|
PLATE CONDY LCP 4.5 10H 242M R
|
Facility
|
OP
|
$7,382.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$959.74 |
| Max. Negotiated Rate |
$7,087.28 |
| Rate for Payer: Aetna Commercial |
$5,684.59
|
| Rate for Payer: Anthem Medicaid |
$2,538.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,758.41
|
| Rate for Payer: Cash Price |
$3,691.29
|
| Rate for Payer: Cigna Commercial |
$6,127.54
|
| Rate for Payer: First Health Commercial |
$7,013.45
|
| Rate for Payer: Humana Commercial |
$6,275.19
|
| Rate for Payer: Humana KY Medicaid |
$2,538.87
|
| Rate for Payer: Kentucky WC Medicaid |
$2,564.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,053.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,448.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,214.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,589.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,496.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,536.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,476.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$959.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,288.60
|
| Rate for Payer: PHCS Commercial |
$7,087.28
|
| Rate for Payer: United Healthcare All Payer |
$6,496.67
|
|
|
PLATE CONDY LCP 4.5 12H 278M L
|
Facility
|
IP
|
$7,474.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.65 |
| Max. Negotiated Rate |
$7,175.26 |
| Rate for Payer: Aetna Commercial |
$5,755.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,829.90
|
| Rate for Payer: Cash Price |
$3,737.11
|
| Rate for Payer: Cigna Commercial |
$6,203.61
|
| Rate for Payer: First Health Commercial |
$7,100.52
|
| Rate for Payer: Humana Commercial |
$6,353.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,128.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,515.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,577.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,605.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.01
|
| Rate for Payer: PHCS Commercial |
$7,175.26
|
| Rate for Payer: United Healthcare All Payer |
$6,577.32
|
|
|
PLATE CONDY LCP 4.5 12H 278M L
|
Facility
|
OP
|
$7,474.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.65 |
| Max. Negotiated Rate |
$7,175.26 |
| Rate for Payer: Cigna Commercial |
$6,203.61
|
| Rate for Payer: First Health Commercial |
$7,100.52
|
| Rate for Payer: Humana Commercial |
$6,353.10
|
| Rate for Payer: Humana KY Medicaid |
$2,570.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,596.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,128.87
|
| Rate for Payer: Anthem Medicaid |
$2,570.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,829.90
|
| Rate for Payer: Cash Price |
$3,737.11
|
| Rate for Payer: Aetna Commercial |
$5,755.16
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,515.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,621.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,577.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,605.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.01
|
| Rate for Payer: PHCS Commercial |
$7,175.26
|
| Rate for Payer: United Healthcare All Payer |
$6,577.32
|
|
|
PLATE CONDY LCP 4.5 12H 278M R
|
Facility
|
IP
|
$7,474.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.65 |
| Max. Negotiated Rate |
$7,175.26 |
| Rate for Payer: Aetna Commercial |
$5,755.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,829.90
|
| Rate for Payer: Cash Price |
$3,737.11
|
| Rate for Payer: Cigna Commercial |
$6,203.61
|
| Rate for Payer: First Health Commercial |
$7,100.52
|
| Rate for Payer: Humana Commercial |
$6,353.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,128.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,515.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,577.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,605.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.01
|
| Rate for Payer: PHCS Commercial |
$7,175.26
|
| Rate for Payer: United Healthcare All Payer |
$6,577.32
|
|
|
PLATE CONDY LCP 4.5 12H 278M R
|
Facility
|
OP
|
$7,474.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$971.65 |
| Max. Negotiated Rate |
$7,175.26 |
| Rate for Payer: Aetna Commercial |
$5,755.16
|
| Rate for Payer: Anthem Medicaid |
$2,570.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,829.90
|
| Rate for Payer: Cash Price |
$3,737.11
|
| Rate for Payer: Cigna Commercial |
$6,203.61
|
| Rate for Payer: First Health Commercial |
$7,100.52
|
| Rate for Payer: Humana Commercial |
$6,353.10
|
| Rate for Payer: Humana KY Medicaid |
$2,570.39
|
| Rate for Payer: Kentucky WC Medicaid |
