|
PLATE LCP TIBIA 3.5MM 15H L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE LCP TIBIA 3.5MM 15H R
|
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
|
|
|
PLATE LCP TIBIA 3.5MM 15H R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE LCP TIBIA 3.5MM 17H L
|
Facility
|
OP
|
$7,691.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.89 |
| Max. Negotiated Rate |
$7,383.81 |
| Rate for Payer: Aetna Commercial |
$5,922.43
|
| Rate for Payer: Anthem Medicaid |
$2,645.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,999.35
|
| Rate for Payer: Cash Price |
$3,845.74
|
| Rate for Payer: Cigna Commercial |
$6,383.92
|
| Rate for Payer: First Health Commercial |
$7,306.90
|
| Rate for Payer: Humana Commercial |
$6,537.75
|
| Rate for Payer: Humana KY Medicaid |
$2,645.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,672.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,307.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,676.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,698.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,768.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,768.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,384.36
|
| Rate for Payer: PHCS Commercial |
$7,383.81
|
| Rate for Payer: United Healthcare All Payer |
$6,768.49
|
|
|
PLATE LCP TIBIA 3.5MM 17H L
|
Facility
|
IP
|
$7,691.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.89 |
| Max. Negotiated Rate |
$7,383.81 |
| Rate for Payer: Aetna Commercial |
$5,922.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,999.35
|
| Rate for Payer: Cash Price |
$3,845.74
|
| Rate for Payer: Cigna Commercial |
$6,383.92
|
| Rate for Payer: First Health Commercial |
$7,306.90
|
| Rate for Payer: Humana Commercial |
$6,537.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,307.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,676.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,768.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,768.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,384.36
|
| Rate for Payer: PHCS Commercial |
$7,383.81
|
| Rate for Payer: United Healthcare All Payer |
$6,768.49
|
|
|
PLATE LCP TIBIA 3.5MM 17H R
|
Facility
|
OP
|
$7,691.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.89 |
| Max. Negotiated Rate |
$7,383.81 |
| Rate for Payer: Aetna Commercial |
$5,922.43
|
| Rate for Payer: Anthem Medicaid |
$2,645.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,999.35
|
| Rate for Payer: Cash Price |
$3,845.74
|
| Rate for Payer: Cigna Commercial |
$6,383.92
|
| Rate for Payer: First Health Commercial |
$7,306.90
|
| Rate for Payer: Humana Commercial |
$6,537.75
|
| Rate for Payer: Humana KY Medicaid |
$2,645.10
|
| Rate for Payer: Kentucky WC Medicaid |
$2,672.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,307.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,676.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,698.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,768.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,768.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,384.36
|
| Rate for Payer: PHCS Commercial |
$7,383.81
|
| Rate for Payer: United Healthcare All Payer |
$6,768.49
|
|
|
PLATE LCP TIBIA 3.5MM 17H R
|
Facility
|
IP
|
$7,691.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$999.89 |
| Max. Negotiated Rate |
$7,383.81 |
| Rate for Payer: Aetna Commercial |
$5,922.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,999.35
|
| Rate for Payer: Cash Price |
$3,845.74
|
| Rate for Payer: Cigna Commercial |
$6,383.92
|
| Rate for Payer: First Health Commercial |
$7,306.90
|
| Rate for Payer: Humana Commercial |
$6,537.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,307.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,676.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,307.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,768.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,768.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,538.29
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$999.89
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,384.36
|
| Rate for Payer: PHCS Commercial |
$7,383.81
|
| Rate for Payer: United Healthcare All Payer |
$6,768.49
|
|
|
PLATE LCP TIBIA 3.5MM 5H L
|
Facility
|
IP
|
$7,389.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.62 |
| Max. Negotiated Rate |
$7,093.79 |
| Rate for Payer: Aetna Commercial |
$5,689.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.70
|
| Rate for Payer: Cash Price |
$3,694.68
|
| Rate for Payer: Cigna Commercial |
$6,133.17
|
| Rate for Payer: First Health Commercial |
$7,019.89
|
| Rate for Payer: Humana Commercial |
$6,280.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.70
|
| Rate for Payer: PHCS Commercial |
$7,093.79
|
| Rate for Payer: United Healthcare All Payer |
$6,502.64
|
|
|
PLATE LCP TIBIA 3.5MM 5H L
|
Facility
|
OP
|
$7,389.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.62 |
| Max. Negotiated Rate |
$7,093.79 |
| Rate for Payer: Aetna Commercial |
$5,689.81
|
| Rate for Payer: Anthem Medicaid |
$2,541.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,763.70
|
| Rate for Payer: Cash Price |
$3,694.68
|
| Rate for Payer: Cigna Commercial |
$6,133.17
|
| Rate for Payer: First Health Commercial |
$7,019.89
|
| Rate for Payer: Humana Commercial |
$6,280.96
|
| Rate for Payer: Humana KY Medicaid |
