|
PLATE CONDYLAR LOCKING R 12H
|
Facility
|
IP
|
$9,650.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.07 |
| Max. Negotiated Rate |
$9,264.22 |
| Rate for Payer: Aetna Commercial |
$7,430.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.18
|
| Rate for Payer: Cash Price |
$4,825.11
|
| Rate for Payer: Cigna Commercial |
$8,009.69
|
| Rate for Payer: First Health Commercial |
$9,167.72
|
| Rate for Payer: Humana Commercial |
$8,202.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.66
|
| Rate for Payer: PHCS Commercial |
$9,264.22
|
| Rate for Payer: United Healthcare All Payer |
$8,492.20
|
|
|
PLATE CONDYLAR LOCKING R 12H
|
Facility
|
OP
|
$9,650.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,895.07 |
| Max. Negotiated Rate |
$9,264.22 |
| Rate for Payer: Aetna Commercial |
$7,430.68
|
| Rate for Payer: Anthem Medicaid |
$3,318.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,527.18
|
| Rate for Payer: Cash Price |
$4,825.11
|
| Rate for Payer: Cigna Commercial |
$8,009.69
|
| Rate for Payer: First Health Commercial |
$9,167.72
|
| Rate for Payer: Humana Commercial |
$8,202.70
|
| Rate for Payer: Humana KY Medicaid |
$3,318.71
|
| Rate for Payer: Kentucky WC Medicaid |
$3,352.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,913.19
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,121.87
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,895.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,385.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,492.20
|
| Rate for Payer: Ohio Health Group HMO |
$7,237.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,720.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,395.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,658.66
|
| Rate for Payer: PHCS Commercial |
$9,264.22
|
| Rate for Payer: United Healthcare All Payer |
$8,492.20
|
|
|
PLATE CONDYLAR LOCKING R 14H
|
Facility
|
IP
|
$9,786.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,935.97 |
| Max. Negotiated Rate |
$9,395.09 |
| Rate for Payer: Aetna Commercial |
$7,535.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,633.51
|
| Rate for Payer: Cash Price |
$4,893.28
|
| Rate for Payer: Cigna Commercial |
$8,122.84
|
| Rate for Payer: First Health Commercial |
$9,297.22
|
| Rate for Payer: Humana Commercial |
$8,318.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,024.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,222.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,339.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,829.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,514.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,752.72
|
| Rate for Payer: PHCS Commercial |
$9,395.09
|
| Rate for Payer: United Healthcare All Payer |
$8,612.16
|
|
|
PLATE CONDYLAR LOCKING R 14H
|
Facility
|
OP
|
$9,786.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,935.97 |
| Max. Negotiated Rate |
$9,395.09 |
| Rate for Payer: Aetna Commercial |
$7,535.64
|
| Rate for Payer: Anthem Medicaid |
$3,365.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,633.51
|
| Rate for Payer: Cash Price |
$4,893.28
|
| Rate for Payer: Cigna Commercial |
$8,122.84
|
| Rate for Payer: First Health Commercial |
$9,297.22
|
| Rate for Payer: Humana Commercial |
$8,318.57
|
| Rate for Payer: Humana KY Medicaid |
$3,365.59
|
| Rate for Payer: Kentucky WC Medicaid |
$3,399.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,024.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,222.47
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,935.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,433.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,612.16
|
| Rate for Payer: Ohio Health Group HMO |
$7,339.91
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,829.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,514.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,752.72
|
| Rate for Payer: PHCS Commercial |
$9,395.09
|
| Rate for Payer: United Healthcare All Payer |
$8,612.16
|
|
|
PLATE CONDYLAR LOCKING R 16H
|
Facility
|
IP
|
$9,919.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.75 |
| Max. Negotiated Rate |
$9,522.39 |
| Rate for Payer: Aetna Commercial |
$7,637.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.94
|
| Rate for Payer: Cash Price |
$4,959.58
|
| Rate for Payer: Cigna Commercial |
$8,232.90
|
| Rate for Payer: First Health Commercial |
$9,423.20
|
| Rate for Payer: Humana Commercial |
$8,431.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,439.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,935.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,629.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.22
|
| Rate for Payer: PHCS Commercial |
$9,522.39
|
| Rate for Payer: United Healthcare All Payer |
$8,728.86
|
|
|
