|
PLATE REVISION MED RT
|
Facility
|
IP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
|
|
PLATE REVISION MED RT
|
Facility
|
OP
|
$8,640.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,123.20 |
| Max. Negotiated Rate |
$8,294.40 |
| Rate for Payer: Aetna Commercial |
$6,652.80
|
| Rate for Payer: Anthem Medicaid |
$2,971.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,739.20
|
| Rate for Payer: Cash Price |
$4,320.00
|
| Rate for Payer: Cigna Commercial |
$7,171.20
|
| Rate for Payer: First Health Commercial |
$8,208.00
|
| Rate for Payer: Humana Commercial |
$7,344.00
|
| Rate for Payer: Humana KY Medicaid |
$2,971.30
|
| Rate for Payer: Kentucky WC Medicaid |
$3,001.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,084.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,376.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,592.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,030.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,603.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,480.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,123.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,678.40
|
| Rate for Payer: PHCS Commercial |
$8,294.40
|
| Rate for Payer: United Healthcare All Payer |
$7,603.20
|
|
|
PLATE REV MTP 2.7MM LT
|
Facility
|
OP
|
$6,659.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.71 |
| Max. Negotiated Rate |
$6,392.96 |
| Rate for Payer: Aetna Commercial |
$5,127.68
|
| Rate for Payer: Anthem Medicaid |
$2,290.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,194.28
|
| Rate for Payer: Cash Price |
$3,329.66
|
| Rate for Payer: Cigna Commercial |
$5,527.24
|
| Rate for Payer: First Health Commercial |
$6,326.36
|
| Rate for Payer: Humana Commercial |
$5,660.43
|
| Rate for Payer: Humana KY Medicaid |
$2,290.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,313.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,460.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,336.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,860.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,994.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.39
|
| Rate for Payer: PHCS Commercial |
$6,392.96
|
| Rate for Payer: United Healthcare All Payer |
$5,860.21
|
|
|
PLATE REV MTP 2.7MM LT
|
Facility
|
IP
|
$6,659.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.71 |
| Max. Negotiated Rate |
$6,392.96 |
| Rate for Payer: Aetna Commercial |
$5,127.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,194.28
|
| Rate for Payer: Cash Price |
$3,329.66
|
| Rate for Payer: Cigna Commercial |
$5,527.24
|
| Rate for Payer: First Health Commercial |
$6,326.36
|
| Rate for Payer: Humana Commercial |
$5,660.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,460.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,860.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,994.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.39
|
| Rate for Payer: PHCS Commercial |
$6,392.96
|
| Rate for Payer: United Healthcare All Payer |
$5,860.21
|
|
|
PLATE REV MTP 2.7MM RT
|
Facility
|
IP
|
$6,659.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.71 |
| Max. Negotiated Rate |
$6,392.96 |
| Rate for Payer: Aetna Commercial |
$5,127.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,194.28
|
| Rate for Payer: Cash Price |
$3,329.66
|
| Rate for Payer: Cigna Commercial |
$5,527.24
|
| Rate for Payer: First Health Commercial |
$6,326.36
|
| Rate for Payer: Humana Commercial |
$5,660.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,460.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,860.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,994.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.39
|
| Rate for Payer: PHCS Commercial |
$6,392.96
|
| Rate for Payer: United Healthcare All Payer |
$5,860.21
|
|
|
PLATE REV MTP 2.7MM RT
|
Facility
|
OP
|
$6,659.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$865.71 |
| Max. Negotiated Rate |
$6,392.96 |
| Rate for Payer: Aetna Commercial |
$5,127.68
|
| Rate for Payer: Anthem Medicaid |
$2,290.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,194.28
|
| Rate for Payer: Cash Price |
$3,329.66
|
| Rate for Payer: Cigna Commercial |
$5,527.24
|
| Rate for Payer: First Health Commercial |
$6,326.36
|
| Rate for Payer: Humana Commercial |
$5,660.43
|
| Rate for Payer: Humana KY Medicaid |
$2,290.14
|
| Rate for Payer: Kentucky WC Medicaid |
$2,313.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,460.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,914.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,997.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,336.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,860.21
|
| Rate for Payer: Ohio Health Group HMO |
$4,994.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,331.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$865.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,064.39
|
| Rate for Payer: PHCS Commercial |
$6,392.96
|
| Rate for Payer: United Healthcare All Payer |
$5,860.21
|
|
|
PLATE RIB LOCKING SEMI RIGID
|
Facility
|
IP
|
$10,621.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.85 |
| Max. Negotiated Rate |
$10,197.02 |
| Rate for Payer: Aetna Commercial |
$8,178.86
|
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,285.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$5,310.95
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$8,816.18
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: First Health Commercial |
