|
PLATE CALCANEUS MESH MEDIUM
|
Facility
|
OP
|
$7,231.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,169.32 |
| Max. Negotiated Rate |
$6,941.84 |
| Rate for Payer: Aetna Commercial |
$5,567.93
|
| Rate for Payer: Anthem Medicaid |
$2,486.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,640.24
|
| Rate for Payer: Cash Price |
$3,615.54
|
| Rate for Payer: Cigna Commercial |
$6,001.80
|
| Rate for Payer: First Health Commercial |
$6,869.53
|
| Rate for Payer: Humana Commercial |
$6,146.42
|
| Rate for Payer: Humana KY Medicaid |
$2,486.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,512.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,929.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,336.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,169.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,536.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,363.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,423.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,784.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,291.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,989.45
|
| Rate for Payer: PHCS Commercial |
$6,941.84
|
| Rate for Payer: United Healthcare All Payer |
$6,363.35
|
|
|
PLATE CALCANEUS MESH MEDIUM
|
Facility
|
IP
|
$7,231.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,169.32 |
| Max. Negotiated Rate |
$6,941.84 |
| Rate for Payer: Aetna Commercial |
$5,567.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,640.24
|
| Rate for Payer: Cash Price |
$3,615.54
|
| Rate for Payer: Cigna Commercial |
$6,001.80
|
| Rate for Payer: First Health Commercial |
$6,869.53
|
| Rate for Payer: Humana Commercial |
$6,146.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,929.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,336.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,169.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,363.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,423.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,784.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,291.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,989.45
|
| Rate for Payer: PHCS Commercial |
$6,941.84
|
| Rate for Payer: United Healthcare All Payer |
$6,363.35
|
|
|
PLATE CALCANEUS SM 3.5MM LT
|
Facility
|
OP
|
$5,537.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.33 |
| Max. Negotiated Rate |
$5,316.24 |
| Rate for Payer: Aetna Commercial |
$4,264.07
|
| Rate for Payer: Anthem Medicaid |
$1,904.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,319.44
|
| Rate for Payer: Cash Price |
$2,768.88
|
| Rate for Payer: Cigna Commercial |
$4,596.33
|
| Rate for Payer: First Health Commercial |
$5,260.86
|
| Rate for Payer: Humana Commercial |
$4,707.09
|
| Rate for Payer: Humana KY Medicaid |
$1,904.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,923.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,540.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,086.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,942.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,873.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,817.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,821.05
|
| Rate for Payer: PHCS Commercial |
$5,316.24
|
| Rate for Payer: United Healthcare All Payer |
$4,873.22
|
|
|
PLATE CALCANEUS SM 3.5MM LT
|
Facility
|
IP
|
$5,537.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.33 |
| Max. Negotiated Rate |
$5,316.24 |
| Rate for Payer: Aetna Commercial |
$4,264.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,319.44
|
| Rate for Payer: Cash Price |
$2,768.88
|
| Rate for Payer: Cigna Commercial |
$4,596.33
|
| Rate for Payer: First Health Commercial |
$5,260.86
|
| Rate for Payer: Humana Commercial |
$4,707.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,540.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,086.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,873.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,817.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,821.05
|
| Rate for Payer: PHCS Commercial |
$5,316.24
|
| Rate for Payer: United Healthcare All Payer |
$4,873.22
|
|
|
PLATE CALCANEUS SM 3.5MM RT
|
Facility
|
OP
|
$5,537.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.33 |
| Max. Negotiated Rate |
$5,316.24 |
| Rate for Payer: Aetna Commercial |
$4,264.07
|
| Rate for Payer: Anthem Medicaid |
$1,904.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,319.44
|
| Rate for Payer: Cash Price |
$2,768.88
|
| Rate for Payer: Cigna Commercial |
$4,596.33
|
| Rate for Payer: First Health Commercial |
$5,260.86
|
| Rate for Payer: Humana Commercial |
$4,707.09
|
| Rate for Payer: Humana KY Medicaid |
$1,904.43
|
| Rate for Payer: Kentucky WC Medicaid |
$1,923.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,540.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,086.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,942.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,873.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,817.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,821.05
|
| Rate for Payer: PHCS Commercial |
$5,316.24
|
| Rate for Payer: United Healthcare All Payer |
$4,873.22
|
|
|
PLATE CALCANEUS SM 3.5MM RT
|
Facility
|
IP
|
$5,537.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,661.33 |