$2,596.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,128.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,515.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,242.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,621.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,577.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,605.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,494.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$971.65
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,317.01
|
| Rate for Payer: PHCS Commercial |
$7,175.26
|
| Rate for Payer: United Healthcare All Payer |
$6,577.32
|
|
|
PLATE CONDY LCP 4.5 14H 314M L
|
Facility
|
IP
|
$7,572.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.45 |
| Max. Negotiated Rate |
$7,269.76 |
| Rate for Payer: Aetna Commercial |
$5,830.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,906.68
|
| Rate for Payer: Cash Price |
$3,786.33
|
| Rate for Payer: Cigna Commercial |
$6,285.32
|
| Rate for Payer: First Health Commercial |
$7,194.04
|
| Rate for Payer: Humana Commercial |
$6,436.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,209.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,588.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,663.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,347.53
|
| Rate for Payer: PHCS Commercial |
$7,269.76
|
| Rate for Payer: United Healthcare All Payer |
$6,663.95
|
|
|
PLATE CONDY LCP 4.5 14H 314M L
|
Facility
|
OP
|
$7,572.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.45 |
| Max. Negotiated Rate |
$7,269.76 |
| Rate for Payer: Aetna Commercial |
$5,830.96
|
| Rate for Payer: Anthem Medicaid |
$2,604.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,906.68
|
| Rate for Payer: Cash Price |
$3,786.33
|
| Rate for Payer: Cigna Commercial |
$6,285.32
|
| Rate for Payer: First Health Commercial |
$7,194.04
|
| Rate for Payer: Humana Commercial |
$6,436.77
|
| Rate for Payer: Humana KY Medicaid |
$2,604.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,630.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,209.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,588.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,656.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,663.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,347.53
|
| Rate for Payer: PHCS Commercial |
$7,269.76
|
| Rate for Payer: United Healthcare All Payer |
$6,663.95
|
|
|
PLATE CONDY LCP 4.5 14H 314M R
|
Facility
|
IP
|
$7,572.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.45 |
| Max. Negotiated Rate |
$7,269.76 |
| Rate for Payer: Aetna Commercial |
$5,830.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,906.68
|
| Rate for Payer: Cash Price |
$3,786.33
|
| Rate for Payer: Cigna Commercial |
$6,285.32
|
| Rate for Payer: First Health Commercial |
$7,194.04
|
| Rate for Payer: Humana Commercial |
$6,436.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,209.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,588.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,663.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,347.53
|
| Rate for Payer: PHCS Commercial |
$7,269.76
|
| Rate for Payer: United Healthcare All Payer |
$6,663.95
|
|
|
PLATE CONDY LCP 4.5 14H 314M R
|
Facility
|
OP
|
$7,572.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$984.45 |
| Max. Negotiated Rate |
$7,269.76 |
| Rate for Payer: Aetna Commercial |
$5,830.96
|
| Rate for Payer: Anthem Medicaid |
$2,604.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,906.68
|
| Rate for Payer: Cash Price |
$3,786.33
|
| Rate for Payer: Cigna Commercial |
$6,285.32
|
| Rate for Payer: First Health Commercial |
$7,194.04
|
| Rate for Payer: Humana Commercial |
$6,436.77
|
| Rate for Payer: Humana KY Medicaid |
$2,604.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,630.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,209.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,588.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,271.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,656.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,663.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,679.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,514.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$984.45
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,347.53
|
| Rate for Payer: PHCS Commercial |
$7,269.76
|
| Rate for Payer: United Healthcare All Payer |
$6,663.95
|
|
|
PLATE CONDY LCP 4.5 16H 350M L
|
Facility
|
IP
|
$7,667.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.80 |
