|
PLATE MINI STR 16H
|
Facility
|
IP
|
$1,909.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.94 |
| Max. Negotiated Rate |
$1,833.40 |
| Rate for Payer: Aetna Commercial |
$1,470.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.64
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cigna Commercial |
$1,585.13
|
| Rate for Payer: First Health Commercial |
$1,814.30
|
| Rate for Payer: Humana Commercial |
$1,623.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,527.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,661.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.76
|
| Rate for Payer: PHCS Commercial |
$1,833.40
|
| Rate for Payer: United Healthcare All Payer |
$1,680.62
|
|
|
PLATE MINI STR 16H
|
Facility
|
OP
|
$1,909.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.94 |
| Max. Negotiated Rate |
$1,833.40 |
| Rate for Payer: Aetna Commercial |
$1,470.54
|
| Rate for Payer: Anthem Medicaid |
$656.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,489.64
|
| Rate for Payer: Cash Price |
$954.89
|
| Rate for Payer: Cigna Commercial |
$1,585.13
|
| Rate for Payer: First Health Commercial |
$1,814.30
|
| Rate for Payer: Humana Commercial |
$1,623.32
|
| Rate for Payer: Humana KY Medicaid |
$656.78
|
| Rate for Payer: Kentucky WC Medicaid |
$663.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,566.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,409.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$572.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$669.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,680.62
|
| Rate for Payer: Ohio Health Group HMO |
$1,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,527.83
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,661.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,317.76
|
| Rate for Payer: PHCS Commercial |
$1,833.40
|
| Rate for Payer: United Healthcare All Payer |
$1,680.62
|
|
|
PLATE MINI STR CONDENSED 16H
|
Facility
|
IP
|
$3,504.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.34 |
| Max. Negotiated Rate |
$3,364.28 |
| Rate for Payer: Aetna Commercial |
$2,698.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.48
|
| Rate for Payer: Cash Price |
$1,752.23
|
| Rate for Payer: Cigna Commercial |
$2,908.70
|
| Rate for Payer: First Health Commercial |
$3,329.24
|
| Rate for Payer: Humana Commercial |
$2,978.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,586.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.08
|
| Rate for Payer: PHCS Commercial |
$3,364.28
|
| Rate for Payer: United Healthcare All Payer |
$3,083.92
|
|
|
PLATE MINI STR CONDENSED 16H
|
Facility
|
OP
|
$3,504.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,051.34 |
| Max. Negotiated Rate |
$3,364.28 |
| Rate for Payer: Aetna Commercial |
$2,698.43
|
| Rate for Payer: Anthem Medicaid |
$1,205.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,733.48
|
| Rate for Payer: Cash Price |
$1,752.23
|
| Rate for Payer: Cigna Commercial |
$2,908.70
|
| Rate for Payer: First Health Commercial |
$3,329.24
|
| Rate for Payer: Humana Commercial |
$2,978.79
|
| Rate for Payer: Humana KY Medicaid |
$1,205.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,217.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,873.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,586.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,051.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,229.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,083.92
|
| Rate for Payer: Ohio Health Group HMO |
$2,628.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,803.57
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,048.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,418.08
|
| Rate for Payer: PHCS Commercial |
$3,364.28
|
| Rate for Payer: United Healthcare All Payer |
$3,083.92
|
|
|
PLATE MIN-MD 1.5 COL 12H*2H L
|
Facility
|
IP
|
$7,206.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.88 |
| Max. Negotiated Rate |
$6,918.01 |
| Rate for Payer: Aetna Commercial |
$5,548.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.88
|
| Rate for Payer: Cash Price |
$3,603.13
|
| Rate for Payer: Cigna Commercial |
$5,981.20
|
| Rate for Payer: First Health Commercial |
$6,845.95
|
| Rate for Payer: Humana Commercial |
$6,125.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,909.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,318.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,341.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,765.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,269.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,972.32
|
| Rate for Payer: PHCS Commercial |
$6,918.01
|
| Rate for Payer: United Healthcare All Payer |
$6,341.51
|
|
|
PLATE MIN-MD 1.5 COL 12H*2H L
|
Facility
|
OP
|
$7,206.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.88 |
| Max. Negotiated Rate |
$6,918.01 |
| Rate for Payer: Aetna Commercial |
$5,548.82
|
| Rate for Payer: Anthem Medicaid |
$2,478.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.88
|
| Rate for Payer: Cash Price |
$3,603.13
|
| Rate for Payer: Cigna Commercial |
$5,981.20
|
| Rate for Payer: First Health Commercial |
$6,845.95
|
| Rate for Payer: Humana Commercial |
$6,125.32
|
| Rate for Payer: Humana KY Medicaid |
$2,478.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,503.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,909.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,318.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,341.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,765.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,269.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,972.32
