|
PLATE DIST LAT FEM 12 HOLE L
|
Facility
|
OP
|
$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 Medicaid |
$3,418.15
|
| 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: Humana KY Medicaid |
$3,418.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,452.94
|
| 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: Molina Healthcare Medicaid |
$3,486.73
|
| 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
|
|
|
PLATE DIST LAT FEM 12 HOLE R
|
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
|
|
|
PLATE DIST LAT FEM 12 HOLE R
|
Facility
|
OP
|
$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 Medicaid |
$3,418.15
|
| 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: Humana KY Medicaid |
$3,418.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,452.94
|
| 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: Molina Healthcare Medicaid |
$3,486.73
|
| 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
|
|
|
PLATE DIST LAT FEM 14 HOLE L
|
Facility
|
OP
|
$12,004.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.25 |
| Max. Negotiated Rate |
$11,523.99 |
| Rate for Payer: Aetna Commercial |
$9,243.20
|
| Rate for Payer: Anthem Medicaid |
$4,128.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,363.24
|
| Rate for Payer: Cash Price |
$6,002.08
|
| Rate for Payer: Cigna Commercial |
$9,963.45
|
| Rate for Payer: First Health Commercial |
$11,403.95
|
| Rate for Payer: Humana Commercial |
$10,203.54
|
| Rate for Payer: Humana KY Medicaid |
$4,128.23
|
| Rate for Payer: Kentucky WC Medicaid |
$4,170.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,843.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,859.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,601.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,211.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,563.66
|
| Rate for Payer: Ohio Health Group HMO |
$9,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,603.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,282.87
|
| Rate for Payer: PHCS Commercial |
$11,523.99
|
| Rate for Payer: United Healthcare All Payer |
$10,563.66
|
|
|
PLATE DIST LAT FEM 14 HOLE L
|
Facility
|
IP
|
$12,004.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,601.25 |
| Max. Negotiated Rate |
$11,523.99 |
| Rate for Payer: Aetna Commercial |
$9,243.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,363.24
|
| Rate for Payer: Cash Price |
$6,002.08
|
| Rate for Payer: Cigna Commercial |
$9,963.45
|
| Rate for Payer: First Health Commercial |
$11,403.95
|
| Rate for Payer: Humana Commercial |
$10,203.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,843.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,859.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,601.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,563.66
|
| Rate for Payer: Ohio Health Group HMO |
$9,003.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,603.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,443.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,282.87
|
| Rate for Payer: PHCS Commercial |
$11,523.99
|
| Rate for Payer: United Healthcare All Payer |
$10,563.66
|
|
|
PLATE DIST LAT FEM 14 HOLE R
|
Facility
|
OP
|
$10,088.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,026.42 |
| Max. Negotiated Rate |
$9,684.56 |
| Rate for Payer: Aetna Commercial |
$7,767.82
|
| Rate for Payer: Anthem Medicaid |
$3,469.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,868.70
|
| Rate for Payer: Cash Price |
$5,044.04
|
| Rate for Payer: Cigna Commercial |
$8,373.11
|
| Rate for Payer: First Health Commercial |
$9,583.68
|
| Rate for Payer: Humana Commercial |
$8,574.87
|
| Rate for Payer: Humana KY Medicaid |
$3,469.29
|
| Rate for Payer: Kentucky WC Medicaid |
$3,504.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,272.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,445.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,026.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,538.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,877.51
|
| Rate for Payer: Ohio Health Group HMO |
$7,566.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,070.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,776.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,960.78
|
| Rate for Payer: PHCS Commercial |
$9,684.56
|
| Rate for Payer: United Healthcare All Payer |
$8,877.51
|
|
|
PLATE DIST LAT FEM 14 HOLE R
|
Facility
|
IP
|
$10,088.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,026.42 |
| Max. Negotiated Rate |
$9,684.56 |
| Rate for Payer: Aetna Commercial |
$7,767.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,868.70
|
| Rate for Payer: Cash Price |
$5,044.04
|
| Rate for Payer: Cigna Commercial |
$8,373.11
|
| Rate for Payer: First Health Commercial |
$9,583.68
|
| Rate for Payer: Humana Commercial |
$8,574.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,272.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,445.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,026.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,877.51
|
| Rate for Payer: Ohio Health Group HMO |
$7,566.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,070.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,776.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,960.78
|
| Rate for Payer: PHCS Commercial |
$9,684.56
|
| Rate for Payer: United Healthcare All Payer |
$8,877.51
|
|
|
PLATE DIST LAT FEM 16 HOLE L
|
Facility
|
OP
|
$17,520.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,256.06 |
| Max. Negotiated Rate |
$16,819.39 |
| Rate for Payer: Aetna Commercial |
$13,490.55
|
| Rate for Payer: Anthem Medicaid |
$6,025.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,665.76
|
| Rate for Payer: Cash Price |
$8,760.10
|
| Rate for Payer: Cigna Commercial |
$14,541.77
