|
PLATE DIST FEM NCB PP R/L 393M
|
Facility
|
IP
|
$12,219.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,665.98 |
| Max. Negotiated Rate |
$11,731.12 |
| Rate for Payer: Aetna Commercial |
$9,409.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,531.54
|
| Rate for Payer: Cash Price |
$6,109.96
|
| Rate for Payer: Cigna Commercial |
$10,142.53
|
| Rate for Payer: First Health Commercial |
$11,608.92
|
| Rate for Payer: Humana Commercial |
$10,386.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,020.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,018.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,665.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,753.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,164.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,775.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,631.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,431.74
|
| Rate for Payer: PHCS Commercial |
$11,731.12
|
| Rate for Payer: United Healthcare All Payer |
$10,753.53
|
|
|
PLATE DIST FEM NCB PP R/L 393M
|
Facility
|
OP
|
$12,219.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,665.98 |
| Max. Negotiated Rate |
$11,731.12 |
| Rate for Payer: Aetna Commercial |
$9,409.34
|
| Rate for Payer: Anthem Medicaid |
$4,202.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,531.54
|
| Rate for Payer: Cash Price |
$6,109.96
|
| Rate for Payer: Cigna Commercial |
$10,142.53
|
| Rate for Payer: First Health Commercial |
$11,608.92
|
| Rate for Payer: Humana Commercial |
$10,386.93
|
| Rate for Payer: Humana KY Medicaid |
$4,202.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,245.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,020.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,018.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,665.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,286.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,753.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,164.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,775.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,631.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,431.74
|
| Rate for Payer: PHCS Commercial |
$11,731.12
|
| Rate for Payer: United Healthcare All Payer |
$10,753.53
|
|
|
PLATE DIST HUM LK MD 5H L 79M
|
Facility
|
OP
|
$6,882.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.81 |
| Max. Negotiated Rate |
$6,607.38 |
| Rate for Payer: Aetna Commercial |
$5,299.67
|
| Rate for Payer: Anthem Medicaid |
$2,366.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,368.50
|
| Rate for Payer: Cash Price |
$3,441.34
|
| Rate for Payer: Cigna Commercial |
$5,712.63
|
| Rate for Payer: First Health Commercial |
$6,538.56
|
| Rate for Payer: Humana Commercial |
$5,850.29
|
| Rate for Payer: Humana KY Medicaid |
$2,366.96
|
| Rate for Payer: Kentucky WC Medicaid |
$2,391.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,643.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,079.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,414.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,056.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,162.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,506.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,987.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.06
|
| Rate for Payer: PHCS Commercial |
$6,607.38
|
| Rate for Payer: United Healthcare All Payer |
$6,056.77
|
|
|
PLATE DIST HUM LK MD 5H L 79M
|
Facility
|
IP
|
$6,882.69
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,064.81 |
| Max. Negotiated Rate |
$6,607.38 |
| Rate for Payer: Aetna Commercial |
$5,299.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,368.50
|
| Rate for Payer: Cash Price |
$3,441.34
|
| Rate for Payer: Cigna Commercial |
$5,712.63
|
| Rate for Payer: First Health Commercial |
$6,538.56
|
| Rate for Payer: Humana Commercial |
$5,850.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,643.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,079.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,064.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,056.77
|
| Rate for Payer: Ohio Health Group HMO |
$5,162.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,506.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,987.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,749.06
|
| Rate for Payer: PHCS Commercial |
$6,607.38
|
| Rate for Payer: United Healthcare All Payer |
$6,056.77
|
|
|
PLATE DIST HUM LK MD 7H L 130M
|
Facility
|
IP
|
$7,328.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$7,035.22 |
| Rate for Payer: Aetna Commercial |
$5,642.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,716.11
|
| Rate for Payer: Cash Price |
$3,664.18
|
| Rate for Payer: Cigna Commercial |
$6,082.53
|
| Rate for Payer: First Health Commercial |
$6,961.93
|
| Rate for Payer: Humana Commercial |
$6,229.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,496.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.56
|
| Rate for Payer: PHCS Commercial |
$7,035.22
|
| Rate for Payer: United Healthcare All Payer |
$6,448.95
|
|
|
PLATE DIST HUM LK MD 7H L 130M
|
Facility
|
OP
|
$7,328.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,198.51 |
| Max. Negotiated Rate |
$7,035.22 |
| Rate for Payer: Aetna Commercial |
$5,642.83
|
| Rate for Payer: Anthem Medicaid |