| Max. Negotiated Rate |
$5,316.24 |
| Rate for Payer: Aetna Commercial |
$4,264.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,319.44
|
| Rate for Payer: Cash Price |
$2,768.88
|
| Rate for Payer: Cigna Commercial |
$4,596.33
|
| Rate for Payer: First Health Commercial |
$5,260.86
|
| Rate for Payer: Humana Commercial |
$4,707.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,540.95
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,086.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,661.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,873.22
|
| Rate for Payer: Ohio Health Group HMO |
$4,153.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,430.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,817.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,821.05
|
| Rate for Payer: PHCS Commercial |
$5,316.24
|
| Rate for Payer: United Healthcare All Payer |
$4,873.22
|
|
|
PLATE CALCANEUS STD MEDIUM
|
Facility
|
OP
|
$7,231.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,169.32 |
| Max. Negotiated Rate |
$6,941.84 |
| Rate for Payer: Aetna Commercial |
$5,567.93
|
| Rate for Payer: Anthem Medicaid |
$2,486.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,640.24
|
| Rate for Payer: Cash Price |
$3,615.54
|
| Rate for Payer: Cigna Commercial |
$6,001.80
|
| Rate for Payer: First Health Commercial |
$6,869.53
|
| Rate for Payer: Humana Commercial |
$6,146.42
|
| Rate for Payer: Humana KY Medicaid |
$2,486.77
|
| Rate for Payer: Kentucky WC Medicaid |
$2,512.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,929.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,336.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,169.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,536.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,363.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,423.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,784.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,291.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,989.45
|
| Rate for Payer: PHCS Commercial |
$6,941.84
|
| Rate for Payer: United Healthcare All Payer |
$6,363.35
|
|
|
PLATE CALCANEUS STD MEDIUM
|
Facility
|
IP
|
$7,231.08
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,169.32 |
| Max. Negotiated Rate |
$6,941.84 |
| Rate for Payer: Aetna Commercial |
$5,567.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,640.24
|
| Rate for Payer: Cash Price |
$3,615.54
|
| Rate for Payer: Cigna Commercial |
$6,001.80
|
| Rate for Payer: First Health Commercial |
$6,869.53
|
| Rate for Payer: Humana Commercial |
$6,146.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,929.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,336.54
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,169.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,363.35
|
| Rate for Payer: Ohio Health Group HMO |
$5,423.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,784.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,291.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,989.45
|
| Rate for Payer: PHCS Commercial |
$6,941.84
|
| Rate for Payer: United Healthcare All Payer |
$6,363.35
|
|
|
PLATE CALCANEUS XL LT 3.5MM
|
Facility
|
IP
|
$6,985.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.52 |
| Max. Negotiated Rate |
$6,705.67 |
| Rate for Payer: Aetna Commercial |
$5,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,448.35
|
| Rate for Payer: Cash Price |
$3,492.53
|
| Rate for Payer: Cigna Commercial |
$5,797.61
|
| Rate for Payer: First Health Commercial |
$6,635.82
|
| Rate for Payer: Humana Commercial |
$5,937.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,727.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,095.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,146.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,238.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,588.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,077.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.70
|
| Rate for Payer: PHCS Commercial |
$6,705.67
|
| Rate for Payer: United Healthcare All Payer |
$6,146.86
|
|
|
PLATE CALCANEUS XL LT 3.5MM
|
Facility
|
OP
|
$6,985.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.52 |
| Max. Negotiated Rate |
$6,705.67 |
| Rate for Payer: Aetna Commercial |
$5,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,402.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,448.35
|
| Rate for Payer: Cash Price |
$3,492.53
|
| Rate for Payer: Cigna Commercial |
$5,797.61
|
| Rate for Payer: First Health Commercial |
$6,635.82
|
| Rate for Payer: Humana Commercial |
$5,937.31
|
| Rate for Payer: Humana KY Medicaid |
$2,402.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,426.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,727.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,095.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,450.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,146.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,238.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,588.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,077.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.70
|
| Rate for Payer: PHCS Commercial |
$6,705.67
|
| Rate for Payer: United Healthcare All Payer |