| Max. Negotiated Rate |
$7,361.00 |
| Rate for Payer: Aetna Commercial |
$5,904.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,980.81
|
| Rate for Payer: Cash Price |
$3,833.86
|
| Rate for Payer: Cigna Commercial |
$6,364.20
|
| Rate for Payer: First Health Commercial |
$7,284.32
|
| Rate for Payer: Humana Commercial |
$6,517.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,287.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,658.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,300.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,747.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,750.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,533.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.99
|
| Rate for Payer: PHCS Commercial |
$7,361.00
|
| Rate for Payer: United Healthcare All Payer |
$6,747.58
|
|
|
PLATE CONDY LCP 4.5 16H 350M L
|
Facility
|
OP
|
$7,667.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$996.80 |
| Max. Negotiated Rate |
$7,361.00 |
| Rate for Payer: Aetna Commercial |
$5,904.14
|
| Rate for Payer: Anthem Medicaid |
$2,636.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,980.81
|
| Rate for Payer: Cash Price |
$3,833.86
|
| Rate for Payer: Cigna Commercial |
$6,364.20
|
| Rate for Payer: First Health Commercial |
$7,284.32
|
| Rate for Payer: Humana Commercial |
$6,517.55
|
| Rate for Payer: Humana KY Medicaid |
$2,636.93
|
| Rate for Payer: Kentucky WC Medicaid |
$2,663.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,287.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,658.77
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,300.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,689.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,747.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,750.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,533.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$996.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,376.99
|
| Rate for Payer: PHCS Commercial |
$7,361.00
|
| Rate for Payer: United Healthcare All Payer |
$6,747.58
|
|
|
PLATE CONDY LCP 4.5 18H 386M L
|
Facility
|
IP
|
$7,766.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.60 |
| Max. Negotiated Rate |
$7,455.50 |
| Rate for Payer: Aetna Commercial |
$5,979.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,057.60
|
| Rate for Payer: Cash Price |
$3,883.08
|
| Rate for Payer: Cigna Commercial |
$6,445.90
|
| Rate for Payer: First Health Commercial |
$7,377.84
|
| Rate for Payer: Humana Commercial |
$6,601.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,368.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,731.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,834.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,824.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,553.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,407.51
|
| Rate for Payer: PHCS Commercial |
$7,455.50
|
| Rate for Payer: United Healthcare All Payer |
$6,834.21
|
|
|
PLATE CONDY LCP 4.5 18H 386M L
|
Facility
|
OP
|
$7,766.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.60 |
| Max. Negotiated Rate |
$7,455.50 |
| Rate for Payer: Anthem Medicaid |
$2,670.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,057.60
|
| Rate for Payer: Cash Price |
$3,883.08
|
| Rate for Payer: Cigna Commercial |
$6,445.90
|
| Rate for Payer: First Health Commercial |
$7,377.84
|
| Rate for Payer: Humana Commercial |
$6,601.23
|
| Rate for Payer: Humana KY Medicaid |
$2,670.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,368.24
|
| Rate for Payer: Aetna Commercial |
$5,979.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,731.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,724.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,834.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,824.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,553.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,407.51
|
| Rate for Payer: PHCS Commercial |
$7,455.50
|
| Rate for Payer: United Healthcare All Payer |
$6,834.21
|
|
|
PLATE CONDY LCP 4.5 18H 386M R
|
Facility
|
IP
|
$7,766.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.60 |
| Max. Negotiated Rate |
$7,455.50 |
| Rate for Payer: Aetna Commercial |
$5,979.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,057.60
|
| Rate for Payer: Cash Price |
$3,883.08
|
| Rate for Payer: Cigna Commercial |
$6,445.90
|
| Rate for Payer: First Health Commercial |
$7,377.84
|
| Rate for Payer: Humana Commercial |