|
| Rate for Payer: First Health Commercial |
$16,644.19
|
| Rate for Payer: Humana Commercial |
$14,892.17
|
| Rate for Payer: Humana KY Medicaid |
$6,025.20
|
| Rate for Payer: Kentucky WC Medicaid |
$6,086.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,366.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,929.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,256.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,146.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,417.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,140.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,016.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,242.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,088.94
|
| Rate for Payer: PHCS Commercial |
$16,819.39
|
| Rate for Payer: United Healthcare All Payer |
$15,417.78
|
|
|
PLATE DIST LAT FEM 16 HOLE L
|
Facility
|
IP
|
$17,520.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,256.06 |
| Max. Negotiated Rate |
$16,819.39 |
| Rate for Payer: Aetna Commercial |
$13,490.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,665.76
|
| Rate for Payer: Cash Price |
$8,760.10
|
| Rate for Payer: Cigna Commercial |
$14,541.77
|
| Rate for Payer: First Health Commercial |
$16,644.19
|
| Rate for Payer: Humana Commercial |
$14,892.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,366.56
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,929.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,256.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,417.78
|
| Rate for Payer: Ohio Health Group HMO |
$13,140.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$14,016.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,242.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$12,088.94
|
| Rate for Payer: PHCS Commercial |
$16,819.39
|
| Rate for Payer: United Healthcare All Payer |
$15,417.78
|
|
|
PLATE DIST LAT FEM 16 HOLE R
|
Facility
|
IP
|
$18,915.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,674.53 |
| Max. Negotiated Rate |
$18,158.50 |
| Rate for Payer: Aetna Commercial |
$14,564.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,753.78
|
| Rate for Payer: Cash Price |
$9,457.55
|
| Rate for Payer: Cigna Commercial |
$15,699.53
|
| Rate for Payer: First Health Commercial |
$17,969.35
|
| Rate for Payer: Humana Commercial |
$16,077.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,510.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,959.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,674.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,645.29
|
| Rate for Payer: Ohio Health Group HMO |
$14,186.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,132.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,456.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,051.42
|
| Rate for Payer: PHCS Commercial |
$18,158.50
|
| Rate for Payer: United Healthcare All Payer |
$16,645.29
|
|
|
PLATE DIST LAT FEM 16 HOLE R
|
Facility
|
OP
|
$18,915.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,674.53 |
| Max. Negotiated Rate |
$18,158.50 |
| Rate for Payer: Aetna Commercial |
$14,564.63
|
| Rate for Payer: Anthem Medicaid |
$6,504.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$14,753.78
|
| Rate for Payer: Cash Price |
$9,457.55
|
| Rate for Payer: Cigna Commercial |
$15,699.53
|
| Rate for Payer: First Health Commercial |
$17,969.35
|
| Rate for Payer: Humana Commercial |
$16,077.83
|
| Rate for Payer: Humana KY Medicaid |
$6,504.90
|
| Rate for Payer: Kentucky WC Medicaid |
$6,571.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$15,510.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$13,959.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,674.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,635.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$16,645.29
|
| Rate for Payer: Ohio Health Group HMO |
$14,186.33
|
| Rate for Payer: Ohio Health Group PPO Differential |
$15,132.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$16,456.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$13,051.42
|
| Rate for Payer: PHCS Commercial |
$18,158.50
|
| Rate for Payer: United Healthcare All Payer |
$16,645.29
|
|
|
PLATE DIST LAT FEM 4 HOLE L
|
Facility
|
IP
|
$9,161.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,748.33 |
| Max. Negotiated Rate |
$8,794.65 |
| Rate for Payer: Aetna Commercial |
$7,054.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,145.65
|
| Rate for Payer: Cash Price |
$4,580.55
|
| Rate for Payer: Cigna Commercial |
$7,603.70
|
| Rate for Payer: First Health Commercial |
$8,703.04
|
| Rate for Payer: Humana Commercial |
$7,786.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,512.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,748.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,061.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,870.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,328.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,970.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,321.15
|
| Rate for Payer: PHCS Commercial |
$8,794.65
|
| Rate for Payer: United Healthcare All Payer |
$8,061.76
|
|
|
PLATE DIST LAT FEM 4 HOLE L
|
Facility
|
OP
|
$9,161.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,748.33 |
| Max. Negotiated Rate |
$8,794.65 |
| Rate for Payer: Aetna Commercial |
$7,054.04
|
| Rate for Payer: Anthem Medicaid |
$3,150.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,145.65
|
| Rate for Payer: Cash Price |
$4,580.55
|
| Rate for Payer: Cigna Commercial |
$7,603.70
|
| Rate for Payer: First Health Commercial |
$8,703.04
|
| Rate for Payer: Humana Commercial |
$7,786.93
|
| Rate for Payer: Humana KY Medicaid |
$3,150.50
|
| Rate for Payer: Kentucky WC Medicaid |
$3,182.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,512.09