$10,090.80
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana Commercial |
$9,028.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,709.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,838.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,186.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,347.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,966.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,380.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,292.79
|
| Rate for Payer: PHCS Commercial |
$10,197.02
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: United Healthcare All Payer |
$9,347.27
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
|
|
PLATE RIB LOCKING SEMI RIGID
|
Facility
|
OP
|
$10,621.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,380.85 |
| Max. Negotiated Rate |
$10,197.02 |
| Rate for Payer: Ohio Health Choice Commercial |
$9,347.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,059.30
|
| Rate for Payer: Ohio Health Group HMO |
$7,966.42
|
| Rate for Payer: Ohio Health Group HMO |
$6,868.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,831.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,380.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,190.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,292.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,839.07
|
| Rate for Payer: PHCS Commercial |
$8,791.97
|
| Rate for Payer: PHCS Commercial |
$10,197.02
|
| Rate for Payer: United Healthcare All Payer |
$8,059.30
|
| Rate for Payer: United Healthcare All Payer |
$9,347.27
|
| Rate for Payer: Aetna Commercial |
$8,178.86
|
| Rate for Payer: Aetna Commercial |
$7,051.89
|
| Rate for Payer: Anthem Medicaid |
$3,652.87
|
| Rate for Payer: Anthem Medicaid |
$3,149.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,285.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,143.47
|
| Rate for Payer: Cash Price |
$5,310.95
|
| Rate for Payer: Cash Price |
$4,579.15
|
| Rate for Payer: Cigna Commercial |
$7,601.39
|
| Rate for Payer: Cigna Commercial |
$8,816.18
|
| Rate for Payer: First Health Commercial |
$8,700.38
|
| Rate for Payer: First Health Commercial |
$10,090.80
|
| Rate for Payer: Humana Commercial |
$9,028.62
|
| Rate for Payer: Humana Commercial |
$7,784.56
|
| Rate for Payer: Humana KY Medicaid |
$3,652.87
|
| Rate for Payer: Humana KY Medicaid |
$3,149.54
|
| Rate for Payer: Kentucky WC Medicaid |
$3,181.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,690.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,709.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,509.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,758.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,838.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,747.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,186.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,726.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,212.73
|
|
|
PLATE S3 11HOLE LEFT
|
Facility
|
IP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Aetna Commercial |
$8,171.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
|
|
PLATE S3 11HOLE LEFT
|
Facility
|
OP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Aetna Commercial |
$8,171.56
|
| Rate for Payer: Anthem Medicaid |
$3,649.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Humana KY Medicaid |
$3,649.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,686.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,722.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
|
|
PLATE S3 11HOLE RIGHT
|
Facility
|
IP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
PLATE S3 11HOLE RIGHT
|
Facility
|
OP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem Medicaid |
$3,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Humana KY Medicaid |
$3,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
PLATE S3 14HOLE LEFT
|
Facility
|
OP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Aetna Commercial |
$8,171.56
|
| Rate for Payer: Anthem Medicaid |
$3,649.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Humana KY Medicaid |
$3,649.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,686.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,722.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
|
|
PLATE S3 14HOLE LEFT
|
Facility
|
IP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Aetna Commercial |
$8,171.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
|
|
PLATE S3 14HOLE RIGHT
|
Facility
|
IP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
PLATE S3 14HOLE RIGHT
|
Facility
|
OP
|
$9,899.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.90 |
| Max. Negotiated Rate |
$9,503.28 |
| Rate for Payer: Aetna Commercial |
$7,622.42
|
| Rate for Payer: Anthem Medicaid |
$3,404.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,721.42
|
| Rate for Payer: Cash Price |
$4,949.62
|
| Rate for Payer: Cigna Commercial |
$8,216.38
|
| Rate for Payer: First Health Commercial |
$9,404.29
|
| Rate for Payer: Humana Commercial |
$8,414.36
|
| Rate for Payer: Humana KY Medicaid |
$3,404.35
|
| Rate for Payer: Kentucky WC Medicaid |
$3,439.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,117.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,305.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,969.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,472.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,711.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,424.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,068.77
