|
PLATE DORSOLAT MIDSHFT RAD 12H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLAT MIDSHFT RAD 14H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLAT MIDSHFT RAD 14H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLAT MIDSHFT RAD 16H
|
Facility
|
OP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem Medicaid |
$1,604.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Humana KY Medicaid |
$1,604.72
|
| Rate for Payer: Kentucky WC Medicaid |
$1,621.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,636.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DORSOLAT MIDSHFT RAD 16H
|
Facility
|
IP
|
$4,666.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.88 |
| Max. Negotiated Rate |
$4,479.60 |
| Rate for Payer: Aetna Commercial |
$3,593.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,639.68
|
| Rate for Payer: Cash Price |
$2,333.12
|
| Rate for Payer: Cigna Commercial |
$3,872.99
|
| Rate for Payer: First Health Commercial |
$4,432.94
|
| Rate for Payer: Humana Commercial |
$3,966.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,826.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,443.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,399.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,106.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,499.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,733.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,059.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,219.71
|
| Rate for Payer: PHCS Commercial |
$4,479.60
|
| Rate for Payer: United Healthcare All Payer |
$4,106.30
|
|
|
PLATE DST HM LK MD 11H L 151M
|
Facility
|
OP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem Medicaid |
$2,710.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Humana KY Medicaid |
$2,710.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE DST HM LK MD 11H L 151M
|
Facility
|
IP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE DST HM LK MD 11H R 151M
|
Facility
|
IP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE DST HM LK MD 11H R 151M
|
Facility
|
OP
|
$7,882.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,364.62 |
| Max. Negotiated Rate |
$7,566.78 |
| Rate for Payer: Aetna Commercial |
$6,069.19
|
| Rate for Payer: Anthem Medicaid |
$2,710.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,148.01
|
| Rate for Payer: Cash Price |
$3,941.03
|
| Rate for Payer: Cigna Commercial |
$6,542.11
|
| Rate for Payer: First Health Commercial |
$7,487.96
|
| Rate for Payer: Humana Commercial |
$6,699.75
|
| Rate for Payer: Humana KY Medicaid |
$2,710.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,738.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,463.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,816.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,364.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,765.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,936.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,911.55
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,305.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,857.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,438.62
|
| Rate for Payer: PHCS Commercial |
$7,566.78
|
| Rate for Payer: United Healthcare All Payer |
$6,936.21
|
|
|
PLATE DST HM LK MD 13H L 174M
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE DST HM LK MD 13H L 174M
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE DST HM LK MD 13H R 174M
|
Facility
|
OP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem Medicaid |
$2,798.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Humana KY Medicaid |
$2,798.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,827.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,855.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE DST HM LK MD 13H R 174M
|
Facility
|
IP
|
$8,138.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,441.59 |
| Max. Negotiated Rate |
$7,813.10 |
| Rate for Payer: Aetna Commercial |
$6,266.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,348.15
|
| Rate for Payer: Cash Price |
$4,069.33
|
| Rate for Payer: Cigna Commercial |
$6,755.08
|
| Rate for Payer: First Health Commercial |
$7,731.72
|
| Rate for Payer: Humana Commercial |
$6,917.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,673.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,006.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,441.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,162.01
|
| Rate for Payer: Ohio Health Group HMO |
$6,103.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,510.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,080.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,615.67
|
| Rate for Payer: PHCS Commercial |
$7,813.10
|
| Rate for Payer: United Healthcare All Payer |
$7,162.01
|
|
|
PLATE DVRAN NARROW LEFT
|
Facility
|
IP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE DVRAN NARROW LEFT
|
Facility
|
OP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem Medicaid |
$2,386.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Humana KY Medicaid |
$2,386.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,410.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE DVRAN NARROW RIGHT
|
Facility
|
IP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE DVRAN NARROW RIGHT
|
Facility
|
OP
|
$6,938.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,081.51 |
| Max. Negotiated Rate |
$6,660.82 |
| Rate for Payer: Aetna Commercial |
$5,342.53
|
| Rate for Payer: Anthem Medicaid |
$2,386.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,411.91
|
| Rate for Payer: Cash Price |
$3,469.18
|
| Rate for Payer: Cigna Commercial |
$5,758.83
|
| Rate for Payer: First Health Commercial |
$6,591.43
|
| Rate for Payer: Humana Commercial |
$5,897.60
|
| Rate for Payer: Humana KY Medicaid |
$2,386.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,410.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,689.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,120.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,081.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,433.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,105.75
|
| Rate for Payer: Ohio Health Group HMO |
$5,203.76
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,550.68
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,036.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,787.46
|
| Rate for Payer: PHCS Commercial |
$6,660.82
|
| Rate for Payer: United Healthcare All Payer |
$6,105.75
|
|
|
PLATE DVRANSL NAR SHORT L
|
Facility
|
OP
|
$7,135.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,140.64 |
| Max. Negotiated Rate |
$6,850.03 |
| Rate for Payer: Aetna Commercial |
$5,494.30
|
| Rate for Payer: Anthem Medicaid |
$2,453.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,565.65
|
| Rate for Payer: Cash Price |
$3,567.72
|
| Rate for Payer: Cigna Commercial |
$5,922.42
|
| Rate for Payer: First Health Commercial |
$6,778.68
|
| Rate for Payer: Humana Commercial |
$6,065.13
|
| Rate for Payer: Humana KY Medicaid |
$2,453.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,851.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,503.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,279.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,351.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,708.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,207.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,923.46
|
| Rate for Payer: PHCS Commercial |
$6,850.03
|
| Rate for Payer: United Healthcare All Payer |
$6,279.20
|
|
|
PLATE DVRANSL NAR SHORT L