$2,520.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,716.11
|
| Rate for Payer: Cash Price |
$3,664.18
|
| Rate for Payer: Cigna Commercial |
$6,082.53
|
| Rate for Payer: First Health Commercial |
$6,961.93
|
| Rate for Payer: Humana Commercial |
$6,229.10
|
| Rate for Payer: Humana KY Medicaid |
$2,520.22
|
| Rate for Payer: Kentucky WC Medicaid |
$2,545.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,009.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,198.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,570.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,448.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,496.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,862.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,375.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,056.56
|
| Rate for Payer: PHCS Commercial |
$7,035.22
|
| Rate for Payer: United Healthcare All Payer |
$6,448.95
|
|
|
PLATE DIST HUM LK MD 9H L 127M
|
Facility
|
OP
|
$7,652.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.74 |
| Max. Negotiated Rate |
$7,346.37 |
| Rate for Payer: Aetna Commercial |
$5,892.40
|
| Rate for Payer: Anthem Medicaid |
$2,631.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,968.93
|
| Rate for Payer: Cash Price |
$3,826.24
|
| Rate for Payer: Cigna Commercial |
$6,351.55
|
| Rate for Payer: First Health Commercial |
$7,269.85
|
| Rate for Payer: Humana Commercial |
$6,504.60
|
| Rate for Payer: Humana KY Medicaid |
$2,631.68
|
| Rate for Payer: Kentucky WC Medicaid |
$2,658.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,275.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,647.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,295.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,684.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,734.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,739.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,121.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,657.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,280.20
|
| Rate for Payer: PHCS Commercial |
$7,346.37
|
| Rate for Payer: United Healthcare All Payer |
$6,734.17
|
|
|
PLATE DIST HUM LK MD 9H L 127M
|
Facility
|
IP
|
$7,652.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,295.74 |
| Max. Negotiated Rate |
$7,346.37 |
| Rate for Payer: Aetna Commercial |
$5,892.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,968.93
|
| Rate for Payer: Cash Price |
$3,826.24
|
| Rate for Payer: Cigna Commercial |
$6,351.55
|
| Rate for Payer: First Health Commercial |
$7,269.85
|
| Rate for Payer: Humana Commercial |
$6,504.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,275.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,647.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,295.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,734.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,739.35
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,121.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,657.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,280.20
|
| Rate for Payer: PHCS Commercial |
$7,346.37
|
| Rate for Payer: United Healthcare All Payer |
$6,734.17
|
|
|
PLATE DISTL ANTEROLATERAL L 4H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL L 4H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL L 6H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL L 6H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL L 8H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL L 8H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL R 4H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL R 4H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL R 6H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL R 6H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL R 8H
|
Facility
|
OP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem Medicaid |
$2,437.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Humana KY Medicaid |
$2,437.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,462.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,486.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DISTL ANTEROLATERAL R 8H
|
Facility
|
IP
|
$7,088.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,126.40 |
| Max. Negotiated Rate |
$6,804.48 |
| Rate for Payer: Aetna Commercial |
$5,457.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,528.64
|
| Rate for Payer: Cash Price |
$3,544.00
|
| Rate for Payer: Cigna Commercial |
$5,883.04
|
| Rate for Payer: First Health Commercial |
$6,733.60
|
| Rate for Payer: Humana Commercial |
$6,024.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,812.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,230.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,126.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,237.44
|
| Rate for Payer: Ohio Health Group HMO |
$5,316.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,670.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,166.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,890.72
|
| Rate for Payer: PHCS Commercial |
$6,804.48
|
| Rate for Payer: United Healthcare All Payer |
$6,237.44
|
|
|
PLATE DIST LAT FEM 10 HOLE L
|
Facility
|
IP
|
$9,794.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,938.27 |
| Max. Negotiated Rate |
$9,402.45 |