$6,146.86
|
|
|
PLATE CALCANEUS XL RT 3.5MM
|
Facility
|
IP
|
$6,985.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.52 |
| Max. Negotiated Rate |
$6,705.67 |
| Rate for Payer: Aetna Commercial |
$5,378.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,448.35
|
| Rate for Payer: Cash Price |
$3,492.53
|
| Rate for Payer: Cigna Commercial |
$5,797.61
|
| Rate for Payer: First Health Commercial |
$6,635.82
|
| Rate for Payer: Humana Commercial |
$5,937.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,727.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,095.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,146.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,238.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,588.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,077.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.70
|
| Rate for Payer: PHCS Commercial |
$6,705.67
|
| Rate for Payer: United Healthcare All Payer |
$6,146.86
|
|
|
PLATE CALCANEUS XL RT 3.5MM
|
Facility
|
OP
|
$6,985.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,095.52 |
| Max. Negotiated Rate |
$6,705.67 |
| Rate for Payer: Aetna Commercial |
$5,378.50
|
| Rate for Payer: Anthem Medicaid |
$2,402.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,448.35
|
| Rate for Payer: Cash Price |
$3,492.53
|
| Rate for Payer: Cigna Commercial |
$5,797.61
|
| Rate for Payer: First Health Commercial |
$6,635.82
|
| Rate for Payer: Humana Commercial |
$5,937.31
|
| Rate for Payer: Humana KY Medicaid |
$2,402.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,426.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,727.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,154.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,095.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,450.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,146.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,238.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,588.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,077.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,819.70
|
| Rate for Payer: PHCS Commercial |
$6,705.67
|
| Rate for Payer: United Healthcare All Payer |
$6,146.86
|
|
|
PLATE CALC PERC LG 2.7M 62M L
|
Facility
|
OP
|
$7,284.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,185.48 |
| Max. Negotiated Rate |
$6,993.52 |
| Rate for Payer: Aetna Commercial |
$5,609.39
|
| Rate for Payer: Anthem Medicaid |
$2,505.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,682.24
|
| Rate for Payer: Cash Price |
$3,642.46
|
| Rate for Payer: Cigna Commercial |
$6,046.48
|
| Rate for Payer: First Health Commercial |
$6,920.67
|
| Rate for Payer: Humana Commercial |
$6,192.18
|
| Rate for Payer: Humana KY Medicaid |
$2,505.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,530.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,973.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,376.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,185.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,555.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,410.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,463.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,827.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,337.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,026.59
|
| Rate for Payer: PHCS Commercial |
$6,993.52
|
| Rate for Payer: United Healthcare All Payer |
$6,410.73
|
|
|
PLATE CALC PERC LG 2.7M 62M L
|
Facility
|
IP
|
$7,284.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,185.48 |
| Max. Negotiated Rate |
$6,993.52 |
| Rate for Payer: Aetna Commercial |
$5,609.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,682.24
|
| Rate for Payer: Cash Price |
$3,642.46
|
| Rate for Payer: Cigna Commercial |
$6,046.48
|
| Rate for Payer: First Health Commercial |
$6,920.67
|
| Rate for Payer: Humana Commercial |
$6,192.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,973.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,376.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,185.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,410.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,463.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,827.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,337.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,026.59
|
| Rate for Payer: PHCS Commercial |
$6,993.52
|
| Rate for Payer: United Healthcare All Payer |
$6,410.73
|
|
|
PLATE CALC PERC LG 2.7M 62M R
|
Facility
|
OP
|
$7,284.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,185.48 |
| Max. Negotiated Rate |
$6,993.52 |
| Rate for Payer: Aetna Commercial |
$5,609.39
|
| Rate for Payer: Anthem Medicaid |
$2,505.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,682.24
|
| Rate for Payer: Cash Price |
$3,642.46
|
| Rate for Payer: Cigna Commercial |
$6,046.48
|
| Rate for Payer: First Health Commercial |
$6,920.67
|
| Rate for Payer: Humana Commercial |
$6,192.18
|
| Rate for Payer: Humana KY Medicaid |
$2,505.28
|
| Rate for Payer: Kentucky WC Medicaid |
