|
PLATE POLYAX TIBIAL 5H LT
|
Facility
|
IP
|
$10,248.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,074.67 |
| Max. Negotiated Rate |
$9,838.94 |
| Rate for Payer: Aetna Commercial |
$7,891.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,994.14
|
| Rate for Payer: Cash Price |
$5,124.45
|
| Rate for Payer: Cigna Commercial |
$8,506.59
|
| Rate for Payer: First Health Commercial |
$9,736.45
|
| Rate for Payer: Humana Commercial |
$8,711.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,404.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,563.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,074.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,019.03
|
| Rate for Payer: Ohio Health Group HMO |
$7,686.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,199.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,916.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,071.74
|
| Rate for Payer: PHCS Commercial |
$9,838.94
|
| Rate for Payer: United Healthcare All Payer |
$9,019.03
|
|
|
PLATE POLYAX TIBIAL 5H RT
|
Facility
|
IP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
PLATE POLYAX TIBIAL 5H RT
|
Facility
|
OP
|
$8,767.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,630.10 |
| Max. Negotiated Rate |
$8,416.32 |
| Rate for Payer: Aetna Commercial |
$6,750.59
|
| Rate for Payer: Anthem Medicaid |
$3,014.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,838.26
|
| Rate for Payer: Cash Price |
$4,383.50
|
| Rate for Payer: Cigna Commercial |
$7,276.61
|
| Rate for Payer: First Health Commercial |
$8,328.65
|
| Rate for Payer: Humana Commercial |
$7,451.95
|
| Rate for Payer: Humana KY Medicaid |
$3,014.97
|
| Rate for Payer: Kentucky WC Medicaid |
$3,045.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,188.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,470.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,630.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,075.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,714.96
|
| Rate for Payer: Ohio Health Group HMO |
$6,575.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,013.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,627.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,049.23
|
| Rate for Payer: PHCS Commercial |
$8,416.32
|
| Rate for Payer: United Healthcare All Payer |
$7,714.96
|
|
|
PLATE POLYAX TIBIAL 8H RT
|
Facility
|
OP
|
$7,797.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.38 |
| Max. Negotiated Rate |
$7,486.00 |
| Rate for Payer: Aetna Commercial |
$6,004.40
|
| Rate for Payer: Anthem Medicaid |
$2,681.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,082.38
|
| Rate for Payer: Cash Price |
$3,898.96
|
| Rate for Payer: Cigna Commercial |
$6,472.27
|
| Rate for Payer: First Health Commercial |
$7,408.02
|
| Rate for Payer: Humana Commercial |
$6,628.23
|
| Rate for Payer: Humana KY Medicaid |
$2,681.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,709.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,394.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,754.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,339.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,735.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,862.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,848.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,238.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,784.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,380.56
|
| Rate for Payer: PHCS Commercial |
$7,486.00
|
| Rate for Payer: United Healthcare All Payer |
$6,862.17
|
|
|
PLATE POLYAX TIBIAL 8H RT
|
Facility
|
IP
|
$7,797.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,339.38 |
| Max. Negotiated Rate |
$7,486.00 |
| Rate for Payer: Aetna Commercial |
$6,004.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,082.38
|
| Rate for Payer: Cash Price |
$3,898.96
|
| Rate for Payer: Cigna Commercial |
$6,472.27
|
| Rate for Payer: First Health Commercial |
$7,408.02
|
| Rate for Payer: Humana Commercial |
$6,628.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,394.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,754.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,339.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,862.17
|
| Rate for Payer: Ohio Health Group HMO |
$5,848.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,238.34
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,784.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,380.56
|
| Rate for Payer: PHCS Commercial |
$7,486.00
|
| Rate for Payer: United Healthcare All Payer |
$6,862.17
|
|
|
PLATE POSTEROLATERAL FIB 3H L
|
Facility
|
IP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.00 |
| Max. Negotiated Rate |
$4,540.80 |
| Rate for Payer: Aetna Commercial |
$3,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.40
|
| Rate for Payer: Cash Price |
$2,365.00
|
| Rate for Payer: Cigna Commercial |
$3,925.90
|
