|
PLATE L 2.4MM 2H TI 5H RT
|
Facility
|
OP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem Medicaid |
$1,584.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Humana KY Medicaid |
$1,584.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,600.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,615.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE L 2.4MM 2H TI 5H RT
|
Facility
|
IP
|
$4,606.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,381.88 |
| Max. Negotiated Rate |
$4,422.00 |
| Rate for Payer: Aetna Commercial |
$3,546.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,592.88
|
| Rate for Payer: Cash Price |
$2,303.12
|
| Rate for Payer: Cigna Commercial |
$3,823.19
|
| Rate for Payer: First Health Commercial |
$4,375.94
|
| Rate for Payer: Humana Commercial |
$3,915.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,777.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,399.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,381.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,053.50
|
| Rate for Payer: Ohio Health Group HMO |
$3,454.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,685.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,007.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,178.31
|
| Rate for Payer: PHCS Commercial |
$4,422.00
|
| Rate for Payer: United Healthcare All Payer |
$4,053.50
|
|
|
PLATE L 2.7MM LT
|
Facility
|
OP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem Medicaid |
$1,302.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Humana KY Medicaid |
$1,302.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,316.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,329.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
PLATE L 2.7MM LT
|
Facility
|
IP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
PLATE L 2.7MM RT
|
Facility
|
OP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem Medicaid |
$1,302.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Humana KY Medicaid |
$1,302.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,316.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,329.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
PLATE L 2.7MM RT
|
Facility
|
IP
|
$3,788.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.62 |
| Max. Negotiated Rate |
$3,637.20 |
| Rate for Payer: Aetna Commercial |
$2,917.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,955.22
|
| Rate for Payer: Cash Price |
$1,894.38
|
| Rate for Payer: Cigna Commercial |
$3,144.66
|
| Rate for Payer: First Health Commercial |
$3,599.31
|
| Rate for Payer: Humana Commercial |
$3,220.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,106.78
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,796.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,136.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,334.10
|
| Rate for Payer: Ohio Health Group HMO |
$2,841.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,031.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,296.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,614.24
|
| Rate for Payer: PHCS Commercial |
$3,637.20
|
| Rate for Payer: United Healthcare All Payer |
$3,334.10
|
|
|
PLATE LAPDUS LOW PROF LONG
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE LAPDUS LOW PROF LONG
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE LAPDUS LOW PROF TITANIUM
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE LAPDUS LOW PROF TITANIUM
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE LAPIDUS LEFT STD 626893
|
Facility
|
IP
|
$16,931.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,079.57 |
| Max. Negotiated Rate |
$16,254.62 |
| Rate for Payer: Aetna Commercial |
$13,037.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,206.88
|
| Rate for Payer: Cash Price |
$8,465.95
|
| Rate for Payer: Cigna Commercial |
$14,053.48
|
| Rate for Payer: First Health Commercial |
$16,085.31
|
| Rate for Payer: Humana Commercial |
$14,392.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,884.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,495.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,079.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,900.07
|
| Rate for Payer: Ohio Health Group HMO |
$12,698.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,545.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,730.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,683.01
|
| Rate for Payer: PHCS Commercial |
$16,254.62
|
| Rate for Payer: United Healthcare All Payer |
$14,900.07
|
|
|
PLATE LAPIDUS LEFT STD 626893
|
Facility
|
OP
|
$16,931.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,079.57 |
| Max. Negotiated Rate |
$16,254.62 |
| Rate for Payer: Aetna Commercial |
$13,037.56
|
| Rate for Payer: Anthem Medicaid |
$5,822.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,206.88
|
| Rate for Payer: Cash Price |
$8,465.95
|
| Rate for Payer: Cigna Commercial |
$14,053.48
|
| Rate for Payer: First Health Commercial |
$16,085.31
|
| Rate for Payer: Humana Commercial |
$14,392.11
|
| Rate for Payer: Humana KY Medicaid |
$5,822.88
|
| Rate for Payer: Kentucky WC Medicaid |