$2,530.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,973.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,376.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,185.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,555.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,410.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,463.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,827.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,337.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,026.59
|
| Rate for Payer: PHCS Commercial |
$6,993.52
|
| Rate for Payer: United Healthcare All Payer |
$6,410.73
|
|
|
PLATE CALC PERC LG 2.7M 62M R
|
Facility
|
IP
|
$7,284.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,185.48 |
| Max. Negotiated Rate |
$6,993.52 |
| Rate for Payer: Aetna Commercial |
$5,609.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,682.24
|
| Rate for Payer: Cash Price |
$3,642.46
|
| Rate for Payer: Cigna Commercial |
$6,046.48
|
| Rate for Payer: First Health Commercial |
$6,920.67
|
| Rate for Payer: Humana Commercial |
$6,192.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,973.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,376.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,185.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,410.73
|
| Rate for Payer: Ohio Health Group HMO |
$5,463.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,827.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,337.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,026.59
|
| Rate for Payer: PHCS Commercial |
$6,993.52
|
| Rate for Payer: United Healthcare All Payer |
$6,410.73
|
|
|
PLATE CALC PERC SM 2.7M 55M L
|
Facility
|
IP
|
$6,927.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.11 |
| Max. Negotiated Rate |
$6,649.96 |
| Rate for Payer: Aetna Commercial |
$5,333.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,403.09
|
| Rate for Payer: Cash Price |
$3,463.52
|
| Rate for Payer: Cigna Commercial |
$5,749.44
|
| Rate for Payer: First Health Commercial |
$6,580.69
|
| Rate for Payer: Humana Commercial |
$5,887.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,112.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,095.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,195.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,026.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,779.66
|
| Rate for Payer: PHCS Commercial |
$6,649.96
|
| Rate for Payer: United Healthcare All Payer |
$6,095.80
|
|
|
PLATE CALC PERC SM 2.7M 55M L
|
Facility
|
OP
|
$6,927.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.11 |
| Max. Negotiated Rate |
$6,649.96 |
| Rate for Payer: Aetna Commercial |
$5,333.82
|
| Rate for Payer: Anthem Medicaid |
$2,382.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,403.09
|
| Rate for Payer: Cash Price |
$3,463.52
|
| Rate for Payer: Cigna Commercial |
$5,749.44
|
| Rate for Payer: First Health Commercial |
$6,580.69
|
| Rate for Payer: Humana Commercial |
$5,887.98
|
| Rate for Payer: Humana KY Medicaid |
$2,382.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,406.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,112.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,430.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,095.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,195.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,026.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,779.66
|
| Rate for Payer: PHCS Commercial |
$6,649.96
|
| Rate for Payer: United Healthcare All Payer |
$6,095.80
|
|
|
PLATE CALC PERC SM 2.7M 55M R
|
Facility
|
OP
|
$6,927.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.11 |
| Max. Negotiated Rate |
$6,649.96 |
| Rate for Payer: Aetna Commercial |
$5,333.82
|
| Rate for Payer: Anthem Medicaid |
$2,382.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,403.09
|
| Rate for Payer: Cash Price |
$3,463.52
|
| Rate for Payer: Cigna Commercial |
$5,749.44
|
| Rate for Payer: First Health Commercial |
$6,580.69
|
| Rate for Payer: Humana Commercial |
$5,887.98
|
| Rate for Payer: Humana KY Medicaid |
$2,382.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,406.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,112.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,430.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,095.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,195.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,026.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,779.66
|
| Rate for Payer: PHCS Commercial |
$6,649.96
|
| Rate for Payer: United Healthcare All Payer |
$6,095.80
|
|
|
PLATE CALC PERC SM 2.7M 55M R
|
Facility
|
IP
|
$6,927.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,078.11 |
| Max. Negotiated Rate |
$6,649.96 |
| Rate for Payer: Aetna Commercial |
$5,333.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,403.09
|
| Rate for Payer: Cash Price |
$3,463.52
|
| Rate for Payer: Cigna Commercial |
$5,749.44
|
| Rate for Payer: First Health Commercial |
$6,580.69
|
| Rate for Payer: Humana Commercial |
$5,887.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,680.17
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,112.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,078.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,095.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,195.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,541.63
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,026.52
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,779.66
