|
PLATE LCP M DS TB 3.5*142 L 6H
|
Facility
|
OP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem Medicaid |
$3,661.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Humana KY Medicaid |
$3,661.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,698.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,734.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
|
|
PLATE LCP M DS TB 3.5*142 L 6H
|
Facility
|
IP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
|
|
PLATE LCP M DS TB 3.5*168 R 8H
|
Facility
|
IP
|
$8,503.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.43 |
| Max. Negotiated Rate |
$8,163.21 |
| Rate for Payer: Aetna Commercial |
$6,547.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,632.61
|
| Rate for Payer: Cash Price |
$4,251.67
|
| Rate for Payer: Cigna Commercial |
$7,057.77
|
| Rate for Payer: First Health Commercial |
$8,078.17
|
| Rate for Payer: Humana Commercial |
$7,227.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,972.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,275.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,551.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,482.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,377.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,105.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,636.04
|
| Rate for Payer: PHCS Commercial |
$8,163.21
|
| Rate for Payer: United Healthcare All Payer |
$7,482.94
|
|
|
PLATE LCP M DS TB 3.5*168 R 8H
|
Facility
|
OP
|
$8,503.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,105.43 |
| Max. Negotiated Rate |
$8,163.21 |
| Rate for Payer: Aetna Commercial |
$6,547.57
|
| Rate for Payer: Anthem Medicaid |
$2,924.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,632.61
|
| Rate for Payer: Cash Price |
$4,251.67
|
| Rate for Payer: Cigna Commercial |
$7,057.77
|
| Rate for Payer: First Health Commercial |
$8,078.17
|
| Rate for Payer: Humana Commercial |
$7,227.84
|
| Rate for Payer: Humana KY Medicaid |
$2,924.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,954.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,972.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,275.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,551.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,982.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,482.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,377.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,700.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,105.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,636.04
|
| Rate for Payer: PHCS Commercial |
$8,163.21
|
| Rate for Payer: United Healthcare All Payer |
$7,482.94
|
|
|
PLATE LCP M DS TIB 3.5*142 R 6
|
Facility
|
IP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
|
|
PLATE LCP M DS TIB 3.5*142 R 6
|
Facility
|
OP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Humana KY Medicaid |
$3,661.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,698.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,734.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem Medicaid |
$3,661.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
|
|
PLATE LCP M DS TIB 3.5*168 L 8
|
Facility
|
OP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem Medicaid |
$3,661.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Humana KY Medicaid |
$3,661.47
|
| Rate for Payer: Kentucky WC Medicaid |
$3,698.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,734.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
|
|
PLATE LCP M DS TIB 3.5*168 L 8
|
Facility
|
IP
|
$10,646.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,384.10 |
| Max. Negotiated Rate |
$10,221.02 |
| Rate for Payer: Aetna Commercial |
$8,198.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,304.58
|
| Rate for Payer: Cash Price |
$5,323.45
|
| Rate for Payer: Cigna Commercial |
$8,836.93
|
| Rate for Payer: First Health Commercial |
$10,114.56
|
| Rate for Payer: Humana Commercial |
$9,049.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,730.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,857.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,194.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,369.27
|
| Rate for Payer: Ohio Health Group HMO |
$7,985.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,129.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,384.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,300.54
|
| Rate for Payer: PHCS Commercial |
$10,221.02
|
| Rate for Payer: United Healthcare All Payer |
$9,369.27
|
|
|
PLATE LCP PRX TIBIA 3.5MM 4H
|
Facility
|
OP
|
$8,843.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.60 |
| Max. Negotiated Rate |
$8,489.37 |
| Rate for Payer: Aetna Commercial |
$6,809.18
|
| Rate for Payer: Anthem Medicaid |
$3,041.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,897.61
|
| Rate for Payer: Cash Price |
$4,421.54
|
| Rate for Payer: Cigna Commercial |
$7,339.76
|
| Rate for Payer: First Health Commercial |
$8,400.94
|
| Rate for Payer: Humana Commercial |
$7,516.63
|
| Rate for Payer: Humana KY Medicaid |
$3,041.14
|
| Rate for Payer: Kentucky WC Medicaid |
