|
PLATE S3 14HOLE 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 3HOLE LEFT
|
Facility
|
OP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem Medicaid |
$3,087.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Humana KY Medicaid |
$3,087.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,119.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,149.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 3HOLE LEFT
|
Facility
|
IP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 3HOLE RIGHT
|
Facility
|
OP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem Medicaid |
$3,087.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Humana KY Medicaid |
$3,087.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,119.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,149.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 3HOLE RIGHT
|
Facility
|
IP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 4HOLE LEFT
|
Facility
|
IP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
PLATE S3 4HOLE LEFT
|
Facility
|
OP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem Medicaid |
$2,861.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Humana KY Medicaid |
$2,861.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
PLATE S3 4HOLE RIGHT
|
Facility
|
IP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 4HOLE RIGHT
|
Facility
|
OP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem Medicaid |
$3,087.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Humana KY Medicaid |
$3,087.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,119.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,149.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 6HOLE 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 6HOLE 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 6HOLE RIGHT
|
Facility
|
IP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 6HOLE RIGHT
|
Facility
|
OP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem Medicaid |
$3,087.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Humana KY Medicaid |
$3,087.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,119.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,149.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 8HOLE 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 8HOLE 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 8HOLE RIGHT
|
Facility
|
OP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem Medicaid |
$3,087.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Humana KY Medicaid |
$3,087.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,119.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,149.73
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE S3 8HOLE RIGHT
|
Facility
|
IP
|
$8,978.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,693.61 |
| Max. Negotiated Rate |
$8,619.55 |
| Rate for Payer: Aetna Commercial |
$6,913.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,003.39
|
| Rate for Payer: Cash Price |
$4,489.35
|
| Rate for Payer: Cigna Commercial |
$7,452.32
|
| Rate for Payer: First Health Commercial |
$8,529.76
|
| Rate for Payer: Humana Commercial |
$7,631.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,362.53
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,626.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,693.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,901.26
|
| Rate for Payer: Ohio Health Group HMO |
$6,734.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,182.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,811.47
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,195.30
|
| Rate for Payer: PHCS Commercial |
$8,619.55
|
| Rate for Payer: United Healthcare All Payer |
$7,901.26
|
|
|
PLATE SBF LONG 11 HOLE
|
Facility
|
IP
|
$2,120.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.24 |
| Max. Negotiated Rate |
$2,035.97 |
| Rate for Payer: Aetna Commercial |
$1,633.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,654.22
|
| Rate for Payer: Cash Price |
$1,060.40
|
| Rate for Payer: Cigna Commercial |
$1,760.26
|
| Rate for Payer: First Health Commercial |
$2,014.76
|
| Rate for Payer: Humana Commercial |
$1,802.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,739.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,565.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,866.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.35
|
| Rate for Payer: PHCS Commercial |
$2,035.97
|
| Rate for Payer: United Healthcare All Payer |
$1,866.30
|
|
|
PLATE SBF LONG 11 HOLE
|
Facility
|
OP
|
$2,120.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$636.24 |
| Max. Negotiated Rate |
$2,035.97 |
| Rate for Payer: Aetna Commercial |
$1,633.02
|
| Rate for Payer: Anthem Medicaid |
$729.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,654.22
|
| Rate for Payer: Cash Price |
$1,060.40
|
| Rate for Payer: Cigna Commercial |
$1,760.26
|
| Rate for Payer: First Health Commercial |
$2,014.76
|
| Rate for Payer: Humana Commercial |
$1,802.68
|
| Rate for Payer: Humana KY Medicaid |
$729.34
|
| Rate for Payer: Kentucky WC Medicaid |
$736.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,739.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,565.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$636.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$743.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,866.30
|
| Rate for Payer: Ohio Health Group HMO |
