|
PLATE STRNL LSS STR 2.3MM 14HO
|
Facility
|
IP
|
$8,652.94
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,595.88 |
| Max. Negotiated Rate |
$8,306.82 |
| Rate for Payer: Aetna Commercial |
$6,662.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,749.29
|
| Rate for Payer: Cash Price |
$4,326.47
|
| Rate for Payer: Cigna Commercial |
$7,181.94
|
| Rate for Payer: First Health Commercial |
$8,220.29
|
| Rate for Payer: Humana Commercial |
$7,355.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,095.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,385.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,595.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,614.59
|
| Rate for Payer: Ohio Health Group HMO |
$6,489.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,922.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,528.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,970.53
|
| Rate for Payer: PHCS Commercial |
$8,306.82
|
| Rate for Payer: United Healthcare All Payer |
$7,614.59
|
|
|
PLATE STRT FIBULA 9 HOLES
|
Facility
|
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
PLATE STRT FIBULA 9 HOLES
|
Facility
|
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,864.00 |
| Rate for Payer: Aetna Commercial |
$3,099.25
|
| Rate for Payer: Anthem Medicaid |
$1,384.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,139.50
|
| Rate for Payer: Cash Price |
$2,012.50
|
| Rate for Payer: Cigna Commercial |
$3,340.75
|
| Rate for Payer: First Health Commercial |
$3,823.75
|
| Rate for Payer: Humana Commercial |
$3,421.25
|
| Rate for Payer: Humana KY Medicaid |
$1,384.20
|
| Rate for Payer: Kentucky WC Medicaid |
$1,398.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,300.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,970.45
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,207.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,411.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,542.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,018.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,220.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,501.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,777.25
|
| Rate for Payer: PHCS Commercial |
$3,864.00
|
| Rate for Payer: United Healthcare All Payer |
$3,542.00
|
|
|
PLATE SUPERIOR DEC 6H BR L
|
Facility
|
IP
|
$7,051.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.45 |
| Max. Negotiated Rate |
$6,769.44 |
| Rate for Payer: Aetna Commercial |
$5,429.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.17
|
| Rate for Payer: Cash Price |
$3,525.75
|
| Rate for Payer: Cigna Commercial |
$5,852.74
|
| Rate for Payer: First Health Commercial |
$6,698.93
|
| Rate for Payer: Humana Commercial |
$5,993.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,641.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,134.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,865.53
|
| Rate for Payer: PHCS Commercial |
$6,769.44
|
| Rate for Payer: United Healthcare All Payer |
$6,205.32
|
|
|
PLATE SUPERIOR DEC 6H BR L
|
Facility
|
OP
|
$7,051.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.45 |
| Max. Negotiated Rate |
$6,769.44 |
| Rate for Payer: Aetna Commercial |
$5,429.65
|
| Rate for Payer: Anthem Medicaid |
$2,425.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.17
|
| Rate for Payer: Cash Price |
$3,525.75
|
| Rate for Payer: Cigna Commercial |
$5,852.74
|
| Rate for Payer: First Health Commercial |
$6,698.93
|
| Rate for Payer: Humana Commercial |
$5,993.77
|
| Rate for Payer: Humana KY Medicaid |
$2,425.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,449.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,473.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,288.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,641.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,134.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,865.53
|
| Rate for Payer: PHCS Commercial |
$6,769.44
|
| Rate for Payer: United Healthcare All Payer |
$6,205.32
|
|
|
PLATE SUPERIOR DEC 6H BR R
|
Facility
|
OP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem Medicaid |
$4,042.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Humana KY Medicaid |
$4,042.14
|
| Rate for Payer: Kentucky WC Medicaid |
$4,083.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,123.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
PLATE SUPERIOR DEC 6H BR R
|
Facility
|
IP
|
$11,753.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,526.15 |
| Max. Negotiated Rate |
$11,283.68 |
| Rate for Payer: Aetna Commercial |
$9,050.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,167.99
|
| Rate for Payer: Cash Price |
$5,876.92
|
| Rate for Payer: Cigna Commercial |
$9,755.68
|
| Rate for Payer: First Health Commercial |
$11,166.14
|
| Rate for Payer: Humana Commercial |
$9,990.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,638.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,674.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,526.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,343.37
|
| Rate for Payer: Ohio Health Group HMO |
$8,815.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,403.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,225.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,110.14
|
| Rate for Payer: PHCS Commercial |
$11,283.68
|
| Rate for Payer: United Healthcare All Payer |
$10,343.37
|
|
|
PLATE SUPERIOR DEC 8H BR L
