|
PLATE RECON LK 3.5MM 14 166MM
|
Facility
|
OP
|
$4,462.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.84 |
| Max. Negotiated Rate |
$4,284.30 |
| Rate for Payer: Aetna Commercial |
$3,436.36
|
| Rate for Payer: Anthem Medicaid |
$1,534.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,480.99
|
| Rate for Payer: Cash Price |
$2,231.41
|
| Rate for Payer: Cigna Commercial |
$3,704.13
|
| Rate for Payer: First Health Commercial |
$4,239.67
|
| Rate for Payer: Humana Commercial |
$3,793.39
|
| Rate for Payer: Humana KY Medicaid |
$1,534.76
|
| Rate for Payer: Kentucky WC Medicaid |
$1,550.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,565.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.34
|
| Rate for Payer: PHCS Commercial |
$4,284.30
|
| Rate for Payer: United Healthcare All Payer |
$3,927.27
|
|
|
PLATE RECON LK 3.5MM 14 166MM
|
Facility
|
IP
|
$4,462.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,338.84 |
| Max. Negotiated Rate |
$4,284.30 |
| Rate for Payer: Aetna Commercial |
$3,436.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,480.99
|
| Rate for Payer: Cash Price |
$2,231.41
|
| Rate for Payer: Cigna Commercial |
$3,704.13
|
| Rate for Payer: First Health Commercial |
$4,239.67
|
| Rate for Payer: Humana Commercial |
$3,793.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,659.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,293.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,338.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,927.27
|
| Rate for Payer: Ohio Health Group HMO |
$3,347.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,570.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,882.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,079.34
|
| Rate for Payer: PHCS Commercial |
$4,284.30
|
| Rate for Payer: United Healthcare All Payer |
$3,927.27
|
|
|
PLATE RECON LT 4H
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE RECON LT 4H
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem Medicaid |
$1,172.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Humana KY Medicaid |
$1,172.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE RECON RT 4H
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE RECON RT 4H
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,023.00 |
| Max. Negotiated Rate |
$3,273.60 |
| Rate for Payer: Aetna Commercial |
$2,625.70
|
| Rate for Payer: Anthem Medicaid |
$1,172.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,659.80
|
| Rate for Payer: Cash Price |
$1,705.00
|
| Rate for Payer: Cigna Commercial |
$2,830.30
|
| Rate for Payer: First Health Commercial |
$3,239.50
|
| Rate for Payer: Humana Commercial |
$2,898.50
|
| Rate for Payer: Humana KY Medicaid |
$1,172.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,184.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,796.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,516.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,023.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,196.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,000.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,557.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,728.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,966.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,352.90
|
| Rate for Payer: PHCS Commercial |
$3,273.60
|
| Rate for Payer: United Healthcare All Payer |
$3,000.80
|
|
|
PLATE REDUCT WIRE 1.25 LG STOP
|
Facility
|
IP
|
$1,972.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.68 |
| Max. Negotiated Rate |
$1,893.37 |
| Rate for Payer: Aetna Commercial |
$1,518.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.36
|
| Rate for Payer: Cash Price |
$986.13
|
| Rate for Payer: Cigna Commercial |
$1,636.98
|
| Rate for Payer: First Health Commercial |
$1,873.65
|
| Rate for Payer: Humana Commercial |
$1,676.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,577.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,715.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.86
|
| Rate for Payer: PHCS Commercial |
$1,893.37
|
| Rate for Payer: United Healthcare All Payer |
$1,735.59
|
|
|
PLATE REDUCT WIRE 1.25 LG STOP
|
Facility
|
OP
|
$1,972.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.68 |
| Max. Negotiated Rate |
$1,893.37 |
| Rate for Payer: Aetna Commercial |
$1,518.64
|
| Rate for Payer: Anthem Medicaid |
$678.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,538.36
|
| Rate for Payer: Cash Price |
$986.13
|
| Rate for Payer: Cigna Commercial |
$1,636.98
|
| Rate for Payer: First Health Commercial |
$1,873.65
|
| Rate for Payer: Humana Commercial |
$1,676.42
|
| Rate for Payer: Humana KY Medicaid |
$678.26
|
| Rate for Payer: Kentucky WC Medicaid |
$685.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,617.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,455.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$591.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$691.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,735.59
|
| Rate for Payer: Ohio Health Group HMO |
$1,479.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,577.81
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,715.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,360.86
|
| Rate for Payer: PHCS Commercial |
$1,893.37
|
| Rate for Payer: United Healthcare All Payer |
$1,735.59
|
|
|
PLATE REDUCT WIRE 1.25 SM STOP
|
Facility
|
IP
|
$1,943.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.99 |
| Max. Negotiated Rate |
$1,865.57 |
| Rate for Payer: Aetna Commercial |
$1,496.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.77
|
| Rate for Payer: Cash Price |