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,760.88
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,748.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,213.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,061.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,870.82
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,328.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,970.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,321.15
|
| Rate for Payer: PHCS Commercial |
$8,794.65
|
| Rate for Payer: United Healthcare All Payer |
$8,061.76
|
|
|
PLATE DIST LAT FEM 4 HOLE R
|
Facility
|
IP
|
$10,979.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.97 |
| Max. Negotiated Rate |
$10,540.70 |
| Rate for Payer: Aetna Commercial |
$8,454.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,564.32
|
| Rate for Payer: Cash Price |
$5,489.95
|
| Rate for Payer: Cigna Commercial |
$9,113.32
|
| Rate for Payer: First Health Commercial |
$10,430.91
|
| Rate for Payer: Humana Commercial |
$9,332.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,003.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,103.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,662.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,234.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,783.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,552.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,576.13
|
| Rate for Payer: PHCS Commercial |
$10,540.70
|
| Rate for Payer: United Healthcare All Payer |
$9,662.31
|
|
|
PLATE DIST LAT FEM 4 HOLE R
|
Facility
|
OP
|
$10,979.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.97 |
| Max. Negotiated Rate |
$10,540.70 |
| Rate for Payer: Aetna Commercial |
$8,454.52
|
| Rate for Payer: Anthem Medicaid |
$3,775.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,564.32
|
| Rate for Payer: Cash Price |
$5,489.95
|
| Rate for Payer: Cigna Commercial |
$9,113.32
|
| Rate for Payer: First Health Commercial |
$10,430.91
|
| Rate for Payer: Humana Commercial |
$9,332.92
|
| Rate for Payer: Humana KY Medicaid |
$3,775.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,814.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,003.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,103.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,293.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,851.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,662.31
|
| Rate for Payer: Ohio Health Group HMO |
$8,234.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,783.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,552.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,576.13
|
| Rate for Payer: PHCS Commercial |
$10,540.70
|
| Rate for Payer: United Healthcare All Payer |
$9,662.31
|
|
|
PLATE DIST LAT FEM 6 HOLE L
|
Facility
|
OP
|
$9,301.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,790.57 |
| Max. Negotiated Rate |
$8,929.83 |
| Rate for Payer: Aetna Commercial |
$7,162.47
|
| Rate for Payer: Anthem Medicaid |
$3,198.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,255.49
|
| Rate for Payer: Cash Price |
$4,650.95
|
| Rate for Payer: Cigna Commercial |
$7,720.59
|
| Rate for Payer: First Health Commercial |
$8,836.81
|
| Rate for Payer: Humana Commercial |
$7,906.62
|
| Rate for Payer: Humana KY Medicaid |
$3,198.93
|
| Rate for Payer: Kentucky WC Medicaid |
$3,231.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,627.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,864.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,790.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,263.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,185.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,976.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,441.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,092.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,418.32
|
| Rate for Payer: PHCS Commercial |
$8,929.83
|
| Rate for Payer: United Healthcare All Payer |
$8,185.68
|
|
|
PLATE DIST LAT FEM 6 HOLE L
|
Facility
|
IP
|
$9,301.91
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,790.57 |
| Max. Negotiated Rate |
$8,929.83 |
| Rate for Payer: Aetna Commercial |
$7,162.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,255.49
|
| Rate for Payer: Cash Price |
$4,650.95
|
| Rate for Payer: Cigna Commercial |
$7,720.59
|
| Rate for Payer: First Health Commercial |
$8,836.81
|
| Rate for Payer: Humana Commercial |
$7,906.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,627.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,864.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,790.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,185.68
|
| Rate for Payer: Ohio Health Group HMO |
$6,976.43
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,441.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,092.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,418.32
|
| Rate for Payer: PHCS Commercial |
$8,929.83
|
| Rate for Payer: United Healthcare All Payer |
$8,185.68
|
|
|
PLATE DIST LAT FEM 6 HOLE R
|
Facility
|
IP
|
$11,154.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,346.34 |
| Max. Negotiated Rate |
$10,708.27 |
| Rate for Payer: Aetna Commercial |
$8,588.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,700.47
|
| Rate for Payer: Cash Price |
$5,577.22
|
| Rate for Payer: Cigna Commercial |
$9,258.19
|
| Rate for Payer: First Health Commercial |
$10,596.73
|
| Rate for Payer: Humana Commercial |
$9,481.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,146.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,231.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,346.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,815.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,365.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,923.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,704.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,696.57