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE SUPERIOR DEC 8H BR L
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE SUPERIOR DECR 8H BR R
|
Facility
|
IP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE SUPERIOR DECR 8H BR R
|
Facility
|
OP
|
$6,942.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,082.60 |
| Max. Negotiated Rate |
$6,664.32 |
| Rate for Payer: Aetna Commercial |
$5,345.34
|
| Rate for Payer: Anthem Medicaid |
$2,387.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,414.76
|
| Rate for Payer: Cash Price |
$3,471.00
|
| Rate for Payer: Cigna Commercial |
$5,761.86
|
| Rate for Payer: First Health Commercial |
$6,594.90
|
| Rate for Payer: Humana Commercial |
$5,900.70
|
| Rate for Payer: Humana KY Medicaid |
$2,387.35
|
| Rate for Payer: Kentucky WC Medicaid |
$2,411.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,692.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,123.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,082.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,435.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,108.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,206.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,553.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,039.54
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,789.98
|
| Rate for Payer: PHCS Commercial |
$6,664.32
|
| Rate for Payer: United Healthcare All Payer |
$6,108.96
|
|
|
PLATE SUPERIOR DECREASED 10H L
|
Facility
|
IP
|
$7,557.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,267.20 |
| Max. Negotiated Rate |
$7,255.06 |
| Rate for Payer: Aetna Commercial |
$5,819.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,894.73
|
| Rate for Payer: Cash Price |
$3,778.68
|
| Rate for Payer: Cigna Commercial |
$6,272.60
|
| Rate for Payer: First Health Commercial |
$7,179.48
|
| Rate for Payer: Humana Commercial |
$6,423.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,197.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,577.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,267.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,650.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,668.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,045.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,574.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,214.57
|
| Rate for Payer: PHCS Commercial |
$7,255.06
|
| Rate for Payer: United Healthcare All Payer |
$6,650.47
|
|
|
PLATE SUPERIOR DECREASED 10H L
|
Facility
|
OP
|
$7,557.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,267.20 |
| Max. Negotiated Rate |
$7,255.06 |
| Rate for Payer: Aetna Commercial |
$5,819.16
|
| Rate for Payer: Anthem Medicaid |
$2,598.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,894.73
|
| Rate for Payer: Cash Price |
$3,778.68
|
| Rate for Payer: Cigna Commercial |
$6,272.60
|
| Rate for Payer: First Health Commercial |
$7,179.48
|
| Rate for Payer: Humana Commercial |
$6,423.75
|
| Rate for Payer: Humana KY Medicaid |
$2,598.97
|
| Rate for Payer: Kentucky WC Medicaid |
$2,625.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,197.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,577.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,267.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,651.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,650.47
|
| Rate for Payer: Ohio Health Group HMO |
$5,668.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,045.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,574.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,214.57
|
| Rate for Payer: PHCS Commercial |
$7,255.06
|
| Rate for Payer: United Healthcare All Payer |
$6,650.47
|
|
|
PLATE SUPERIOR DECREASED 10H R
|
Facility
|
OP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem Medicaid |
$1,813.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Humana KY Medicaid |
$1,813.64
|
| Rate for Payer: Kentucky WC Medicaid |
$1,832.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,850.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE SUPERIOR DECREASED 10H R
|
Facility
|
IP
|
$5,273.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,582.12 |
| Max. Negotiated Rate |
$5,062.80 |
| Rate for Payer: Aetna Commercial |
$4,060.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,113.52
|
| Rate for Payer: Cash Price |
$2,636.88
|
| Rate for Payer: Cigna Commercial |
$4,377.21
|
| Rate for Payer: First Health Commercial |
$5,010.06
|
| Rate for Payer: Humana Commercial |
$4,482.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,324.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,892.03
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,582.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,640.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,955.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,219.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,588.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,638.89
|
| Rate for Payer: PHCS Commercial |
$5,062.80
|
| Rate for Payer: United Healthcare All Payer |
$4,640.90
|
|
|
PLATE SUPERIOR DECREASED 6H L
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE SUPERIOR DECREASED 6H L
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE SUPERIOR DECREASED 6H R
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE SUPERIOR DECREASED 6H R
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE SUPERIOR DECREASED 7H L
|
Facility
|
