cash Price |
$3,841.03
|
| Rate for Payer: Cigna Commercial |
$6,376.11
|
| Rate for Payer: First Health Commercial |
$7,297.96
|
|
|
PLATE LAT DIS HM LK 7H 102M L
|
Facility
|
OP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem Medicaid |
$2,472.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Humana KY Medicaid |
$2,472.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DIS HM LK 7H 102M L
|
Facility
|
IP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DIS HM LK 7H 102M R
|
Facility
|
OP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem Medicaid |
$2,472.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Humana KY Medicaid |
$2,472.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,497.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,521.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DIS HM LK 7H 102M R
|
Facility
|
IP
|
$7,189.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.59 |
| Max. Negotiated Rate |
$6,901.56 |
| Rate for Payer: Aetna Commercial |
$5,535.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,607.51
|
| Rate for Payer: Cash Price |
$3,594.56
|
| Rate for Payer: Cigna Commercial |
$5,966.97
|
| Rate for Payer: First Health Commercial |
$6,829.66
|
| Rate for Payer: Humana Commercial |
$6,110.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,895.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,305.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,156.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,326.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,391.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,437.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$934.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,228.63
|
| Rate for Payer: PHCS Commercial |
$6,901.56
|
| Rate for Payer: United Healthcare All Payer |
$6,326.43
|
|
|
PLATE LAT DIS HM LK 9H 128M L
|
Facility
|
IP
|
$7,547.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$981.11 |
| Max. Negotiated Rate |
$7,245.13 |
| Rate for Payer: Aetna Commercial |
$5,811.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,886.67
|
| Rate for Payer: Cash Price |
$3,773.50
|
| Rate for Payer: Cigna Commercial |
$6,264.02
|
| Rate for Payer: First Health Commercial |
$7,169.66
|
| Rate for Payer: Humana Commercial |
$6,414.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,188.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,569.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,264.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,641.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,660.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,509.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$981.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,339.57
|
| Rate for Payer: PHCS Commercial |
$7,245.13
|
| Rate for Payer: United Healthcare All Payer |
$6,641.37
|
|