$6,601.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,368.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,731.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,834.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,824.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,553.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,407.51
|
| Rate for Payer: PHCS Commercial |
$7,455.50
|
| Rate for Payer: United Healthcare All Payer |
$6,834.21
|
|
|
PLATE CONDY LCP 4.5 18H 386M R
|
Facility
|
OP
|
$7,766.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,009.60 |
| Max. Negotiated Rate |
$7,455.50 |
| Rate for Payer: Aetna Commercial |
$5,979.94
|
| Rate for Payer: Anthem Medicaid |
$2,670.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,057.60
|
| Rate for Payer: Cash Price |
$3,883.08
|
| Rate for Payer: Cigna Commercial |
$6,445.90
|
| Rate for Payer: First Health Commercial |
$7,377.84
|
| Rate for Payer: Humana Commercial |
$6,601.23
|
| Rate for Payer: Humana KY Medicaid |
$2,670.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,697.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,368.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,731.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,329.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,724.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,834.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,824.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,553.23
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,009.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,407.51
|
| Rate for Payer: PHCS Commercial |
$7,455.50
|
| Rate for Payer: United Healthcare All Payer |
$6,834.21
|
|
|
PLATE CONDY LCP 4.5 6H 170M R
|
Facility
|
IP
|
$7,134.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.52 |
| Max. Negotiated Rate |
$6,849.39 |
| Rate for Payer: Aetna Commercial |
$5,493.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,565.13
|
| Rate for Payer: Cash Price |
$3,567.39
|
| Rate for Payer: Cigna Commercial |
$5,921.87
|
| Rate for Payer: First Health Commercial |
$6,778.04
|
| Rate for Payer: Humana Commercial |
$6,064.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,351.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.78
|
| Rate for Payer: PHCS Commercial |
$6,849.39
|
| Rate for Payer: United Healthcare All Payer |
$6,278.61
|
|
|
PLATE CONDY LCP 4.5 6H 170M R
|
Facility
|
OP
|
$7,134.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.52 |
| Max. Negotiated Rate |
$6,849.39 |
| Rate for Payer: Aetna Commercial |
$5,493.78
|
| Rate for Payer: Anthem Medicaid |
$2,453.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,565.13
|
| Rate for Payer: Cash Price |
$3,567.39
|
| Rate for Payer: Cigna Commercial |
$5,921.87
|
| Rate for Payer: First Health Commercial |
$6,778.04
|
| Rate for Payer: Humana Commercial |
$6,064.56
|
| Rate for Payer: Humana KY Medicaid |
$2,453.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,478.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,850.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,265.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,140.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,502.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,278.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,351.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,426.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$927.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,211.78
|
| Rate for Payer: PHCS Commercial |
$6,849.39
|
| Rate for Payer: United Healthcare All Payer |
$6,278.61
|
|
|
PLATE CONDY LCP 4.5 8H 206M R
|
Facility
|
OP
|
$7,219.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.55 |
| Max. Negotiated Rate |
$6,930.85 |
| Rate for Payer: Aetna Commercial |
$5,559.12
|
| Rate for Payer: Anthem Medicaid |
$2,482.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.32
|
| Rate for Payer: Cash Price |
$3,609.82
|
| Rate for Payer: Cigna Commercial |
$5,992.30
|
| Rate for Payer: First Health Commercial |
$6,858.66
|
| Rate for Payer: Humana Commercial |
$6,136.69
|
| Rate for Payer: Humana KY Medicaid |
$2,482.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.09
|
| Rate for Payer: PHCS Commercial |
$6,930.85
|
| Rate for Payer: United Healthcare All Payer |
$6,353.28
|
|
|
PLATE CONDY LCP 4.5 8H 206M R
|
Facility
|
IP
|
$7,219.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.55 |
| Max. Negotiated Rate |
$6,930.85 |
| Rate for Payer: Aetna Commercial |
$5,559.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.32
|
| Rate for Payer: Cash Price |
$3,609.82
|
| Rate for Payer: Cigna Commercial |