$5,882.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$13,884.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,495.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,079.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,939.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$14,900.07
|
| Rate for Payer: Ohio Health Group HMO |
$12,698.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,545.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$14,730.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,683.01
|
| Rate for Payer: PHCS Commercial |
$16,254.62
|
| Rate for Payer: United Healthcare All Payer |
$14,900.07
|
|
|
PLATE LAT DIS HM LK 11H 153M L
|
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 LAT DIS HM LK 11H 153M L
|
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 LAT DIS HM LK 11H 153M R
|
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 LAT DIS HM LK 11H 153M R
|
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 LAT DIS HM LK 7H 102M L
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DIS HM LK 7H 102M L
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DIS HM LK 7H 102M R
|
Facility
|
OP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem Medicaid |
$2,541.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Humana KY Medicaid |
$2,541.12
|
| Rate for Payer: Kentucky WC Medicaid |
$2,566.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DIS HM LK 7H 102M R
|
Facility
|
IP
|
$7,389.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,216.74 |
| Max. Negotiated Rate |
$7,093.56 |
| Rate for Payer: Aetna Commercial |
$5,689.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.51
|
| Rate for Payer: Cash Price |
$3,694.56
|
| Rate for Payer: Cigna Commercial |
$6,132.97
|
| Rate for Payer: First Health Commercial |
$7,019.66
|
| Rate for Payer: Humana Commercial |
$6,280.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.08
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,541.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,911.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,428.53
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,098.49
|
| Rate for Payer: PHCS Commercial |
$7,093.56
|
| Rate for Payer: United Healthcare All Payer |
$6,502.43
|
|
|
PLATE LAT DIS HM LK 9H 128M L
|
Facility
|
IP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LAT DIS HM LK 9H 128M L
|
Facility
|
OP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem Medicaid |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Humana KY Medicaid |
$2,664.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,691.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LAT DIS HM LK 9H 128M R
|
Facility
|
OP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem Medicaid |
$2,664.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Humana KY Medicaid |
$2,664.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,691.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,717.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LAT DIS HM LK 9H 128M R
|
Facility
|
IP
|
$7,747.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,324.10 |
| Max. Negotiated Rate |
$7,437.13 |
| Rate for Payer: Aetna Commercial |
$5,965.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,042.67
|
| Rate for Payer: Cash Price |
$3,873.50
|
| Rate for Payer: Cigna Commercial |
$6,430.02
|
| Rate for Payer: First Health Commercial |
$7,359.66
|
| Rate for Payer: Humana Commercial |
$6,584.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,352.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,717.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,324.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,817.37
|
| Rate for Payer: Ohio Health Group HMO |
$5,810.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,197.61
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,739.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,345.44
|
| Rate for Payer: PHCS Commercial |
$7,437.13
|
| Rate for Payer: United Healthcare All Payer |
$6,817.37
|
|
|
PLATE LAT DIST HM LK 5H 77M L
|
Facility
|
OP
|
$6,990.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,097.22 |
| Max. Negotiated Rate |
$6,711.10 |
| Rate for Payer: Aetna Commercial |
$5,382.86
|
| Rate for Payer: Anthem Medicaid |
$2,404.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,452.77
|
| Rate for Payer: Cash Price |
$3,495.36
|
| Rate for Payer: Cigna Commercial |
$5,802.31
|
| Rate for Payer: First Health Commercial |
$6,641.19
|
| Rate for Payer: Humana Commercial |
$5,942.12
|
| Rate for Payer: Humana KY Medicaid |
$2,404.11
|
| Rate for Payer: Kentucky WC Medicaid |
$2,428.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,732.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,159.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,097.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,452.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,151.84
|
| Rate for Payer: Ohio Health Group HMO |
$5,243.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,592.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,081.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,823.60
|
| Rate for Payer: PHCS Commercial |
$6,711.10
|
| Rate for Payer: United Healthcare All Payer |
$6,151.84
|
|