IP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE SUPERIOR DECREASED 7H L
|
Facility
|
OP
|
$5,408.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,622.62 |
| Max. Negotiated Rate |
$5,192.40 |
| Rate for Payer: Aetna Commercial |
$4,164.74
|
| Rate for Payer: Anthem Medicaid |
$1,860.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,218.82
|
| Rate for Payer: Cash Price |
$2,704.38
|
| Rate for Payer: Cigna Commercial |
$4,489.26
|
| Rate for Payer: First Health Commercial |
$5,138.31
|
| Rate for Payer: Humana Commercial |
$4,597.44
|
| Rate for Payer: Humana KY Medicaid |
$1,860.07
|
| Rate for Payer: Kentucky WC Medicaid |
$1,879.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,435.18
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,991.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,622.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,897.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,759.70
|
| Rate for Payer: Ohio Health Group HMO |
$4,056.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,327.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,705.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,732.04
|
| Rate for Payer: PHCS Commercial |
$5,192.40
|
| Rate for Payer: United Healthcare All Payer |
$4,759.70
|
|
|
PLATE SUPERIOR DECREASED 7H R
|
Facility
|
OP
|
$5,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$5,016.00 |
| Rate for Payer: Aetna Commercial |
$4,023.25
|
| Rate for Payer: Anthem Medicaid |
$1,796.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.50
|
| Rate for Payer: Cash Price |
$2,612.50
|
| Rate for Payer: Cigna Commercial |
$4,336.75
|
| Rate for Payer: First Health Commercial |
$4,963.75
|
| Rate for Payer: Humana Commercial |
$4,441.25
|
| Rate for Payer: Humana KY Medicaid |
$1,796.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,815.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,832.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,598.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,545.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,605.25
|
| Rate for Payer: PHCS Commercial |
$5,016.00
|
| Rate for Payer: United Healthcare All Payer |
$4,598.00
|
|
|
PLATE SUPERIOR DECREASED 7H R
|
Facility
|
IP
|
$5,225.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,567.50 |
| Max. Negotiated Rate |
$5,016.00 |
| Rate for Payer: Aetna Commercial |
$4,023.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,075.50
|
| Rate for Payer: Cash Price |
$2,612.50
|
| Rate for Payer: Cigna Commercial |
$4,336.75
|
| Rate for Payer: First Health Commercial |
$4,963.75
|
| Rate for Payer: Humana Commercial |
$4,441.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,284.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,856.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,567.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,598.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,918.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,180.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,545.75
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,605.25
|
| Rate for Payer: PHCS Commercial |
$5,016.00
|
| Rate for Payer: United Healthcare All Payer |
$4,598.00
|
|
|
PLATE SUPERIOR DECREASED 8H L
|
Facility
|
OP
|
$5,716.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.88 |
| Max. Negotiated Rate |
$5,487.60 |
| Rate for Payer: Aetna Commercial |
$4,401.51
|
| Rate for Payer: Anthem Medicaid |
$1,965.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,458.68
|
| Rate for Payer: Cash Price |
$2,858.12
|
| Rate for Payer: Cigna Commercial |
$4,744.49
|
| Rate for Payer: First Health Commercial |
$5,430.44
|
| Rate for Payer: Humana Commercial |
$4,858.81
|
| Rate for Payer: Humana KY Medicaid |
$1,965.82
|
| Rate for Payer: Kentucky WC Medicaid |
$1,985.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,687.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,218.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,714.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,005.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,030.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,287.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,573.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,973.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,944.21
|
| Rate for Payer: PHCS Commercial |
$5,487.60
|
| Rate for Payer: United Healthcare All Payer |
$5,030.30
|
|
|
PLATE SUPERIOR DECREASED 8H L
|
Facility
|
IP
|
$5,716.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,714.88 |
| Max. Negotiated Rate |
$5,487.60 |
| Rate for Payer: Aetna Commercial |
$4,401.51
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,458.68
|
| Rate for Payer: Cash Price |
$2,858.12
|
| Rate for Payer: Cigna Commercial |
$4,744.49
|
| Rate for Payer: First Health Commercial |
$5,430.44
|
| Rate for Payer: Humana Commercial |
$4,858.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,687.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,218.59
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,714.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,030.30
|
| Rate for Payer: Ohio Health Group HMO |
$4,287.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,573.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,973.14
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,944.21
|
| Rate for Payer: PHCS Commercial |
$5,487.60
|
| Rate for Payer: United Healthcare All Payer |
$5,030.30
|
|
