|
PLATE SUPERIOR DECREASED 10H R
|
Facility
|
IP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE SUPERIOR DECREASED 6H L
|
Facility
|
IP
|
$4,949.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.49 |
| Max. Negotiated Rate |
$4,751.95 |
| Rate for Payer: Aetna Commercial |
$3,811.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,860.96
|
| Rate for Payer: Cash Price |
$2,474.98
|
| Rate for Payer: Cigna Commercial |
$4,108.46
|
| Rate for Payer: First Health Commercial |
$4,702.45
|
| Rate for Payer: Humana Commercial |
$4,207.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,058.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,355.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.48
|
| Rate for Payer: PHCS Commercial |
$4,751.95
|
| Rate for Payer: United Healthcare All Payer |
$4,355.96
|
|
|
PLATE SUPERIOR DECREASED 6H L
|
Facility
|
OP
|
$4,949.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.49 |
| Max. Negotiated Rate |
$4,751.95 |
| Rate for Payer: Aetna Commercial |
$3,811.46
|
| Rate for Payer: Anthem Medicaid |
$1,702.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,860.96
|
| Rate for Payer: Cash Price |
$2,474.98
|
| Rate for Payer: Cigna Commercial |
$4,108.46
|
| Rate for Payer: First Health Commercial |
$4,702.45
|
| Rate for Payer: Humana Commercial |
$4,207.46
|
| Rate for Payer: Humana KY Medicaid |
$1,702.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,719.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,058.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,736.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,355.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.48
|
| Rate for Payer: PHCS Commercial |
$4,751.95
|
| Rate for Payer: United Healthcare All Payer |
$4,355.96
|
|
|
PLATE SUPERIOR DECREASED 6H R
|
Facility
|
OP
|
$4,949.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.49 |
| Max. Negotiated Rate |
$4,751.95 |
| Rate for Payer: Aetna Commercial |
$3,811.46
|
| Rate for Payer: Anthem Medicaid |
$1,702.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,860.96
|
| Rate for Payer: Cash Price |
$2,474.98
|
| Rate for Payer: Cigna Commercial |
$4,108.46
|
| Rate for Payer: First Health Commercial |
$4,702.45
|
| Rate for Payer: Humana Commercial |
$4,207.46
|
| Rate for Payer: Humana KY Medicaid |
$1,702.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,719.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,058.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,736.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,355.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.48
|
| Rate for Payer: PHCS Commercial |
$4,751.95
|
| Rate for Payer: United Healthcare All Payer |
$4,355.96
|
|
|
PLATE SUPERIOR DECREASED 6H R
|
Facility
|
IP
|
$4,949.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.49 |
| Max. Negotiated Rate |
$4,751.95 |
| Rate for Payer: Humana Commercial |
$4,207.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,058.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,355.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.48
|
| Rate for Payer: PHCS Commercial |
$4,751.95
|
| Rate for Payer: United Healthcare All Payer |
$4,355.96
|
| Rate for Payer: Aetna Commercial |
$3,811.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,860.96
|
| Rate for Payer: Cash Price |
$2,474.98
|
| Rate for Payer: Cigna Commercial |
$4,108.46
|
| Rate for Payer: First Health Commercial |
$4,702.45
|
|
|
PLATE SUPERIOR DECREASED 7H L
|
Facility
|
IP
|
$6,899.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.97 |
| Max. Negotiated Rate |
$6,623.76 |
| Rate for Payer: Aetna Commercial |
$5,312.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,381.80
|
| Rate for Payer: Cash Price |
$3,449.88
|
| Rate for Payer: Cigna Commercial |
$5,726.79
|
| Rate for Payer: First Health Commercial |
$6,554.76
|
| Rate for Payer: Humana Commercial |
$5,864.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,657.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,092.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,069.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,071.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,174.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.92
|
| Rate for Payer: PHCS Commercial |
$6,623.76
|
| Rate for Payer: United Healthcare All Payer |
$6,071.78
|
|
|
PLATE SUPERIOR DECREASED 7H L
|
Facility
|
OP
|
$6,899.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.97 |
| Max. Negotiated Rate |
$6,623.76 |
| Rate for Payer: Aetna Commercial |
$5,312.81
|
| Rate for Payer: Anthem Medicaid |
$2,372.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,381.80
|
| Rate for Payer: Cash Price |
$3,449.88
|
| Rate for Payer: Cigna Commercial |
$5,726.79
|
| Rate for Payer: First Health Commercial |
$6,554.76
|
| Rate for Payer: Humana Commercial |
$5,864.79
|
| Rate for Payer: Humana KY Medicaid |
$2,372.82
|
| Rate for Payer: Kentucky WC Medicaid |
$2,396.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,657.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,092.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,069.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,420.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,071.78
|
| Rate for Payer: Ohio Health Group HMO |
$5,174.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,379.95
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$896.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,138.92
|
| Rate for Payer: PHCS Commercial |
$6,623.76
|
| Rate for Payer: United Healthcare All Payer |
$6,071.78
|
|
|
PLATE SUPERIOR DECREASED 7H R
|
Facility
|
OP
|
$4,949.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.49 |
| Max. Negotiated Rate |
$4,751.95 |
| Rate for Payer: Aetna Commercial |
$3,811.46
|
| Rate for Payer: Anthem Medicaid |
$1,702.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,860.96
|
| Rate for Payer: Cash Price |
$2,474.98
|
| Rate for Payer: Cigna Commercial |
$4,108.46
|