$2,541.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,567.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,059.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,453.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,216.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,592.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,502.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,542.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,477.87
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$960.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,290.70
|
| Rate for Payer: PHCS Commercial |
$7,093.79
|
| Rate for Payer: United Healthcare All Payer |
$6,502.64
|
|
|
PLATE LCP TIBIA 3.5MM 5H 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 5H 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 7H L
|
Facility
|
OP
|
$7,440.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.24 |
| Max. Negotiated Rate |
$7,142.67 |
| Rate for Payer: Aetna Commercial |
$5,729.02
|
| Rate for Payer: Anthem Medicaid |
$2,558.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,803.42
|
| Rate for Payer: Cash Price |
$3,720.14
|
| Rate for Payer: Cigna Commercial |
$6,175.43
|
| Rate for Payer: First Health Commercial |
$7,068.27
|
| Rate for Payer: Humana Commercial |
$6,324.24
|
| Rate for Payer: Humana KY Medicaid |
$2,558.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,584.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,101.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,490.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,232.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,610.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,547.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,580.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.49
|
| Rate for Payer: PHCS Commercial |
$7,142.67
|
| Rate for Payer: United Healthcare All Payer |
$6,547.45
|
|
|
PLATE LCP TIBIA 3.5MM 7H L
|
Facility
|
IP
|
$7,440.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$967.24 |
| Max. Negotiated Rate |
$7,142.67 |
| Rate for Payer: Humana Commercial |
$6,324.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,101.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,490.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,232.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,547.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,580.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,488.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$967.24
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,306.49
|
| Rate for Payer: PHCS Commercial |
$7,142.67
|
| Rate for Payer: United Healthcare All Payer |
$6,547.45
|
| Rate for Payer: Aetna Commercial |
$5,729.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,803.42
|
| Rate for Payer: Cash Price |
$3,720.14
|
| Rate for Payer: Cigna Commercial |
$6,175.43
|
| Rate for Payer: First Health Commercial |
$7,068.27
|
|
|
PLATE LCP TIBIA 3.5MM 7H 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 7H 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 9H L
|
Facility
|
OP
|
$7,487.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.41 |
| Max. Negotiated Rate |
$7,188.29 |
| Rate for Payer: Aetna Commercial |
$5,765.61
|
| Rate for Payer: Anthem Medicaid |
$2,575.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,840.48
|
| Rate for Payer: Cash Price |
$3,743.90
|
| Rate for Payer: Cigna Commercial |
$6,214.87
|
| Rate for Payer: First Health Commercial |
$7,113.41
|
| Rate for Payer: Humana Commercial |
$6,364.63
|
| Rate for Payer: Humana KY Medicaid |
$2,575.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,601.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,526.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,626.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,589.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,615.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,321.22
|
| Rate for Payer: PHCS Commercial |
$7,188.29
|
| Rate for Payer: United Healthcare All Payer |
$6,589.26
|
|
|
PLATE LCP TIBIA 3.5MM 9H L
|
Facility
|
IP
|
$7,487.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.41 |
| Max. Negotiated Rate |
$7,188.29 |
| Rate for Payer: Aetna Commercial |
$5,765.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,840.48
|
| Rate for Payer: Cash Price |
$3,743.90
|
| Rate for Payer: Cigna Commercial |
$6,214.87
|
| Rate for Payer: First Health Commercial |
$7,113.41
|
| Rate for Payer: Humana Commercial |
$6,364.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,526.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,589.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,615.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,321.22
|
| Rate for Payer: PHCS Commercial |
$7,188.29
|
| Rate for Payer: United Healthcare All Payer |
$6,589.26
|
|
|
PLATE LCP TIBIA 3.5MM 9H R
|
Facility
|
IP
|
$7,487.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.41 |
| Max. Negotiated Rate |
$7,188.29 |
| Rate for Payer: Aetna Commercial |
$5,765.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,840.48
|
| Rate for Payer: Cash Price |
$3,743.90
|
| Rate for Payer: Cigna Commercial |
$6,214.87
|
| Rate for Payer: First Health Commercial |
$7,113.41
|
| Rate for Payer: Humana Commercial |