|
| Rate for Payer: PHCS Commercial |
$6,649.96
|
| Rate for Payer: United Healthcare All Payer |
$6,095.80
|
|
|
PLATE CALC PERC XL 2.7M 68M L
|
Facility
|
OP
|
$7,449.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,234.80 |
| Max. Negotiated Rate |
$7,151.38 |
| Rate for Payer: Aetna Commercial |
$5,736.00
|
| Rate for Payer: Anthem Medicaid |
$2,561.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,810.49
|
| Rate for Payer: Cash Price |
$3,724.68
|
| Rate for Payer: Cigna Commercial |
$6,182.96
|
| Rate for Payer: First Health Commercial |
$7,076.88
|
| Rate for Payer: Humana Commercial |
$6,331.95
|
| Rate for Payer: Humana KY Medicaid |
$2,561.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,587.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,108.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,613.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,555.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,587.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,959.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,480.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,140.05
|
| Rate for Payer: PHCS Commercial |
$7,151.38
|
| Rate for Payer: United Healthcare All Payer |
$6,555.43
|
|
|
PLATE CALC PERC XL 2.7M 68M L
|
Facility
|
IP
|
$7,449.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,234.80 |
| Max. Negotiated Rate |
$7,151.38 |
| Rate for Payer: Aetna Commercial |
$5,736.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,810.49
|
| Rate for Payer: Cash Price |
$3,724.68
|
| Rate for Payer: Cigna Commercial |
$6,182.96
|
| Rate for Payer: First Health Commercial |
$7,076.88
|
| Rate for Payer: Humana Commercial |
$6,331.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,108.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,555.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,587.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,959.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,480.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,140.05
|
| Rate for Payer: PHCS Commercial |
$7,151.38
|
| Rate for Payer: United Healthcare All Payer |
$6,555.43
|
|
|
PLATE CALC PERC XL 2.7M 68M R
|
Facility
|
IP
|
$7,449.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,234.80 |
| Max. Negotiated Rate |
$7,151.38 |
| Rate for Payer: Aetna Commercial |
$5,736.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,810.49
|
| Rate for Payer: Cash Price |
$3,724.68
|
| Rate for Payer: Cigna Commercial |
$6,182.96
|
| Rate for Payer: First Health Commercial |
$7,076.88
|
| Rate for Payer: Humana Commercial |
$6,331.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,108.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,555.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,587.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,959.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,480.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,140.05
|
| Rate for Payer: PHCS Commercial |
$7,151.38
|
| Rate for Payer: United Healthcare All Payer |
$6,555.43
|
|
|
PLATE CALC PERC XL 2.7M 68M R
|
Facility
|
OP
|
$7,449.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,234.80 |
| Max. Negotiated Rate |
$7,151.38 |
| Rate for Payer: Aetna Commercial |
$5,736.00
|
| Rate for Payer: Anthem Medicaid |
$2,561.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,810.49
|
| Rate for Payer: Cash Price |
$3,724.68
|
| Rate for Payer: Cigna Commercial |
$6,182.96
|
| Rate for Payer: First Health Commercial |
$7,076.88
|
| Rate for Payer: Humana Commercial |
$6,331.95
|
| Rate for Payer: Humana KY Medicaid |
$2,561.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,587.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,108.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,497.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,234.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,613.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,555.43
|
| Rate for Payer: Ohio Health Group HMO |
$5,587.01
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,959.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,480.93
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,140.05
|
| Rate for Payer: PHCS Commercial |
$7,151.38
|
| Rate for Payer: United Healthcare All Payer |
$6,555.43
|
|
|
PLATE CHIN 6H 4MM
|
Facility
|
IP
|
$2,176.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$652.86 |
| Max. Negotiated Rate |
$2,089.15 |
| Rate for Payer: Aetna Commercial |
$1,675.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,697.44
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna Commercial |
$1,806.25
|
| Rate for Payer: First Health Commercial |
$2,067.39
|
| Rate for Payer: Humana Commercial |
$1,849.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,784.48
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,606.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$652.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,915.06
|
| Rate for Payer: Ohio Health Group HMO |
$1,632.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,740.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,893.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,501.58
|
| Rate for Payer: PHCS Commercial |
$2,089.15
|
| Rate for Payer: United Healthcare All Payer |
$1,915.06
|
|