| Rate for Payer: First Health Commercial |
$4,702.45
|
| Rate for Payer: Humana Commercial |
$4,207.46
|
| Rate for Payer: Humana KY Medicaid |
$1,702.29
|
| Rate for Payer: Kentucky WC Medicaid |
$1,719.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,058.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,736.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,355.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.48
|
| Rate for Payer: PHCS Commercial |
$4,751.95
|
| Rate for Payer: United Healthcare All Payer |
$4,355.96
|
|
|
PLATE SUPERIOR DECREASED 7H R
|
Facility
|
IP
|
$4,949.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$643.49 |
| Max. Negotiated Rate |
$4,751.95 |
| Rate for Payer: Aetna Commercial |
$3,811.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,860.96
|
| Rate for Payer: Cash Price |
$2,474.98
|
| Rate for Payer: Cigna Commercial |
$4,108.46
|
| Rate for Payer: First Health Commercial |
$4,702.45
|
| Rate for Payer: Humana Commercial |
$4,207.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,058.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,653.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,484.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,355.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,712.46
|
| Rate for Payer: Ohio Health Group PPO Differential |
$989.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$643.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,534.48
|
| Rate for Payer: PHCS Commercial |
$4,751.95
|
| Rate for Payer: United Healthcare All Payer |
$4,355.96
|
|
|
PLATE SUPERIOR DECREASED 8H L
|
Facility
|
IP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE SUPERIOR DECREASED 8H L
|
Facility
|
OP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem Medicaid |
$1,807.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Humana KY Medicaid |
$1,807.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,825.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,843.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE SUPERIOR DECREASED 8H R
|
Facility
|
OP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Humana KY Medicaid |
$1,807.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,825.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,843.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem Medicaid |
$1,807.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
|
|
PLATE SUPERIOR DECREASED 8H R
|
Facility
|
IP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE SUPERIOR LATERAL 3H R
|
Facility
|
OP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem Medicaid |
$1,807.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Humana KY Medicaid |
$1,807.37
|
| Rate for Payer: Kentucky WC Medicaid |
$1,825.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,843.63
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE SUPERIOR LATERAL 3H R
|
Facility
|
IP
|
$5,255.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$683.22 |
| Max. Negotiated Rate |
$5,045.28 |
| Rate for Payer: Aetna Commercial |
$4,046.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,099.29
|
| Rate for Payer: Cash Price |
$2,627.75
|
| Rate for Payer: Cigna Commercial |
$4,362.06
|
| Rate for Payer: First Health Commercial |
$4,992.72
|
| Rate for Payer: Humana Commercial |
$4,467.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,309.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,878.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,576.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,624.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,941.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,051.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$683.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,629.20
|
| Rate for Payer: PHCS Commercial |
$5,045.28
|
| Rate for Payer: United Healthcare All Payer |
$4,624.84
|
|
|
PLATE SUPERIOR LATERAL 4H L
|
Facility
|
IP
|
$10,767.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.83 |
| Max. Negotiated Rate |
$10,337.18 |
| Rate for Payer: Aetna Commercial |
$8,291.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,398.96
|
| Rate for Payer: Cash Price |
$5,383.95
|
| Rate for Payer: Cigna Commercial |
$8,937.36
|
| Rate for Payer: First Health Commercial |
$10,229.50
|
| Rate for Payer: Humana Commercial |
$9,152.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,829.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,946.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,230.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,475.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,075.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.05
|
| Rate for Payer: PHCS Commercial |
$10,337.18
|
| Rate for Payer: United Healthcare All Payer |
$9,475.75
|
|
|
PLATE SUPERIOR LATERAL 4H L
|
Facility
|
OP
|
$10,767.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,399.83 |
| Max. Negotiated Rate |
$10,337.18 |
| Rate for Payer: Aetna Commercial |
$8,291.28
|
| Rate for Payer: Anthem Medicaid |
$3,703.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,398.96
|
| Rate for Payer: Cash Price |
$5,383.95
|
| Rate for Payer: Cigna Commercial |
$8,937.36
|
| Rate for Payer: First Health Commercial |
$10,229.50
|
| Rate for Payer: Humana Commercial |
$9,152.72
|
| Rate for Payer: Humana KY Medicaid |
$3,703.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,740.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,829.68
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,946.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,230.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,777.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,475.75
|
| Rate for Payer: Ohio Health Group HMO |
$8,075.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,153.58
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,399.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,338.05
|
| Rate for Payer: PHCS Commercial |
$10,337.18
|
| Rate for Payer: United Healthcare All Payer |
$9,475.75