| Rate for Payer: First Health Commercial |
$4,493.50
|
| Rate for Payer: Humana Commercial |
$4,020.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,878.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,115.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,263.70
|
| Rate for Payer: PHCS Commercial |
$4,540.80
|
| Rate for Payer: United Healthcare All Payer |
$4,162.40
|
|
|
PLATE POSTEROLATERAL FIB 3H L
|
Facility
|
OP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.00 |
| Max. Negotiated Rate |
$4,540.80 |
| Rate for Payer: Aetna Commercial |
$3,642.10
|
| Rate for Payer: Anthem Medicaid |
$1,626.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.40
|
| Rate for Payer: Cash Price |
$2,365.00
|
| Rate for Payer: Cigna Commercial |
$3,925.90
|
| Rate for Payer: First Health Commercial |
$4,493.50
|
| Rate for Payer: Humana Commercial |
$4,020.50
|
| Rate for Payer: Humana KY Medicaid |
$1,626.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,878.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,115.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,263.70
|
| Rate for Payer: PHCS Commercial |
$4,540.80
|
| Rate for Payer: United Healthcare All Payer |
$4,162.40
|
|
|
PLATE POSTEROLATERAL FIB 3H R
|
Facility
|
IP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.00 |
| Max. Negotiated Rate |
$4,540.80 |
| Rate for Payer: Aetna Commercial |
$3,642.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.40
|
| Rate for Payer: Cash Price |
$2,365.00
|
| Rate for Payer: Cigna Commercial |
$3,925.90
|
| Rate for Payer: First Health Commercial |
$4,493.50
|
| Rate for Payer: Humana Commercial |
$4,020.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,878.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,115.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,263.70
|
| Rate for Payer: PHCS Commercial |
$4,540.80
|
| Rate for Payer: United Healthcare All Payer |
$4,162.40
|
|
|
PLATE POSTEROLATERAL FIB 3H R
|
Facility
|
OP
|
$4,730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,419.00 |
| Max. Negotiated Rate |
$4,540.80 |
| Rate for Payer: Aetna Commercial |
$3,642.10
|
| Rate for Payer: Anthem Medicaid |
$1,626.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,689.40
|
| Rate for Payer: Cash Price |
$2,365.00
|
| Rate for Payer: Cigna Commercial |
$3,925.90
|
| Rate for Payer: First Health Commercial |
$4,493.50
|
| Rate for Payer: Humana Commercial |
$4,020.50
|
| Rate for Payer: Humana KY Medicaid |
$1,626.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,643.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,878.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,490.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,419.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,659.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,162.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,547.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,784.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,115.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,263.70
|
| Rate for Payer: PHCS Commercial |
$4,540.80
|
| Rate for Payer: United Healthcare All Payer |
$4,162.40
|
|
|
PLATE POSTEROLATERAL FIB 4H L
|
Facility
|
IP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
|
PLATE POSTEROLATERAL FIB 4H L
|
Facility
|
OP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem Medicaid |
$1,643.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Humana KY Medicaid |
$1,643.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
|
PLATE POSTEROLATERAL FIB 4H R
|
Facility
|
IP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
|
PLATE POSTEROLATERAL FIB 4H R
|
Facility
|
OP
|
$4,778.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.62 |
| Max. Negotiated Rate |
$4,587.60 |
| Rate for Payer: Aetna Commercial |
$3,679.64
|
| Rate for Payer: Anthem Medicaid |
$1,643.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,727.43
|
| Rate for Payer: Cash Price |
$2,389.38
|
| Rate for Payer: Cigna Commercial |
$3,966.36
|
| Rate for Payer: First Health Commercial |
$4,539.81
|
| Rate for Payer: Humana Commercial |
$4,061.94
|
| Rate for Payer: Humana KY Medicaid |
$1,643.41
|
| Rate for Payer: Kentucky WC Medicaid |
$1,660.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,918.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,526.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,433.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,676.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,205.30
|
| Rate for Payer: Ohio Health Group HMO |
$3,584.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,823.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,157.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,297.34
|
| Rate for Payer: PHCS Commercial |
$4,587.60
|
| Rate for Payer: United Healthcare All Payer |
$4,205.30
|
|
|
PLATE POSTEROLATERAL FIB 5H L
|
Facility
|
OP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem Medicaid |