$971.65
|
| Rate for Payer: Cigna Commercial |
$1,612.94
|
| Rate for Payer: First Health Commercial |
$1,846.13
|
| Rate for Payer: Humana Commercial |
$1,651.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,593.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,434.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,710.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,457.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,554.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.88
|
| Rate for Payer: PHCS Commercial |
$1,865.57
|
| Rate for Payer: United Healthcare All Payer |
$1,710.10
|
|
|
PLATE REDUCT WIRE 1.25 SM STOP
|
Facility
|
OP
|
$1,943.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$582.99 |
| Max. Negotiated Rate |
$1,865.57 |
| Rate for Payer: Aetna Commercial |
$1,496.34
|
| Rate for Payer: Anthem Medicaid |
$668.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,515.77
|
| Rate for Payer: Cash Price |
$971.65
|
| Rate for Payer: Cigna Commercial |
$1,612.94
|
| Rate for Payer: First Health Commercial |
$1,846.13
|
| Rate for Payer: Humana Commercial |
$1,651.81
|
| Rate for Payer: Humana KY Medicaid |
$668.30
|
| Rate for Payer: Kentucky WC Medicaid |
$675.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,593.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,434.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$582.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$681.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,710.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,457.47
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,554.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,690.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,340.88
|
| Rate for Payer: PHCS Commercial |
$1,865.57
|
| Rate for Payer: United Healthcare All Payer |
$1,710.10
|
|
|
PLATE REVISION MED RT
|
Facility
|
OP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem Medicaid |
$3,040.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Humana KY Medicaid |
$3,040.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,071.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,101.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLATE REVISION MED RT
|
Facility
|
IP
|
$8,840.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,652.00 |
| Max. Negotiated Rate |
$8,486.40 |
| Rate for Payer: Aetna Commercial |
$6,806.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,895.20
|
| Rate for Payer: Cash Price |
$4,420.00
|
| Rate for Payer: Cigna Commercial |
$7,337.20
|
| Rate for Payer: First Health Commercial |
$8,398.00
|
| Rate for Payer: Humana Commercial |
$7,514.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,248.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,523.92
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,779.20
|
| Rate for Payer: Ohio Health Group HMO |
$6,630.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,072.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,690.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,099.60
|
| Rate for Payer: PHCS Commercial |
$8,486.40
|
| Rate for Payer: United Healthcare All Payer |
$7,779.20
|
|
|
PLATE REV MTP 2.7MM LT
|
Facility
|
OP
|
$6,859.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,057.80 |
| Max. Negotiated Rate |
$6,584.96 |
| Rate for Payer: Aetna Commercial |
$5,281.68
|
| Rate for Payer: Anthem Medicaid |
$2,358.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,350.28
|
| Rate for Payer: Cash Price |
$3,429.66
|
| Rate for Payer: Cigna Commercial |
$5,693.24
|
| Rate for Payer: First Health Commercial |
$6,516.36
|
| Rate for Payer: Humana Commercial |
$5,830.43
|
| Rate for Payer: Humana KY Medicaid |
$2,358.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,382.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,036.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,487.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,967.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,732.94
|
| Rate for Payer: PHCS Commercial |
$6,584.96
|
| Rate for Payer: United Healthcare All Payer |
$6,036.21
|
|
|
PLATE REV MTP 2.7MM LT
|
Facility
|
IP
|
$6,859.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,057.80 |
| Max. Negotiated Rate |
$6,584.96 |
| Rate for Payer: Aetna Commercial |
$5,281.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,350.28
|
| Rate for Payer: Cash Price |
$3,429.66
|
| Rate for Payer: Cigna Commercial |
$5,693.24
|
| Rate for Payer: First Health Commercial |
$6,516.36
|
| Rate for Payer: Humana Commercial |
$5,830.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,036.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,487.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,967.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,732.94
|
| Rate for Payer: PHCS Commercial |
$6,584.96
|
| Rate for Payer: United Healthcare All Payer |
$6,036.21
|
|
|
PLATE REV MTP 2.7MM RT
|
Facility
|
OP
|
$6,859.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,057.80 |
| Max. Negotiated Rate |
$6,584.96 |
| Rate for Payer: Aetna Commercial |
$5,281.68
|
| Rate for Payer: Anthem Medicaid |
$2,358.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,350.28
|
| Rate for Payer: Cash Price |
$3,429.66
|
| Rate for Payer: Cigna Commercial |
$5,693.24
|
| Rate for Payer: First Health Commercial |
$6,516.36
|
| Rate for Payer: Humana Commercial |
$5,830.43
|
| Rate for Payer: Humana KY Medicaid |
$2,358.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,382.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,406.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,036.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,487.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,967.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,732.94