|
| Rate for Payer: PHCS Commercial |
$9,503.28
|
| Rate for Payer: United Healthcare All Payer |
$8,711.34
|
|
|
PLATE S3 3HOLE LEFT
|
Facility
|
OP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem Medicaid |
$3,018.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Humana KY Medicaid |
$3,018.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 3HOLE LEFT
|
Facility
|
IP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 3HOLE RIGHT
|
Facility
|
IP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 3HOLE RIGHT
|
Facility
|
OP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem Medicaid |
$3,018.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Humana KY Medicaid |
$3,018.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 4HOLE LEFT
|
Facility
|
OP
|
$8,121.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.82 |
| Max. Negotiated Rate |
$7,796.83 |
| Rate for Payer: Aetna Commercial |
$6,253.71
|
| Rate for Payer: Anthem Medicaid |
$2,793.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,334.93
|
| Rate for Payer: Cash Price |
$4,060.85
|
| Rate for Payer: Cigna Commercial |
$6,741.01
|
| Rate for Payer: First Health Commercial |
$7,715.62
|
| Rate for Payer: Humana Commercial |
$6,903.44
|
| Rate for Payer: Humana KY Medicaid |
$2,793.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,821.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,659.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,993.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,436.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,849.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,147.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,091.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,517.73
|
| Rate for Payer: PHCS Commercial |
$7,796.83
|
| Rate for Payer: United Healthcare All Payer |
$7,147.10
|
|
|
PLATE S3 4HOLE LEFT
|
Facility
|
IP
|
$8,121.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,055.82 |
| Max. Negotiated Rate |
$7,796.83 |
| Rate for Payer: Aetna Commercial |
$6,253.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,334.93
|
| Rate for Payer: Cash Price |
$4,060.85
|
| Rate for Payer: Cigna Commercial |
$6,741.01
|
| Rate for Payer: First Health Commercial |
$7,715.62
|
| Rate for Payer: Humana Commercial |
$6,903.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,659.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,993.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,436.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,147.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,091.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,624.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,055.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,517.73
|
| Rate for Payer: PHCS Commercial |
$7,796.83
|
| Rate for Payer: United Healthcare All Payer |
$7,147.10
|
|
|
PLATE S3 4HOLE RIGHT
|
Facility
|
OP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem Medicaid |
$3,018.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Humana KY Medicaid |
$3,018.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,049.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,079.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 4HOLE RIGHT
|
Facility
|
IP
|
$8,778.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,141.23 |
| Max. Negotiated Rate |
$8,427.55 |
| Rate for Payer: Aetna Commercial |
$6,759.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,847.39
|
| Rate for Payer: Cash Price |
$4,389.35
|
| Rate for Payer: Cigna Commercial |
$7,286.32
|
| Rate for Payer: First Health Commercial |
$8,339.76
|
| Rate for Payer: Humana Commercial |
$7,461.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,198.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,478.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,633.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,725.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,584.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,755.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,141.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,721.40
|
| Rate for Payer: PHCS Commercial |
$8,427.55
|
| Rate for Payer: United Healthcare All Payer |
$7,725.26
|
|
|
PLATE S3 6HOLE LEFT
|
Facility
|
OP
|
$10,612.41
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,379.61 |
| Max. Negotiated Rate |
$10,187.91 |
| Rate for Payer: Anthem Medicaid |
$3,649.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,277.68
|
| Rate for Payer: Cash Price |
$5,306.20
|
| Rate for Payer: Cigna Commercial |
$8,808.30
|
| Rate for Payer: First Health Commercial |
$10,081.79
|
| Rate for Payer: Humana Commercial |
$9,020.55
|
| Rate for Payer: Humana KY Medicaid |
$3,649.61
|
| Rate for Payer: Kentucky WC Medicaid |
$3,686.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,702.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,831.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,183.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,722.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,338.92
|
| Rate for Payer: Ohio Health Group HMO |
$7,959.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,122.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,379.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,289.85
|
| Rate for Payer: PHCS Commercial |
$10,187.91
|
| Rate for Payer: United Healthcare All Payer |
$9,338.92
|
| Rate for Payer: Aetna Commercial |
$8,171.56
|
|
