|
PLATE DIST CLAVICLE 3.5MM 9H L
|
Facility
|
IP
|
$5,502.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,650.75 |
| Max. Negotiated Rate |
$5,282.40 |
| Rate for Payer: Aetna Commercial |
$4,236.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,291.95
|
| Rate for Payer: Cash Price |
$2,751.25
|
| Rate for Payer: Cigna Commercial |
$4,567.07
|
| Rate for Payer: First Health Commercial |
$5,227.38
|
| Rate for Payer: Humana Commercial |
$4,677.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,512.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,060.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,650.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,842.20
|
| Rate for Payer: Ohio Health Group HMO |
$4,126.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,402.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,787.18
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,796.72
|
| Rate for Payer: PHCS Commercial |
$5,282.40
|
| Rate for Payer: United Healthcare All Payer |
$4,842.20
|
|
|
PLATE DIST CLAVICLE 3.5MM 9H R
|
Facility
|
OP
|
$4,793.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.12 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna Commercial |
$3,691.19
|
| Rate for Payer: Anthem Medicaid |
$1,648.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.12
|
| Rate for Payer: Cash Price |
$2,396.88
|
| Rate for Payer: Cigna Commercial |
$3,978.81
|
| Rate for Payer: First Health Commercial |
$4,554.06
|
| Rate for Payer: Humana Commercial |
$4,074.69
|
| Rate for Payer: Humana KY Medicaid |
$1,648.57
|
| Rate for Payer: Kentucky WC Medicaid |
$1,665.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,681.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,835.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.69
|
| Rate for Payer: PHCS Commercial |
$4,602.00
|
| Rate for Payer: United Healthcare All Payer |
$4,218.50
|
|
|
PLATE DIST CLAVICLE 3.5MM 9H R
|
Facility
|
IP
|
$4,793.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,438.12 |
| Max. Negotiated Rate |
$4,602.00 |
| Rate for Payer: Aetna Commercial |
$3,691.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,739.12
|
| Rate for Payer: Cash Price |
$2,396.88
|
| Rate for Payer: Cigna Commercial |
$3,978.81
|
| Rate for Payer: First Health Commercial |
$4,554.06
|
| Rate for Payer: Humana Commercial |
$4,074.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,930.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,537.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,438.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,218.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,595.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,835.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,170.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,307.69
|
| Rate for Payer: PHCS Commercial |
$4,602.00
|
| Rate for Payer: United Healthcare All Payer |
$4,218.50
|
|
|
PLATE DIST FEM 12 HOLE L
|
Facility
|
IP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE DIST FEM 12 HOLE L
|
Facility
|
OP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem Medicaid |
$3,471.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Humana KY Medicaid |
$3,471.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,507.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,541.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE DIST FEM 12 HOLE R
|
Facility
|
IP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE DIST FEM 12 HOLE R
|
Facility
|
OP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem Medicaid |
$3,471.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Humana KY Medicaid |
$3,471.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,507.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,541.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE DIST FEM 15 HOLE L
|
Facility
|
IP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE DIST FEM 15 HOLE L
|
Facility
|
OP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem Medicaid |
$3,798.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Humana KY Medicaid |
$3,798.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,837.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,874.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE DIST FEM 15 HOLE R
|
Facility
|
IP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE DIST FEM 15 HOLE R
|
Facility
|
OP
|
$11,045.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,313.66 |
| Max. Negotiated Rate |
$10,603.70 |
| Rate for Payer: Aetna Commercial |
$8,505.05
|
| Rate for Payer: Anthem Medicaid |
$3,798.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,615.51
|
| Rate for Payer: Cash Price |
$5,522.76
|
| Rate for Payer: Cigna Commercial |
$9,167.78
|
| Rate for Payer: First Health Commercial |
$10,493.24
|
| Rate for Payer: Humana Commercial |
$9,388.69
|
| Rate for Payer: Humana KY Medicaid |
$3,798.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,837.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,057.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,151.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,313.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,874.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,720.06
|
| Rate for Payer: Ohio Health Group HMO |
$8,284.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,836.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,609.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,621.41
|
| Rate for Payer: PHCS Commercial |
$10,603.70
|
| Rate for Payer: United Healthcare All Payer |
$9,720.06
|
|
|
PLATE DIST FEM 18 HOLE L
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 18 HOLE L
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 18 HOLE R
|
Facility
|
IP
|
$11,229.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.71 |
| Max. Negotiated Rate |
$10,779.86 |
| Rate for Payer: Aetna Commercial |
$8,646.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,758.64
|
| Rate for Payer: Cash Price |
$5,614.51
|
| Rate for Payer: Cigna Commercial |
$9,320.09
|
| Rate for Payer: First Health Commercial |
$10,667.57
|
| Rate for Payer: Humana Commercial |
$9,544.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,207.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,287.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,368.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,421.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,983.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,769.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,748.02
|
| Rate for Payer: PHCS Commercial |
$10,779.86
|
| Rate for Payer: United Healthcare All Payer |
$9,881.54
|
|
|
PLATE DIST FEM 18 HOLE R
|
Facility
|
OP
|
$11,229.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,368.71 |
| Max. Negotiated Rate |
$10,779.86 |
| Rate for Payer: Aetna Commercial |
$8,646.35
|
| Rate for Payer: Anthem Medicaid |
$3,861.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,758.64
|
| Rate for Payer: Cash Price |
$5,614.51
|
| Rate for Payer: Cigna Commercial |
$9,320.09
|
| Rate for Payer: First Health Commercial |
$10,667.57
|
| Rate for Payer: Humana Commercial |
$9,544.67
|
| Rate for Payer: Humana KY Medicaid |
$3,861.66
|
| Rate for Payer: Kentucky WC Medicaid |
$3,900.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,207.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,287.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,368.71
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,939.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,881.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,421.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,983.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,769.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,748.02
|
| Rate for Payer: PHCS Commercial |
$10,779.86
|
| Rate for Payer: United Healthcare All Payer |
$9,881.54
|
|
|
PLATE DIST FEM 21 HOLE L
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 21 HOLE L
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 21 HOLE R
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 21 HOLE R
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 9 HOLE L
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 9 HOLE L
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 9 HOLE R
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM 9 HOLE R
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE DIST FEM NCB PP R/L 238M
|
Facility
|
OP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem Medicaid |
$3,341.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Humana KY Medicaid |
$3,341.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
|
PLATE DIST FEM NCB PP R/L 238M
|
Facility
|
IP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