|
| Rate for Payer: PHCS Commercial |
$6,584.96
|
| Rate for Payer: United Healthcare All Payer |
$6,036.21
|
|
|
PLATE REV MTP 2.7MM RT
|
Facility
|
IP
|
$6,859.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,057.80 |
| Max. Negotiated Rate |
$6,584.96 |
| Rate for Payer: Aetna Commercial |
$5,281.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,350.28
|
| Rate for Payer: Cash Price |
$3,429.66
|
| Rate for Payer: Cigna Commercial |
$5,693.24
|
| Rate for Payer: First Health Commercial |
$6,516.36
|
| Rate for Payer: Humana Commercial |
$5,830.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,624.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,062.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,057.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,036.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,144.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,487.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,967.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,732.94
|
| Rate for Payer: PHCS Commercial |
$6,584.96
|
| Rate for Payer: United Healthcare All Payer |
$6,036.21
|
|
|
PLATE RIB LOCKING SEMI RIGID
|
Facility
|
OP
|
$10,862.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.61 |
| Max. Negotiated Rate |
$10,427.54 |
| Rate for Payer: Aetna Commercial |
$8,363.76
|
| Rate for Payer: Aetna Commercial |
$6,265.22
|
| Rate for Payer: Anthem Medicaid |
$3,735.45
|
| Rate for Payer: Anthem Medicaid |
$2,798.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,472.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,346.59
|
| Rate for Payer: Cash Price |
$5,431.01
|
| Rate for Payer: Cash Price |
$4,068.32
|
| Rate for Payer: Cigna Commercial |
$6,753.42
|
| Rate for Payer: Cigna Commercial |
$9,015.48
|
| Rate for Payer: First Health Commercial |
$7,729.82
|
| Rate for Payer: First Health Commercial |
$10,318.92
|
| Rate for Payer: Humana Commercial |
$9,232.72
|
| Rate for Payer: Humana Commercial |
$6,916.15
|
| Rate for Payer: Humana KY Medicaid |
$3,735.45
|
| Rate for Payer: Humana KY Medicaid |
$2,798.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,826.67
|
| Rate for Payer: Kentucky WC Medicaid |
$3,773.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,906.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,672.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,004.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,016.17
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,258.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,810.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,854.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,558.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,160.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,146.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,102.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,689.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,509.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,449.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,078.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,494.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,614.29
|
| Rate for Payer: PHCS Commercial |
$7,811.18
|
| Rate for Payer: PHCS Commercial |
$10,427.54
|
| Rate for Payer: United Healthcare All Payer |
$7,160.25
|
| Rate for Payer: United Healthcare All Payer |
$9,558.58
|
|
|
PLATE RIB LOCKING SEMI RIGID
|
Facility
|
IP
|
$10,862.02
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.61 |
| Max. Negotiated Rate |
$10,427.54 |
| Rate for Payer: Aetna Commercial |
$8,363.76
|
| Rate for Payer: Aetna Commercial |
$6,265.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,472.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,346.59
|
| Rate for Payer: Cash Price |
$5,431.01
|
| Rate for Payer: Cash Price |
$4,068.32
|
| Rate for Payer: Cigna Commercial |
$9,015.48
|
| Rate for Payer: Cigna Commercial |
$6,753.42
|
| Rate for Payer: First Health Commercial |
$7,729.82
|
| Rate for Payer: First Health Commercial |
$10,318.92
|
| Rate for Payer: Humana Commercial |
$6,916.15
|
| Rate for Payer: Humana Commercial |
$9,232.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,906.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,672.05
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,016.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,004.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,440.99
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,258.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,558.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,160.25
|
| Rate for Payer: Ohio Health Group HMO |
$8,146.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,102.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,689.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,509.32
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,449.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,078.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,614.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,494.79
|
| Rate for Payer: PHCS Commercial |
$10,427.54
|
| Rate for Payer: PHCS Commercial |
$7,811.18
|
| Rate for Payer: United Healthcare All Payer |
$9,558.58
|
| Rate for Payer: United Healthcare All Payer |
$7,160.25
|
|
|
PLATE S3 11HOLE LEFT
|
Facility
|
IP
|
$10,852.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,255.74 |
| Max. Negotiated Rate |
$10,418.38 |
| Rate for Payer: Aetna Commercial |