$3,072.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,251.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,526.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,102.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,781.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,632.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,741.36
|
| Rate for Payer: PHCS Commercial |
$8,489.37
|
| Rate for Payer: United Healthcare All Payer |
$7,781.92
|
|
|
PLATE LCP PRX TIBIA 3.5MM 4H
|
Facility
|
IP
|
$8,843.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,149.60 |
| Max. Negotiated Rate |
$8,489.37 |
| Rate for Payer: Aetna Commercial |
$6,809.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,897.61
|
| Rate for Payer: Cash Price |
$4,421.54
|
| Rate for Payer: Cigna Commercial |
$7,339.76
|
| Rate for Payer: First Health Commercial |
$8,400.94
|
| Rate for Payer: Humana Commercial |
$7,516.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,251.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,526.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,652.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,781.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,632.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,768.62
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,149.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,741.36
|
| Rate for Payer: PHCS Commercial |
$8,489.37
|
| Rate for Payer: United Healthcare All Payer |
$7,781.92
|
|
|
PLATE LCP SUP ANT CLV 3.5 5H L
|
Facility
|
IP
|
$5,190.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.78 |
| Max. Negotiated Rate |
$4,983.02 |
| Rate for Payer: Aetna Commercial |
$3,996.80
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.71
|
| Rate for Payer: Cash Price |
$2,595.32
|
| Rate for Payer: Cigna Commercial |
$4,308.24
|
| Rate for Payer: First Health Commercial |
$4,931.12
|
| Rate for Payer: Humana Commercial |
$4,412.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.10
|
| Rate for Payer: PHCS Commercial |
$4,983.02
|
| Rate for Payer: United Healthcare All Payer |
$4,567.77
|
|
|
PLATE LCP SUP ANT CLV 3.5 5H L
|
Facility
|
OP
|
$5,190.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$674.78 |
| Max. Negotiated Rate |
$4,983.02 |
| Rate for Payer: Aetna Commercial |
$3,996.80
|
| Rate for Payer: Anthem Medicaid |
$1,785.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,048.71
|
| Rate for Payer: Cash Price |
$2,595.32
|
| Rate for Payer: Cigna Commercial |
$4,308.24
|
| Rate for Payer: First Health Commercial |
$4,931.12
|
| Rate for Payer: Humana Commercial |
$4,412.05
|
| Rate for Payer: Humana KY Medicaid |
$1,785.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,803.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,256.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,830.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,557.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,820.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,567.77
|
| Rate for Payer: Ohio Health Group HMO |
$3,892.99
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,038.13
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$674.78
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,609.10
|
| Rate for Payer: PHCS Commercial |
$4,983.02
|
| Rate for Payer: United Healthcare All Payer |
$4,567.77
|
|
|
PLATE LCP SUP ANT CLV 3.5 7H L
|
Facility
|
IP
|
$5,590.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.82 |
| Max. Negotiated Rate |
$5,367.26 |
| Rate for Payer: Aetna Commercial |
$4,304.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.90
|
| Rate for Payer: Cash Price |
$2,795.45
|
| Rate for Payer: Cigna Commercial |
$4,640.45
|
| Rate for Payer: First Health Commercial |
$5,311.36
|
| Rate for Payer: Humana Commercial |
$4,752.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,919.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,118.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,733.18
|
| Rate for Payer: PHCS Commercial |
$5,367.26
|
| Rate for Payer: United Healthcare All Payer |
$4,919.99
|
|
|
PLATE LCP SUP ANT CLV 3.5 7H L
|
Facility
|
OP
|
$5,590.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.82 |
| Max. Negotiated Rate |
$5,367.26 |
| Rate for Payer: Aetna Commercial |
$4,304.99
|
| Rate for Payer: Anthem Medicaid |
$1,922.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,360.90
|
| Rate for Payer: Cash Price |
$2,795.45
|
| Rate for Payer: Cigna Commercial |
$4,640.45
|
| Rate for Payer: First Health Commercial |
$5,311.36
|
| Rate for Payer: Humana Commercial |
$4,752.26
|
| Rate for Payer: Humana KY Medicaid |
$1,922.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,942.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,584.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,126.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,677.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,961.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,919.99
|
| Rate for Payer: Ohio Health Group HMO |
$4,193.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,118.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$726.82
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,733.18