$1,660.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Humana KY Medicaid |
$1,660.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,677.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,693.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE POSTEROLATERAL FIB 5H L
|
Facility
|
IP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE POSTEROLATERAL FIB 5H R
|
Facility
|
OP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem Medicaid |
$1,660.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Humana KY Medicaid |
$1,660.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,677.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,693.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE POSTEROLATERAL FIB 5H R
|
Facility
|
IP
|
$4,827.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,448.25 |
| Max. Negotiated Rate |
$4,634.40 |
| Rate for Payer: Aetna Commercial |
$3,717.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,765.45
|
| Rate for Payer: Cash Price |
$2,413.75
|
| Rate for Payer: Cigna Commercial |
$4,006.82
|
| Rate for Payer: First Health Commercial |
$4,586.12
|
| Rate for Payer: Humana Commercial |
$4,103.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,958.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,562.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,448.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,248.20
|
| Rate for Payer: Ohio Health Group HMO |
$3,620.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,862.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,199.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,330.97
|
| Rate for Payer: PHCS Commercial |
$4,634.40
|
| Rate for Payer: United Healthcare All Payer |
$4,248.20
|
|
|
PLATE POSTEROLATERAL FIB 6H L
|
Facility
|
OP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem Medicaid |
$1,676.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Humana KY Medicaid |
$1,676.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,710.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE POSTEROLATERAL FIB 6H L
|
Facility
|
IP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE POSTEROLATERAL FIB 6H R
|
Facility
|
IP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE POSTEROLATERAL FIB 6H R
|
Facility
|
OP
|
$4,876.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,462.88 |
| Max. Negotiated Rate |
$4,681.20 |
| Rate for Payer: Aetna Commercial |
$3,754.71
|
| Rate for Payer: Anthem Medicaid |
$1,676.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,803.47
|
| Rate for Payer: Cash Price |
$2,438.12
|
| Rate for Payer: Cigna Commercial |
$4,047.29
|
| Rate for Payer: First Health Commercial |
$4,632.44
|
| Rate for Payer: Humana Commercial |
$4,144.81
|
| Rate for Payer: Humana KY Medicaid |
$1,676.94
|
| Rate for Payer: Kentucky WC Medicaid |
$1,694.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,998.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,598.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,462.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,710.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,291.10
|
| Rate for Payer: Ohio Health Group HMO |
$3,657.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,901.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,242.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,364.61
|
| Rate for Payer: PHCS Commercial |
$4,681.20
|
| Rate for Payer: United Healthcare All Payer |
$4,291.10
|
|
|
PLATE POSTEROLATERAL FIB 7H L
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE POSTEROLATERAL FIB 7H L
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE POSTEROLATERAL FIB 7H R
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem Medicaid |
$1,693.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Humana KY Medicaid |
$1,693.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,710.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,727.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
|
PLATE POSTEROLATERAL FIB 7H R
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,477.50 |
| Max. Negotiated Rate |
$4,728.00 |
| Rate for Payer: Aetna Commercial |
$3,792.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,841.50
|
| Rate for Payer: Cash Price |
$2,462.50
|
| Rate for Payer: Cigna Commercial |
$4,087.75
|
| Rate for Payer: First Health Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial |
$4,186.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,038.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,634.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,477.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,334.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,693.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,940.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,284.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,398.25
|
| Rate for Payer: PHCS Commercial |
$4,728.00
|
| Rate for Payer: United Healthcare All Payer |
$4,334.00
|
|