| Rate for Payer: Aetna Commercial |
$7,541.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,639.49
|
| Rate for Payer: Cash Price |
$4,897.11
|
| Rate for Payer: Cigna Commercial |
$8,129.20
|
| Rate for Payer: First Health Commercial |
$9,304.51
|
| Rate for Payer: Humana Commercial |
$8,325.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,031.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,228.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,938.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,618.91
|
| Rate for Payer: Ohio Health Group HMO |
$7,345.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,835.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,520.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,758.01
|
| Rate for Payer: PHCS Commercial |
$9,402.45
|
| Rate for Payer: United Healthcare All Payer |
$8,618.91
|
|
|
PLATE DIST LAT FEM 10 HOLE L
|
Facility
|
OP
|
$9,794.22
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,938.27 |
| Max. Negotiated Rate |
$9,402.45 |
| Rate for Payer: Aetna Commercial |
$7,541.55
|
| Rate for Payer: Anthem Medicaid |
$3,368.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,639.49
|
| Rate for Payer: Cash Price |
$4,897.11
|
| Rate for Payer: Cigna Commercial |
$8,129.20
|
| Rate for Payer: First Health Commercial |
$9,304.51
|
| Rate for Payer: Humana Commercial |
$8,325.09
|
| Rate for Payer: Humana KY Medicaid |
$3,368.23
|
| Rate for Payer: Kentucky WC Medicaid |
$3,402.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,031.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,228.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,938.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,435.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,618.91
|
| Rate for Payer: Ohio Health Group HMO |
$7,345.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,835.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,520.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,758.01
|
| Rate for Payer: PHCS Commercial |
$9,402.45
|
| Rate for Payer: United Healthcare All Payer |
$8,618.91
|
|
|
PLATE DIST LAT FEM 10 HOLE R
|
Facility
|
IP
|
$12,455.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.55 |
| Max. Negotiated Rate |
$11,956.96 |
| Rate for Payer: Aetna Commercial |
$9,590.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,715.03
|
| Rate for Payer: Cash Price |
$6,227.58
|
| Rate for Payer: Cigna Commercial |
$10,337.79
|
| Rate for Payer: First Health Commercial |
$11,832.41
|
| Rate for Payer: Humana Commercial |
$10,586.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,213.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,191.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,736.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,960.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,341.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,964.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,836.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,594.07
|
| Rate for Payer: PHCS Commercial |
$11,956.96
|
| Rate for Payer: United Healthcare All Payer |
$10,960.55
|
|
|
PLATE DIST LAT FEM 10 HOLE R
|
Facility
|
OP
|
$12,455.17
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,736.55 |
| Max. Negotiated Rate |
$11,956.96 |
| Rate for Payer: Aetna Commercial |
$9,590.48
|
| Rate for Payer: Anthem Medicaid |
$4,283.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,715.03
|
| Rate for Payer: Cash Price |
$6,227.58
|
| Rate for Payer: Cigna Commercial |
$10,337.79
|
| Rate for Payer: First Health Commercial |
$11,832.41
|
| Rate for Payer: Humana Commercial |
$10,586.89
|
| Rate for Payer: Humana KY Medicaid |
$4,283.33
|
| Rate for Payer: Kentucky WC Medicaid |
$4,326.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,213.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,191.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,736.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,369.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,960.55
|
| Rate for Payer: Ohio Health Group HMO |
$9,341.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,964.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,836.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,594.07
|
| Rate for Payer: PHCS Commercial |
$11,956.96
|
| Rate for Payer: United Healthcare All Payer |
$10,960.55
|
|
|
PLATE DIST LAT FEM 12 HOLE L
|
Facility
|
IP
|
$9,939.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,981.81 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$7,653.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,752.72
|
| Rate for Payer: Cash Price |
$4,969.69
|
| Rate for Payer: Cigna Commercial |
$8,249.69
|
| Rate for Payer: First Health Commercial |
$9,442.41
|
| Rate for Payer: Humana Commercial |
$8,448.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,150.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,335.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,981.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,746.65
|
| Rate for Payer: Ohio Health Group HMO |
$7,454.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,951.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,647.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,858.17
|
| Rate for Payer: PHCS Commercial |
$9,541.80
|
| Rate for Payer: United Healthcare All Payer |
$8,746.65
|
|