|
| Rate for Payer: PHCS Commercial |
$5,367.26
|
| Rate for Payer: United Healthcare All Payer |
$4,919.99
|
|
|
PLATE LCP SUP CLAV 3.5 7H L
|
Facility
|
IP
|
$5,444.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.83 |
| Max. Negotiated Rate |
$5,227.08 |
| Rate for Payer: Aetna Commercial |
$4,192.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.01
|
| Rate for Payer: Cash Price |
$2,722.44
|
| Rate for Payer: Cigna Commercial |
$4,519.25
|
| Rate for Payer: First Health Commercial |
$5,172.64
|
| Rate for Payer: Humana Commercial |
$4,628.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,464.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,687.91
|
| Rate for Payer: PHCS Commercial |
$5,227.08
|
| Rate for Payer: United Healthcare All Payer |
$4,791.49
|
|
|
PLATE LCP SUP CLAV 3.5 7H L
|
Facility
|
OP
|
$5,444.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$707.83 |
| Max. Negotiated Rate |
$5,227.08 |
| Rate for Payer: Aetna Commercial |
$4,192.56
|
| Rate for Payer: Anthem Medicaid |
$1,872.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,247.01
|
| Rate for Payer: Cash Price |
$2,722.44
|
| Rate for Payer: Cigna Commercial |
$4,519.25
|
| Rate for Payer: First Health Commercial |
$5,172.64
|
| Rate for Payer: Humana Commercial |
$4,628.15
|
| Rate for Payer: Humana KY Medicaid |
$1,872.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,891.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,464.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,018.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,633.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,910.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,791.49
|
| Rate for Payer: Ohio Health Group HMO |
$4,083.66
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,088.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$707.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,687.91
|
| Rate for Payer: PHCS Commercial |
$5,227.08
|
| Rate for Payer: United Healthcare All Payer |
$4,791.49
|
|
|
PLATE LCP TIBIA 3.5MM 11H L
|
Facility
|
IP
|
$7,535.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.59 |
| Max. Negotiated Rate |
$7,233.92 |
| Rate for Payer: Aetna Commercial |
$5,802.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,877.56
|
| Rate for Payer: Cash Price |
$3,767.66
|
| Rate for Payer: Cigna Commercial |
$6,254.32
|
| Rate for Payer: First Health Commercial |
$7,158.56
|
| Rate for Payer: Humana Commercial |
$6,405.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,178.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,561.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,260.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,631.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,651.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,335.95
|
| Rate for Payer: PHCS Commercial |
$7,233.92
|
| Rate for Payer: United Healthcare All Payer |
$6,631.09
|
|
|
PLATE LCP TIBIA 3.5MM 11H L
|
Facility
|
OP
|
$7,535.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$979.59 |
| Max. Negotiated Rate |
$7,233.92 |
| Rate for Payer: Aetna Commercial |
$5,802.20
|
| Rate for Payer: Anthem Medicaid |
$2,591.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,877.56
|
| Rate for Payer: Cash Price |
$3,767.66
|
| Rate for Payer: Cigna Commercial |
$6,254.32
|
| Rate for Payer: First Health Commercial |
$7,158.56
|
| Rate for Payer: Humana Commercial |
$6,405.03
|
| Rate for Payer: Humana KY Medicaid |
$2,591.40
|
| Rate for Payer: Kentucky WC Medicaid |
$2,617.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,178.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,561.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,260.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,643.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,631.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,651.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,507.07
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$979.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,335.95
|
| Rate for Payer: PHCS Commercial |
$7,233.92
|
| Rate for Payer: United Healthcare All Payer |
$6,631.09
|
|
|
PLATE LCP TIBIA 3.5MM 11H R
|
Facility
|
OP
|
$7,389.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$7,093.86 |
| Rate for Payer: Aetna Commercial |
$5,689.87
|
| Rate for Payer: Anthem Medicaid |
$2,541.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.76
|
| Rate for Payer: Cash Price |
$3,694.72
|
| Rate for Payer: Cigna Commercial |
$6,133.24
|
| Rate for Payer: First Health Commercial |
$7,019.97
|
| Rate for Payer: Humana Commercial |
$6,281.02
|
| Rate for Payer: Humana KY Medicaid |
$2,541.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,567.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.73
|
| Rate for Payer: PHCS Commercial |
$7,093.86
|
| Rate for Payer: United Healthcare All Payer |
$6,502.71
|
|
|
PLATE LCP TIBIA 3.5MM 11H R
|
Facility
|
IP
|
$7,389.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$7,093.86 |
| Rate for Payer: Aetna Commercial |
$5,689.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.76
|
| Rate for Payer: Cash Price |
$3,694.72