$8,356.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,464.93
|
| Rate for Payer: Cash Price |
$5,426.24
|
| Rate for Payer: Cigna Commercial |
$9,007.56
|
| Rate for Payer: First Health Commercial |
$10,309.86
|
| Rate for Payer: Humana Commercial |
$9,224.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,899.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,009.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,255.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,550.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,139.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,441.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,488.21
|
| Rate for Payer: PHCS Commercial |
$10,418.38
|
| Rate for Payer: United Healthcare All Payer |
$9,550.18
|
|
|
PLATE S3 11HOLE LEFT
|
Facility
|
OP
|
$10,852.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,255.74 |
| Max. Negotiated Rate |
$10,418.38 |
| Rate for Payer: Aetna Commercial |
$8,356.41
|
| Rate for Payer: Anthem Medicaid |
$3,732.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,464.93
|
| Rate for Payer: Cash Price |
$5,426.24
|
| Rate for Payer: Cigna Commercial |
$9,007.56
|
| Rate for Payer: First Health Commercial |
$10,309.86
|
| Rate for Payer: Humana Commercial |
$9,224.61
|
| Rate for Payer: Humana KY Medicaid |
$3,732.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,770.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,899.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,009.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,255.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,807.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,550.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,139.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,441.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,488.21
|
| Rate for Payer: PHCS Commercial |
$10,418.38
|
| Rate for Payer: United Healthcare All Payer |
$9,550.18
|
|
|
PLATE S3 11HOLE RIGHT
|
Facility
|
IP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
|
PLATE S3 11HOLE RIGHT
|
Facility
|
OP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem Medicaid |
$3,473.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Humana KY Medicaid |
$3,473.13
|
| Rate for Payer: Kentucky WC Medicaid |
$3,508.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,542.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
|
PLATE S3 14HOLE LEFT
|
Facility
|
IP
|
$10,852.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,255.74 |
| Max. Negotiated Rate |
$10,418.38 |
| Rate for Payer: Aetna Commercial |
$8,356.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,464.93
|
| Rate for Payer: Cash Price |
$5,426.24
|
| Rate for Payer: Cigna Commercial |
$9,007.56
|
| Rate for Payer: First Health Commercial |
$10,309.86
|
| Rate for Payer: Humana Commercial |
$9,224.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,899.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,009.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,255.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,550.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,139.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,441.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,488.21
|
| Rate for Payer: PHCS Commercial |
$10,418.38
|
| Rate for Payer: United Healthcare All Payer |
$9,550.18
|
|
|
PLATE S3 14HOLE LEFT
|
Facility
|
OP
|
$10,852.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,255.74 |
| Max. Negotiated Rate |
$10,418.38 |
| Rate for Payer: Aetna Commercial |
$8,356.41
|
| Rate for Payer: Anthem Medicaid |
$3,732.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,464.93
|
| Rate for Payer: Cash Price |
$5,426.24
|
| Rate for Payer: Cigna Commercial |
$9,007.56
|
| Rate for Payer: First Health Commercial |
$10,309.86
|
| Rate for Payer: Humana Commercial |
$9,224.61
|
| Rate for Payer: Humana KY Medicaid |
$3,732.17
|
| Rate for Payer: Kentucky WC Medicaid |
$3,770.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,899.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,009.13
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,255.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,807.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,550.18
|
| Rate for Payer: Ohio Health Group HMO |
$8,139.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,681.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,441.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,488.21
|
| Rate for Payer: PHCS Commercial |
$10,418.38
|
| Rate for Payer: United Healthcare All Payer |
$9,550.18
|
|
|
PLATE S3 14HOLE RIGHT
|
Facility
|
IP
|
$10,099.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,029.78 |
| Max. Negotiated Rate |
$9,695.28 |
| Rate for Payer: Aetna Commercial |
$7,776.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,877.41
|
| Rate for Payer: Cash Price |
$5,049.62
|
| Rate for Payer: Cigna Commercial |
$8,382.38
|
| Rate for Payer: First Health Commercial |
$9,594.29
|
| Rate for Payer: Humana Commercial |
$8,584.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,281.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,453.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,029.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,887.34
|
| Rate for Payer: Ohio Health Group HMO |
$7,574.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,079.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,786.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,968.48
|
| Rate for Payer: PHCS Commercial |
$9,695.28
|
| Rate for Payer: United Healthcare All Payer |
$8,887.34
|
|