|
| Rate for Payer: PHCS Commercial |
$6,918.01
|
| Rate for Payer: United Healthcare All Payer |
$6,341.51
|
|
|
PLATE MIN-MD 1.5 COL 12H*2H R
|
Facility
|
OP
|
$7,206.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.88 |
| Max. Negotiated Rate |
$6,918.01 |
| Rate for Payer: Aetna Commercial |
$5,548.82
|
| Rate for Payer: Anthem Medicaid |
$2,478.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.88
|
| Rate for Payer: Cash Price |
$3,603.13
|
| Rate for Payer: Cigna Commercial |
$5,981.20
|
| Rate for Payer: First Health Commercial |
$6,845.95
|
| Rate for Payer: Humana Commercial |
$6,125.32
|
| Rate for Payer: Humana KY Medicaid |
$2,478.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,503.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,909.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,318.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,527.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,341.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,765.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,269.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,972.32
|
| Rate for Payer: PHCS Commercial |
$6,918.01
|
| Rate for Payer: United Healthcare All Payer |
$6,341.51
|
|
|
PLATE MIN-MD 1.5 COL 12H*2H R
|
Facility
|
IP
|
$7,206.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,161.88 |
| Max. Negotiated Rate |
$6,918.01 |
| Rate for Payer: Aetna Commercial |
$5,548.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,620.88
|
| Rate for Payer: Cash Price |
$3,603.13
|
| Rate for Payer: Cigna Commercial |
$5,981.20
|
| Rate for Payer: First Health Commercial |
$6,845.95
|
| Rate for Payer: Humana Commercial |
$6,125.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,909.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,318.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,161.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,341.51
|
| Rate for Payer: Ohio Health Group HMO |
$5,404.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,765.01
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,269.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,972.32
|
| Rate for Payer: PHCS Commercial |
$6,918.01
|
| Rate for Payer: United Healthcare All Payer |
$6,341.51
|
|
|
PLATE MIN-MD 1.5 COL 6H*2H L
|
Facility
|
IP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
|
PLATE MIN-MD 1.5 COL 6H*2H L
|
Facility
|
OP
|
$5,693.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,708.01 |
| Max. Negotiated Rate |
$5,465.64 |
| Rate for Payer: Aetna Commercial |
$4,383.90
|
| Rate for Payer: Anthem Medicaid |
$1,957.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,440.84
|
| Rate for Payer: Cash Price |
$2,846.69
|
| Rate for Payer: Cigna Commercial |
$4,725.51
|
| Rate for Payer: First Health Commercial |
$5,408.71
|
| Rate for Payer: Humana Commercial |
$4,839.37
|
| Rate for Payer: Humana KY Medicaid |
$1,957.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,977.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,668.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,201.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,708.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,997.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,010.17
|
| Rate for Payer: Ohio Health Group HMO |
$4,270.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,554.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,953.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,928.43
|
| Rate for Payer: PHCS Commercial |
$5,465.64
|
| Rate for Payer: United Healthcare All Payer |
$5,010.17
|
|
|
PLATE MPT 0^ SM LEFT
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
PLATE MPT 0^ SM LEFT
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
PLATE MPT 5^ SM LEFT
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
PLATE MPT 5^ SM LEFT
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
PLATE MTP 0*SHORT RIGHT
|
Facility
|
IP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
PLATE MTP 0*SHORT RIGHT
|
Facility
|
OP
|
$7,562.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.75 |
| Max. Negotiated Rate |
$7,260.00 |
| Rate for Payer: Aetna Commercial |
$5,823.12
|
| Rate for Payer: Anthem Medicaid |
$2,600.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,898.75
|
| Rate for Payer: Cash Price |
$3,781.25
|
| Rate for Payer: Cigna Commercial |
$6,276.88
|
| Rate for Payer: First Health Commercial |
$7,184.38
|
| Rate for Payer: Humana Commercial |
$6,428.12
|
| Rate for Payer: Humana KY Medicaid |
$2,600.74
|
| Rate for Payer: Kentucky WC Medicaid |
$2,627.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,201.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,581.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,268.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,655.00
|
| Rate for Payer: Ohio Health Group HMO |
$5,671.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,050.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,579.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,218.12
|
| Rate for Payer: PHCS Commercial |
$7,260.00
|
| Rate for Payer: United Healthcare All Payer |
$6,655.00
|
|
|
PLATE MTP 48 STRAIGHT LEFT
|
Facility
|
OP
|
$7,891.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.30 |
| Max. Negotiated Rate |
$7,575.36 |
| Rate for Payer: Aetna Commercial |
$6,076.07