|
| Rate for Payer: Cigna Commercial |
$6,133.24
|
| Rate for Payer: First Health Commercial |
$7,019.97
|
| Rate for Payer: Humana Commercial |
$6,281.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.73
|
| Rate for Payer: PHCS Commercial |
$7,093.86
|
| Rate for Payer: United Healthcare All Payer |
$6,502.71
|
|
|
PLATE LCP TIBIA 3.5MM 13H L
|
Facility
|
OP
|
$7,586.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$986.21 |
| Max. Negotiated Rate |
$7,282.79 |
| Rate for Payer: Aetna Commercial |
$5,841.40
|
| Rate for Payer: Anthem Medicaid |
$2,608.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,917.27
|
| Rate for Payer: Cash Price |
$3,793.12
|
| Rate for Payer: Cigna Commercial |
$6,296.58
|
| Rate for Payer: First Health Commercial |
$7,206.93
|
| Rate for Payer: Humana Commercial |
$6,448.30
|
| Rate for Payer: Humana KY Medicaid |
$2,608.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,635.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,220.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,598.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,275.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,661.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,675.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,689.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,517.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,351.73
|
| Rate for Payer: PHCS Commercial |
$7,282.79
|
| Rate for Payer: United Healthcare All Payer |
$6,675.89
|
|
|
PLATE LCP TIBIA 3.5MM 13H L
|
Facility
|
IP
|
$7,586.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$986.21 |
| Max. Negotiated Rate |
$7,282.79 |
| Rate for Payer: Aetna Commercial |
$5,841.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,917.27
|
| Rate for Payer: Cash Price |
$3,793.12
|
| Rate for Payer: Cigna Commercial |
$6,296.58
|
| Rate for Payer: First Health Commercial |
$7,206.93
|
| Rate for Payer: Humana Commercial |
$6,448.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,220.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,598.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,275.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,675.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,689.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,517.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$986.21
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,351.73
|
| Rate for Payer: PHCS Commercial |
$7,282.79
|
| Rate for Payer: United Healthcare All Payer |
$6,675.89
|
|
|
PLATE LCP TIBIA 3.5MM 13H R
|
Facility
|
OP
|
$7,389.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$7,093.86 |
| Rate for Payer: Anthem Medicaid |
$2,541.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.76
|
| Rate for Payer: Cash Price |
$3,694.72
|
| Rate for Payer: Cigna Commercial |
$6,133.24
|
| Rate for Payer: First Health Commercial |
$7,019.97
|
| Rate for Payer: Humana Commercial |
$6,281.02
|
| Rate for Payer: Humana KY Medicaid |
$2,541.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,567.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.73
|
| Rate for Payer: PHCS Commercial |
$7,093.86
|
| Rate for Payer: United Healthcare All Payer |
$6,502.71
|
| Rate for Payer: Aetna Commercial |
$5,689.87
|
|
|
PLATE LCP TIBIA 3.5MM 13H R
|
Facility
|
IP
|
$7,389.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.63 |
| Max. Negotiated Rate |
$7,093.86 |
| Rate for Payer: Aetna Commercial |
$5,689.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.76
|
| Rate for Payer: Cash Price |
$3,694.72
|
| Rate for Payer: Cigna Commercial |
$6,133.24
|
| Rate for Payer: First Health Commercial |
$7,019.97
|
| Rate for Payer: Humana Commercial |
$6,281.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.89
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.73
|
| Rate for Payer: PHCS Commercial |
$7,093.86
|
| Rate for Payer: United Healthcare All Payer |
$6,502.71
|
|
|
PLATE LCP TIBIA 3.5MM 15H L
|
Facility
|
OP
|
$7,647.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$994.16 |
| Max. Negotiated Rate |
$7,341.46 |
| Rate for Payer: Aetna Commercial |
$5,888.46
|
| Rate for Payer: Anthem Medicaid |
$2,629.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,964.93
|
| Rate for Payer: Cash Price |
$3,823.67
|
| Rate for Payer: Cigna Commercial |
$6,347.30
|
| Rate for Payer: First Health Commercial |
$7,264.98
|
| Rate for Payer: Humana Commercial |
$6,500.25
|
| Rate for Payer: Humana KY Medicaid |
$2,629.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,656.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,270.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,643.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,294.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,682.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,729.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,735.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,529.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$994.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,370.68
|
| Rate for Payer: PHCS Commercial |
$7,341.46
|
| Rate for Payer: United Healthcare All Payer |
$6,729.67
|
|