$5,992.30
|
| Rate for Payer: First Health Commercial |
$6,858.66
|
| Rate for Payer: Humana Commercial |
$6,136.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.09
|
| Rate for Payer: PHCS Commercial |
$6,930.85
|
| Rate for Payer: United Healthcare All Payer |
$6,353.28
|
|
|
PLATE CONDYLR LCP 4.5 8H 206 L
|
Facility
|
OP
|
$7,219.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.55 |
| Max. Negotiated Rate |
$6,930.85 |
| Rate for Payer: Aetna Commercial |
$5,559.12
|
| Rate for Payer: Anthem Medicaid |
$2,482.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.32
|
| Rate for Payer: Cash Price |
$3,609.82
|
| Rate for Payer: Cigna Commercial |
$5,992.30
|
| Rate for Payer: First Health Commercial |
$6,858.66
|
| Rate for Payer: Humana Commercial |
$6,136.69
|
| Rate for Payer: Humana KY Medicaid |
$2,482.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,508.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,532.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.09
|
| Rate for Payer: PHCS Commercial |
$6,930.85
|
| Rate for Payer: United Healthcare All Payer |
$6,353.28
|
|
|
PLATE CONDYLR LCP 4.5 8H 206 L
|
Facility
|
IP
|
$7,219.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$938.55 |
| Max. Negotiated Rate |
$6,930.85 |
| Rate for Payer: Aetna Commercial |
$5,559.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,631.32
|
| Rate for Payer: Cash Price |
$3,609.82
|
| Rate for Payer: Cigna Commercial |
$5,992.30
|
| Rate for Payer: First Health Commercial |
$6,858.66
|
| Rate for Payer: Humana Commercial |
$6,136.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,920.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,328.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,165.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,353.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,414.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,443.93
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$938.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,238.09
|
| Rate for Payer: PHCS Commercial |
$6,930.85
|
| Rate for Payer: United Healthcare All Payer |
$6,353.28
|
|
|
PLATE CORONOID LEFT
|
Facility
|
OP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Anthem Medicaid |
$1,388.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Humana KY Medicaid |
$1,388.50
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE CORONOID LEFT
|
Facility
|
IP
|
$4,037.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.88 |
| Max. Negotiated Rate |
$3,876.00 |
| Rate for Payer: Aetna Commercial |
$3,108.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,149.25
|
| Rate for Payer: Cash Price |
$2,018.75
|
| Rate for Payer: Cigna Commercial |
$3,351.12
|
| Rate for Payer: First Health Commercial |
$3,835.62
|
| Rate for Payer: Humana Commercial |
$3,431.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,310.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,979.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.00
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$807.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$524.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,251.62
|
| Rate for Payer: PHCS Commercial |
$3,876.00
|
| Rate for Payer: United Healthcare All Payer |
$3,553.00
|
|
|
PLATE CORONOID LT
|
Facility
|
IP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
|
PLATE CORONOID LT
|
Facility
|
OP
|
$5,150.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$669.56 |
| Max. Negotiated Rate |
$4,944.48 |
| Rate for Payer: Aetna Commercial |
$3,965.88
|
| Rate for Payer: Anthem Medicaid |
$1,771.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,017.39
|
| Rate for Payer: Cash Price |
$2,575.25
|
| Rate for Payer: Cigna Commercial |
$4,274.92
|
| Rate for Payer: First Health Commercial |
$4,892.98
|
| Rate for Payer: Humana Commercial |
$4,377.92
|
| Rate for Payer: Humana KY Medicaid |
$1,771.26
|
| Rate for Payer: Kentucky WC Medicaid |
$1,789.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,223.41
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,801.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,545.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,806.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,532.44
|
| Rate for Payer: Ohio Health Group HMO |
$3,862.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,030.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$669.56
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,596.66
|
| Rate for Payer: PHCS Commercial |
$4,944.48
|
| Rate for Payer: United Healthcare All Payer |
$4,532.44
|
|