|
| Rate for Payer: Anthem Medicaid |
$2,713.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,154.98
|
| Rate for Payer: Cash Price |
$3,945.50
|
| Rate for Payer: Cigna Commercial |
$6,549.53
|
| Rate for Payer: First Health Commercial |
$7,496.45
|
| Rate for Payer: Humana Commercial |
$6,707.35
|
| Rate for Payer: Humana KY Medicaid |
$2,713.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,470.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,768.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.79
|
| Rate for Payer: PHCS Commercial |
$7,575.36
|
| Rate for Payer: United Healthcare All Payer |
$6,944.08
|
|
|
PLATE MTP 48 STRAIGHT LEFT
|
Facility
|
IP
|
$7,891.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.30 |
| Max. Negotiated Rate |
$7,575.36 |
| Rate for Payer: Aetna Commercial |
$6,076.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,154.98
|
| Rate for Payer: Cash Price |
$3,945.50
|
| Rate for Payer: Cigna Commercial |
$6,549.53
|
| Rate for Payer: First Health Commercial |
$7,496.45
|
| Rate for Payer: Humana Commercial |
$6,707.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,470.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.56
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.08
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,312.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,444.79
|
| Rate for Payer: PHCS Commercial |
$7,575.36
|
| Rate for Payer: United Healthcare All Payer |
$6,944.08
|
|
|
PLATE MTP CP 5H R
|
Facility
|
IP
|
$12,954.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.42 |
| Max. Negotiated Rate |
$12,436.54 |
| Rate for Payer: Aetna Commercial |
$9,975.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,104.69
|
| Rate for Payer: Cash Price |
$6,477.36
|
| Rate for Payer: Cigna Commercial |
$10,752.43
|
| Rate for Payer: First Health Commercial |
$12,306.99
|
| Rate for Payer: Humana Commercial |
$11,011.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,622.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,560.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,400.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,716.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,363.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,270.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,938.76
|
| Rate for Payer: PHCS Commercial |
$12,436.54
|
| Rate for Payer: United Healthcare All Payer |
$11,400.16
|
|
|
PLATE MTP CP 5H R
|
Facility
|
OP
|
$12,954.73
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,886.42 |
| Max. Negotiated Rate |
$12,436.54 |
| Rate for Payer: Aetna Commercial |
$9,975.14
|
| Rate for Payer: Anthem Medicaid |
$4,455.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,104.69
|
| Rate for Payer: Cash Price |
$6,477.36
|
| Rate for Payer: Cigna Commercial |
$10,752.43
|
| Rate for Payer: First Health Commercial |
$12,306.99
|
| Rate for Payer: Humana Commercial |
$11,011.52
|
| Rate for Payer: Humana KY Medicaid |
$4,455.13
|
| Rate for Payer: Kentucky WC Medicaid |
$4,500.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,622.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,560.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,886.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,544.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,400.16
|
| Rate for Payer: Ohio Health Group HMO |
$9,716.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,363.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,270.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,938.76
|
| Rate for Payer: PHCS Commercial |
$12,436.54
|
| Rate for Payer: United Healthcare All Payer |
$11,400.16
|
|
|
PLATE MTP FUSION EXT LEFT
|
Facility
|
OP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem Medicaid |
$2,594.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Humana KY Medicaid |
$2,594.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,620.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION EXT LEFT
|
Facility
|
IP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION EXT RIGHT
|
Facility
|
OP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem Medicaid |
$2,594.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Humana KY Medicaid |
$2,594.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,620.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,646.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION EXT RIGHT
|
Facility
|
IP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
|
PLATE MTP FUSION SM LEFT
|
Facility
|
IP
|
$7,544.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,263.28 |
| Max. Negotiated Rate |
$7,242.48 |
| Rate for Payer: Aetna Commercial |
$5,809.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,884.52
|
| Rate for Payer: Cash Price |
$3,772.12
|
| Rate for Payer: Cigna Commercial |
$6,261.73
|
| Rate for Payer: First Health Commercial |
$7,167.04
|
| Rate for Payer: Humana Commercial |
$6,412.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,186.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,567.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,263.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,638.94
|
| Rate for Payer: Ohio Health Group HMO |
$5,658.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,035.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,563.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,205.53
|
| Rate for Payer: PHCS Commercial |
$7,242.48
|
| Rate for Payer: United Healthcare All Payer |
$6,638.94
|
|