PLATE CONDYLAR LOCKING R 16H
|
Facility
|
OP
|
$9,919.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.75 |
| Max. Negotiated Rate |
$9,522.39 |
| Rate for Payer: Aetna Commercial |
$7,637.75
|
| Rate for Payer: Anthem Medicaid |
$3,411.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.94
|
| Rate for Payer: Cash Price |
$4,959.58
|
| Rate for Payer: Cigna Commercial |
$8,232.90
|
| Rate for Payer: First Health Commercial |
$9,423.20
|
| Rate for Payer: Humana Commercial |
$8,431.29
|
| Rate for Payer: Humana KY Medicaid |
$3,411.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,439.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,935.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,629.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.22
|
| Rate for Payer: PHCS Commercial |
$9,522.39
|
| Rate for Payer: United Healthcare All Payer |
$8,728.86
|
|
|
PLATE CONDYLAR LOCKING R 18H
|
Facility
|
IP
|
$9,919.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.75 |
| Max. Negotiated Rate |
$9,522.39 |
| Rate for Payer: Aetna Commercial |
$7,637.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.94
|
| Rate for Payer: Cash Price |
$4,959.58
|
| Rate for Payer: Cigna Commercial |
$8,232.90
|
| Rate for Payer: First Health Commercial |
$9,423.20
|
| Rate for Payer: Humana Commercial |
$8,431.29
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,439.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,935.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,629.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.22
|
| Rate for Payer: PHCS Commercial |
$9,522.39
|
| Rate for Payer: United Healthcare All Payer |
$8,728.86
|
|
|
PLATE CONDYLAR LOCKING R 18H
|
Facility
|
OP
|
$9,919.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,975.75 |
| Max. Negotiated Rate |
$9,522.39 |
| Rate for Payer: Aetna Commercial |
$7,637.75
|
| Rate for Payer: Anthem Medicaid |
$3,411.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,736.94
|
| Rate for Payer: Cash Price |
$4,959.58
|
| Rate for Payer: Cigna Commercial |
$8,232.90
|
| Rate for Payer: First Health Commercial |
$9,423.20
|
| Rate for Payer: Humana Commercial |
$8,431.29
|
| Rate for Payer: Humana KY Medicaid |
$3,411.20
|
| Rate for Payer: Kentucky WC Medicaid |
$3,445.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,133.71
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,320.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,975.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,479.64
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,728.86
|
| Rate for Payer: Ohio Health Group HMO |
$7,439.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,935.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,629.67
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,844.22
|
| Rate for Payer: PHCS Commercial |
$9,522.39
|
| Rate for Payer: United Healthcare All Payer |
$8,728.86
|
|
|
PLATE CONDYLAR LT 2.0MM
|
Facility
|
OP
|
$3,091.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.49 |
| Max. Negotiated Rate |
$2,967.96 |
| Rate for Payer: Aetna Commercial |
$2,380.55
|
| Rate for Payer: Anthem Medicaid |
$1,063.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,411.46
|
| Rate for Payer: Cash Price |
$1,545.81
|
| Rate for Payer: Cigna Commercial |
$2,566.04
|
| Rate for Payer: First Health Commercial |
$2,937.04
|
| Rate for Payer: Humana Commercial |
$2,627.88
|
| Rate for Payer: Humana KY Medicaid |
$1,063.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,074.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,535.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,084.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,473.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,689.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.22
|
| Rate for Payer: PHCS Commercial |
$2,967.96
|
| Rate for Payer: United Healthcare All Payer |
$2,720.63
|
|
|
PLATE CONDYLAR LT 2.0MM
|
Facility
|
IP
|
$3,091.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$927.49 |
| Max. Negotiated Rate |
$2,967.96 |
| Rate for Payer: Aetna Commercial |
$2,380.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,411.46
|
| Rate for Payer: Cash Price |
$1,545.81
|
| Rate for Payer: Cigna Commercial |
$2,566.04
|
| Rate for Payer: First Health Commercial |
$2,937.04
|
| Rate for Payer: Humana Commercial |
$2,627.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,535.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,281.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$927.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,720.63
|
| Rate for Payer: Ohio Health Group HMO |
$2,318.72
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,473.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,689.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,133.22