$1,590.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,696.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,845.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,463.35
|
| Rate for Payer: PHCS Commercial |
$2,035.97
|
| Rate for Payer: United Healthcare All Payer |
$1,866.30
|
|
|
PLATE SBF LONG 5 HOLE
|
Facility
|
IP
|
$2,093.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.03 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna Commercial |
$1,611.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,632.88
|
| Rate for Payer: Cash Price |
$1,046.72
|
| Rate for Payer: Cigna Commercial |
$1,737.56
|
| Rate for Payer: First Health Commercial |
$1,988.77
|
| Rate for Payer: Humana Commercial |
$1,779.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,716.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,544.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,842.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,570.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,674.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,444.47
|
| Rate for Payer: PHCS Commercial |
$2,009.70
|
| Rate for Payer: United Healthcare All Payer |
$1,842.23
|
|
|
PLATE SBF LONG 5 HOLE
|
Facility
|
OP
|
$2,093.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$628.03 |
| Max. Negotiated Rate |
$2,009.70 |
| Rate for Payer: Aetna Commercial |
$1,611.95
|
| Rate for Payer: Anthem Medicaid |
$719.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,632.88
|
| Rate for Payer: Cash Price |
$1,046.72
|
| Rate for Payer: Cigna Commercial |
$1,737.56
|
| Rate for Payer: First Health Commercial |
$1,988.77
|
| Rate for Payer: Humana Commercial |
$1,779.42
|
| Rate for Payer: Humana KY Medicaid |
$719.93
|
| Rate for Payer: Kentucky WC Medicaid |
$727.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,716.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,544.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$628.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$734.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,842.23
|
| Rate for Payer: Ohio Health Group HMO |
$1,570.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,674.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,821.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,444.47
|
| Rate for Payer: PHCS Commercial |
$2,009.70
|
| Rate for Payer: United Healthcare All Payer |
$1,842.23
|
|
|
PLATE SBF TWISTED 90 DEG
|
Facility
|
OP
|
$2,100.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.08 |
| Max. Negotiated Rate |
$2,016.27 |
| Rate for Payer: Aetna Commercial |
$1,617.22
|
| Rate for Payer: Anthem Medicaid |
$722.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.22
|
| Rate for Payer: Cash Price |
$1,050.14
|
| Rate for Payer: Cigna Commercial |
$1,743.23
|
| Rate for Payer: First Health Commercial |
$1,995.27
|
| Rate for Payer: Humana Commercial |
$1,785.24
|
| Rate for Payer: Humana KY Medicaid |
$722.29
|
| Rate for Payer: Kentucky WC Medicaid |
$729.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$736.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.19
|
| Rate for Payer: PHCS Commercial |
$2,016.27
|
| Rate for Payer: United Healthcare All Payer |
$1,848.25
|
|
|
PLATE SBF TWISTED 90 DEG
|
Facility
|
IP
|
$2,100.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$630.08 |
| Max. Negotiated Rate |
$2,016.27 |
| Rate for Payer: Aetna Commercial |
$1,617.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,638.22
|
| Rate for Payer: Cash Price |
$1,050.14
|
| Rate for Payer: Cigna Commercial |
$1,743.23
|
| Rate for Payer: First Health Commercial |
$1,995.27
|
| Rate for Payer: Humana Commercial |
$1,785.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,722.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,550.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$630.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,848.25
|
| Rate for Payer: Ohio Health Group HMO |
$1,575.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,680.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,827.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,449.19
|
| Rate for Payer: PHCS Commercial |
$2,016.27
|
| Rate for Payer: United Healthcare All Payer |
$1,848.25
|
|
|
PLATE SCREW 2.5X18 LOCKING
|
Facility
|
IP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
|
PLATE SCREW 2.5X18 LOCKING
|
Facility
|
OP
|
$1,946.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000285
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$583.80 |
| Max. Negotiated Rate |
$1,868.16 |
| Rate for Payer: Aetna Commercial |
$1,498.42
|
| Rate for Payer: Anthem Medicaid |
$669.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,517.88
|
| Rate for Payer: Cash Price |
$973.00
|
| Rate for Payer: Cigna Commercial |
$1,615.18
|
| Rate for Payer: First Health Commercial |
$1,848.70
|
| Rate for Payer: Humana Commercial |
$1,654.10
|
| Rate for Payer: Humana KY Medicaid |
$669.23
|
| Rate for Payer: Kentucky WC Medicaid |
$676.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,595.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,436.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$583.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$682.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,712.48
|
| Rate for Payer: Ohio Health Group HMO |
$1,459.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,693.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,342.74
|
| Rate for Payer: PHCS Commercial |
$1,868.16
|
| Rate for Payer: United Healthcare All Payer |
$1,712.48
|
|