$6,364.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,526.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,589.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,615.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,321.22
|
| Rate for Payer: PHCS Commercial |
$7,188.29
|
| Rate for Payer: United Healthcare All Payer |
$6,589.26
|
|
|
PLATE LCP TIBIA 3.5MM 9H R
|
Facility
|
OP
|
$7,487.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$973.41 |
| Max. Negotiated Rate |
$7,188.29 |
| Rate for Payer: Aetna Commercial |
$5,765.61
|
| Rate for Payer: Anthem Medicaid |
$2,575.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,840.48
|
| Rate for Payer: Cash Price |
$3,743.90
|
| Rate for Payer: Cigna Commercial |
$6,214.87
|
| Rate for Payer: First Health Commercial |
$7,113.41
|
| Rate for Payer: Humana Commercial |
$6,364.63
|
| Rate for Payer: Humana KY Medicaid |
$2,575.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,601.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,140.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,526.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,246.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,626.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,589.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,615.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,497.56
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$973.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,321.22
|
| Rate for Payer: PHCS Commercial |
$7,188.29
|
| Rate for Payer: United Healthcare All Payer |
$6,589.26
|
|
|
PLATE LD FM LK 4.5M 10H 230M L
|
Facility
|
OP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Humana KY Medicaid |
$2,809.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,837.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,865.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem Medicaid |
$2,809.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
|
|
PLATE LD FM LK 4.5M 10H 230M L
|
Facility
|
IP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE LD FM LK 4.5M 10H 230M R
|
Facility
|
OP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem Medicaid |
$2,809.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Humana KY Medicaid |
$2,809.06
|
| Rate for Payer: Kentucky WC Medicaid |
$2,837.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,865.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE LD FM LK 4.5M 10H 230M R
|
Facility
|
IP
|
$8,168.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,061.87 |
| Max. Negotiated Rate |
$7,841.51 |
| Rate for Payer: Aetna Commercial |
$6,289.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,371.23
|
| Rate for Payer: Cash Price |
$4,084.12
|
| Rate for Payer: Cigna Commercial |
$6,779.64
|
| Rate for Payer: First Health Commercial |
$7,759.83
|
| Rate for Payer: Humana Commercial |
$6,943.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,697.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,028.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,450.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,188.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,126.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,633.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,061.87
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,532.15
|
| Rate for Payer: PHCS Commercial |
$7,841.51
|
| Rate for Payer: United Healthcare All Payer |
$7,188.05
|
|
|
PLATE LD FM LK 4.5M 13H 286M L
|
Facility
|
OP
|
$8,424.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.23 |
| Max. Negotiated Rate |
$8,087.84 |
| Rate for Payer: Aetna Commercial |
$6,487.12
|
| Rate for Payer: Anthem Medicaid |
$2,897.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,571.37
|
| Rate for Payer: Cash Price |
$4,212.42
|
| Rate for Payer: Cigna Commercial |
$6,992.61
|
| Rate for Payer: First Health Commercial |
$8,003.59
|
| Rate for Payer: Humana Commercial |
$7,161.11
|
| Rate for Payer: Humana KY Medicaid |
$2,897.30
|
| Rate for Payer: Kentucky WC Medicaid |
$2,926.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,217.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,527.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,955.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,413.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.70
|
| Rate for Payer: PHCS Commercial |
$8,087.84
|
| Rate for Payer: United Healthcare All Payer |
$7,413.85
|
|
|
PLATE LD FM LK 4.5M 13H 286M L
|
Facility
|
IP
|
$8,424.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,095.23 |
| Max. Negotiated Rate |
$8,087.84 |
| Rate for Payer: Aetna Commercial |
$6,487.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,571.37
|
| Rate for Payer: Cash Price |
$4,212.42
|
| Rate for Payer: Cigna Commercial |
$6,992.61
|
| Rate for Payer: First Health Commercial |
$8,003.59
|
| Rate for Payer: Humana Commercial |
$7,161.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,908.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,217.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,527.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,413.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,318.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,684.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,095.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,611.70
|
| Rate for Payer: PHCS Commercial |
$8,087.84
|
| Rate for Payer: United Healthcare All Payer |
$7,413.85
|
|