|
|
|
PLATE SUPERIOR LATERAL 5H L
|
Facility
|
IP
|
$7,807.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.91 |
| Max. Negotiated Rate |
$7,494.72 |
| Rate for Payer: Aetna Commercial |
$6,011.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,089.46
|
| Rate for Payer: Cash Price |
$3,903.50
|
| Rate for Payer: Cigna Commercial |
$6,479.81
|
| Rate for Payer: First Health Commercial |
$7,416.65
|
| Rate for Payer: Humana Commercial |
$6,635.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,401.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,761.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,870.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,855.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,561.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,420.17
|
| Rate for Payer: PHCS Commercial |
$7,494.72
|
| Rate for Payer: United Healthcare All Payer |
$6,870.16
|
|
|
PLATE SUPERIOR LATERAL 5H L
|
Facility
|
OP
|
$7,807.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.91 |
| Max. Negotiated Rate |
$7,494.72 |
| Rate for Payer: Aetna Commercial |
$6,011.39
|
| Rate for Payer: Anthem Medicaid |
$2,684.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,089.46
|
| Rate for Payer: Cash Price |
$3,903.50
|
| Rate for Payer: Cigna Commercial |
$6,479.81
|
| Rate for Payer: First Health Commercial |
$7,416.65
|
| Rate for Payer: Humana Commercial |
$6,635.95
|
| Rate for Payer: Humana KY Medicaid |
$2,684.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,712.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,401.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,761.57
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,738.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,870.16
|
| Rate for Payer: Ohio Health Group HMO |
$5,855.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,561.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,420.17
|
| Rate for Payer: PHCS Commercial |
$7,494.72
|
| Rate for Payer: United Healthcare All Payer |
$6,870.16
|
|
|
PLATE SUPERIOR LATERAL 7H R
|
Facility
|
OP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem Medicaid |
$2,820.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Humana KY Medicaid |
$2,820.67
|
| Rate for Payer: Kentucky WC Medicaid |
$2,849.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,877.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
PLATE SUPERIOR LATERAL 7H R
|
Facility
|
IP
|
$8,202.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,066.26 |
| Max. Negotiated Rate |
$7,873.92 |
| Rate for Payer: Aetna Commercial |
$6,315.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,397.56
|
| Rate for Payer: Cash Price |
$4,101.00
|
| Rate for Payer: Cigna Commercial |
$6,807.66
|
| Rate for Payer: First Health Commercial |
$7,791.90
|
| Rate for Payer: Humana Commercial |
$6,971.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,725.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,053.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,460.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,217.76
|
| Rate for Payer: Ohio Health Group HMO |
$6,151.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,640.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,066.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,542.62
|
| Rate for Payer: PHCS Commercial |
$7,873.92
|
| Rate for Payer: United Healthcare All Payer |
$7,217.76
|
|
|
PLATE SUP MED LCK 8H*97MM LEFT
|
Facility
|
OP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem Medicaid |
$1,587.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Humana KY Medicaid |
$1,587.16
|
| Rate for Payer: Kentucky WC Medicaid |
$1,603.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,619.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE SUP MED LCK 8H*97MM LEFT
|
Facility
|
IP
|
$4,615.18
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$599.97 |
| Max. Negotiated Rate |
$4,430.57 |
| Rate for Payer: Aetna Commercial |
$3,553.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,599.84
|
| Rate for Payer: Cash Price |
$2,307.59
|
| Rate for Payer: Cigna Commercial |
$3,830.60
|
| Rate for Payer: First Health Commercial |
$4,384.42
|
| Rate for Payer: Humana Commercial |
$3,922.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,784.45
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,406.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,384.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,061.36
|
| Rate for Payer: Ohio Health Group HMO |
$3,461.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$923.04
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$599.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,430.71
|
| Rate for Payer: PHCS Commercial |
$4,430.57
|
| Rate for Payer: United Healthcare All Payer |
$4,061.36
|
|
|
PLATE T 2.0MM 2X2 HOLE
|
Facility
|
IP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
|
|
PLATE T 2.0MM 2X2 HOLE
|
Facility
|
OP
|
$1,096.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$1,052.95 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Anthem Medicaid |
$377.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$855.52
|
| Rate for Payer: Cash Price |
$548.41
|
| Rate for Payer: Cigna Commercial |
$910.36
|
| Rate for Payer: First Health Commercial |
$1,041.98
|
| Rate for Payer: Humana Commercial |
$932.30
|
| Rate for Payer: Humana KY Medicaid |
$377.20
|
| Rate for Payer: Kentucky WC Medicaid |
$381.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$899.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$809.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$329.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$965.20
|
| Rate for Payer: Ohio Health Group HMO |
$822.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$219.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$142.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$340.01
|
| Rate for Payer: PHCS Commercial |
$1,052.95
|
| Rate for Payer: United Healthcare All Payer |
$965.20
|
|