|
Facility
|
IP
|
$7,135.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,140.64 |
| Max. Negotiated Rate |
$6,850.03 |
| Rate for Payer: Aetna Commercial |
$5,494.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,565.65
|
| Rate for Payer: Cash Price |
$3,567.72
|
| Rate for Payer: Cigna Commercial |
$5,922.42
|
| Rate for Payer: First Health Commercial |
$6,778.68
|
| Rate for Payer: Humana Commercial |
$6,065.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,851.07
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,279.20
|
| Rate for Payer: Ohio Health Group HMO |
$5,351.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,708.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,207.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,923.46
|
| Rate for Payer: PHCS Commercial |
$6,850.03
|
| Rate for Payer: United Healthcare All Payer |
$6,279.20
|
|
|
PLATE DVRANSL NAR SHORT R
|
Facility
|
IP
|
$7,343.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.05 |
| Max. Negotiated Rate |
$7,049.76 |
| Rate for Payer: Aetna Commercial |
$5,654.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,727.93
|
| Rate for Payer: Cash Price |
$3,671.75
|
| Rate for Payer: Cigna Commercial |
$6,095.10
|
| Rate for Payer: First Health Commercial |
$6,976.32
|
| Rate for Payer: Humana Commercial |
$6,241.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,021.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,419.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,203.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,462.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,507.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,874.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,388.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.02
|
| Rate for Payer: PHCS Commercial |
$7,049.76
|
| Rate for Payer: United Healthcare All Payer |
$6,462.28
|
|
|
PLATE DVRANSL NAR SHORT R
|
Facility
|
OP
|
$7,343.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.05 |
| Max. Negotiated Rate |
$7,049.76 |
| Rate for Payer: Aetna Commercial |
$5,654.49
|
| Rate for Payer: Anthem Medicaid |
$2,525.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,727.93
|
| Rate for Payer: Cash Price |
$3,671.75
|
| Rate for Payer: Cigna Commercial |
$6,095.10
|
| Rate for Payer: First Health Commercial |
$6,976.32
|
| Rate for Payer: Humana Commercial |
$6,241.98
|
| Rate for Payer: Humana KY Medicaid |
$2,525.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,551.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,021.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,419.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,203.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,576.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,462.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,507.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,874.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,388.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.02
|
| Rate for Payer: PHCS Commercial |
$7,049.76
|
| Rate for Payer: United Healthcare All Payer |
$6,462.28
|
|
|
PLATE DVRAS SHORT LEFT
|
Facility
|
OP
|
$7,343.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.05 |
| Max. Negotiated Rate |
$7,049.76 |
| Rate for Payer: Aetna Commercial |
$5,654.49
|
| Rate for Payer: Anthem Medicaid |
$2,525.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,727.93
|
| Rate for Payer: Cash Price |
$3,671.75
|
| Rate for Payer: Cigna Commercial |
$6,095.10
|
| Rate for Payer: First Health Commercial |
$6,976.32
|
| Rate for Payer: Humana Commercial |
$6,241.98
|
| Rate for Payer: Humana KY Medicaid |
$2,525.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,551.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,021.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,419.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,203.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,576.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,462.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,507.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,874.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,388.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.02
|
| Rate for Payer: PHCS Commercial |
$7,049.76
|
| Rate for Payer: United Healthcare All Payer |
$6,462.28
|
|
|
PLATE DVRAS SHORT LEFT
|
Facility
|
IP
|
$7,343.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.05 |
| Max. Negotiated Rate |
$7,049.76 |
| Rate for Payer: Aetna Commercial |
$5,654.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,727.93
|
| Rate for Payer: Cash Price |
$3,671.75
|
| Rate for Payer: Cigna Commercial |
$6,095.10
|
| Rate for Payer: First Health Commercial |
$6,976.32
|
| Rate for Payer: Humana Commercial |
$6,241.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,021.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,419.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,203.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,462.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,507.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,874.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,388.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.02
|
| Rate for Payer: PHCS Commercial |
$7,049.76
|
| Rate for Payer: United Healthcare All Payer |
$6,462.28
|
|
|
PLATE DVRAS SHORT RIGHT
|
Facility
|
IP
|
$7,343.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.05 |
| Max. Negotiated Rate |
$7,049.76 |
| Rate for Payer: Aetna Commercial |
$5,654.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,727.93
|
| Rate for Payer: Cash Price |
$3,671.75
|
| Rate for Payer: Cigna Commercial |
$6,095.10
|
| Rate for Payer: First Health Commercial |
$6,976.32
|
| Rate for Payer: Humana Commercial |
$6,241.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,021.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,419.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,203.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,462.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,507.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,874.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,388.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.02
|
| Rate for Payer: PHCS Commercial |
$7,049.76
|
| Rate for Payer: United Healthcare All Payer |
$6,462.28
|
|
|
PLATE DVRAS SHORT RIGHT
|
Facility
|
OP
|
$7,343.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,203.05 |
| Max. Negotiated Rate |
$7,049.76 |
| Rate for Payer: Aetna Commercial |
$5,654.49
|
| Rate for Payer: Anthem Medicaid |
$2,525.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,727.93
|
| Rate for Payer: Cash Price |
$3,671.75
|
| Rate for Payer: Cigna Commercial |
$6,095.10
|
| Rate for Payer: First Health Commercial |
$6,976.32
|
| Rate for Payer: Humana Commercial |
$6,241.98
|
| Rate for Payer: Humana KY Medicaid |
$2,525.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,551.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,021.67
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,419.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,203.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,576.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,462.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,507.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,874.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,388.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,067.02
|
| Rate for Payer: PHCS Commercial |
$7,049.76
|
| Rate for Payer: United Healthcare All Payer |
$6,462.28
|
|