|
| Rate for Payer: PHCS Commercial |
$10,708.27
|
| Rate for Payer: United Healthcare All Payer |
$9,815.92
|
|
|
PLATE DIST LAT FEM 6 HOLE R
|
Facility
|
OP
|
$11,154.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,346.34 |
| Max. Negotiated Rate |
$10,708.27 |
| Rate for Payer: Aetna Commercial |
$8,588.93
|
| Rate for Payer: Anthem Medicaid |
$3,836.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,700.47
|
| Rate for Payer: Cash Price |
$5,577.22
|
| Rate for Payer: Cigna Commercial |
$9,258.19
|
| Rate for Payer: First Health Commercial |
$10,596.73
|
| Rate for Payer: Humana Commercial |
$9,481.28
|
| Rate for Payer: Humana KY Medicaid |
$3,836.02
|
| Rate for Payer: Kentucky WC Medicaid |
$3,875.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,146.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,231.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,346.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,912.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,815.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,365.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,923.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,704.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,696.57
|
| Rate for Payer: PHCS Commercial |
$10,708.27
|
| Rate for Payer: United Healthcare All Payer |
$9,815.92
|
|
|
PLATE DIST LAT FEM 8 HOLE L
|
Facility
|
IP
|
$12,259.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,677.94 |
| Max. Negotiated Rate |
$11,769.42 |
| Rate for Payer: Aetna Commercial |
$9,440.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,562.65
|
| Rate for Payer: Cash Price |
$6,129.91
|
| Rate for Payer: Cigna Commercial |
$10,175.64
|
| Rate for Payer: First Health Commercial |
$11,646.82
|
| Rate for Payer: Humana Commercial |
$10,420.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,053.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,047.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,677.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,788.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,194.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,807.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,666.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,459.27
|
| Rate for Payer: PHCS Commercial |
$11,769.42
|
| Rate for Payer: United Healthcare All Payer |
$10,788.63
|
|
|
PLATE DIST LAT FEM 8 HOLE L
|
Facility
|
OP
|
$12,259.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,677.94 |
| Max. Negotiated Rate |
$11,769.42 |
| Rate for Payer: Aetna Commercial |
$9,440.05
|
| Rate for Payer: Anthem Medicaid |
$4,216.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,562.65
|
| Rate for Payer: Cash Price |
$6,129.91
|
| Rate for Payer: Cigna Commercial |
$10,175.64
|
| Rate for Payer: First Health Commercial |
$11,646.82
|
| Rate for Payer: Humana Commercial |
$10,420.84
|
| Rate for Payer: Humana KY Medicaid |
$4,216.15
|
| Rate for Payer: Kentucky WC Medicaid |
$4,259.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,053.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,047.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,677.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,300.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,788.63
|
| Rate for Payer: Ohio Health Group HMO |
$9,194.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,807.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,666.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,459.27
|
| Rate for Payer: PHCS Commercial |
$11,769.42
|
| Rate for Payer: United Healthcare All Payer |
$10,788.63
|
|
|
PLATE DIST LAT FEM 8 HOLE R
|
Facility
|
OP
|
$9,645.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.66 |
| Max. Negotiated Rate |
$9,259.70 |
| Rate for Payer: Aetna Commercial |
$7,427.05
|
| Rate for Payer: Anthem Medicaid |
$3,317.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.51
|
| Rate for Payer: Cash Price |
$4,822.76
|
| Rate for Payer: Cigna Commercial |
$8,005.78
|
| Rate for Payer: First Health Commercial |
$9,163.24
|
| Rate for Payer: Humana Commercial |
$8,198.69
|
| Rate for Payer: Humana KY Medicaid |
$3,317.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,350.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,383.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.41
|
| Rate for Payer: PHCS Commercial |
$9,259.70
|
| Rate for Payer: United Healthcare All Payer |
$8,488.06
|
|
|
PLATE DIST LAT FEM 8 HOLE R
|
Facility
|
IP
|
$9,645.52
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,893.66 |
| Max. Negotiated Rate |
$9,259.70 |
| Rate for Payer: Aetna Commercial |
$7,427.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,523.51
|
| Rate for Payer: Cash Price |
$4,822.76
|
| Rate for Payer: Cigna Commercial |
$8,005.78
|
| Rate for Payer: First Health Commercial |
$9,163.24
|
| Rate for Payer: Humana Commercial |
$8,198.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,909.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,118.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,893.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,488.06
|
| Rate for Payer: Ohio Health Group HMO |
$7,234.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,716.42
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,391.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,655.41
|
| Rate for Payer: PHCS Commercial |
$9,259.70
|
| Rate for Payer: United Healthcare All Payer |
$8,488.06
|
|
|
PLATE DISTL FEM LAT L 12H 281M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTL FEM LAT L 12H 281M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