|
| Rate for Payer: PHCS Commercial |
$2,967.96
|
| Rate for Payer: United Healthcare All Payer |
$2,720.63
|
|
|
PLATE CONDYLAR LT 2.7MM
|
Facility
|
OP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem Medicaid |
$1,087.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Humana KY Medicaid |
$1,087.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE CONDYLAR LT 2.7MM
|
Facility
|
IP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE CONDYLAR RT 2.7MM
|
Facility
|
OP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem Medicaid |
$1,087.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Humana KY Medicaid |
$1,087.00
|
| Rate for Payer: Kentucky WC Medicaid |
$1,098.07
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,108.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE CONDYLAR RT 2.7MM
|
Facility
|
IP
|
$3,160.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$948.24 |
| Max. Negotiated Rate |
$3,034.38 |
| Rate for Payer: Aetna Commercial |
$2,433.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,465.43
|
| Rate for Payer: Cash Price |
$1,580.41
|
| Rate for Payer: Cigna Commercial |
$2,623.47
|
| Rate for Payer: First Health Commercial |
$3,002.77
|
| Rate for Payer: Humana Commercial |
$2,686.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,591.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,332.68
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$948.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,781.51
|
| Rate for Payer: Ohio Health Group HMO |
$2,370.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,528.65
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,749.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,180.96
|
| Rate for Payer: PHCS Commercial |
$3,034.38
|
| Rate for Payer: United Healthcare All Payer |
$2,781.51
|
|
|
PLATE CONDY LCP 4.5 10H 242M L
|
Facility
|
IP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
PLATE CONDY LCP 4.5 10H 242M L
|
Facility
|
OP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem Medicaid |
$2,607.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Humana KY Medicaid |
$2,607.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,634.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,659.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
PLATE CONDY LCP 4.5 10H 242M R
|
Facility
|
OP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem Medicaid |
$2,607.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Humana KY Medicaid |
$2,607.65
|
| Rate for Payer: Kentucky WC Medicaid |
$2,634.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,659.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
PLATE CONDY LCP 4.5 10H 242M R
|
Facility
|
IP
|
$7,582.58
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,274.77 |
| Max. Negotiated Rate |
$7,279.28 |
| Rate for Payer: Aetna Commercial |
$5,838.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,914.41
|
| Rate for Payer: Cash Price |
$3,791.29
|
| Rate for Payer: Cigna Commercial |
$6,293.54
|
| Rate for Payer: First Health Commercial |
$7,203.45
|
| Rate for Payer: Humana Commercial |
$6,445.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,217.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,595.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,274.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,672.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,686.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,066.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,596.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,231.98
|
| Rate for Payer: PHCS Commercial |
$7,279.28
|
| Rate for Payer: United Healthcare All Payer |
$6,672.67
|
|
|
PLATE CONDY LCP 4.5 12H 278M L
|
Facility
|
IP
|
$7,674.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.27 |
| Max. Negotiated Rate |
$7,367.26 |
| Rate for Payer: Aetna Commercial |
$5,909.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,985.90
|
| Rate for Payer: Cash Price |
$3,837.11
|
| Rate for Payer: Cigna Commercial |
$6,369.61
|
| Rate for Payer: First Health Commercial |
$7,290.52
|
| Rate for Payer: Humana Commercial |
$6,523.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,292.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,663.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,753.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,755.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,139.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,676.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,295.22
|
| Rate for Payer: PHCS Commercial |
$7,367.26
|
| Rate for Payer: United Healthcare All Payer |
$6,753.32
|
|
|
PLATE CONDY LCP 4.5 12H 278M L
|
Facility
|
OP
|
$7,674.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.27 |
| Max. Negotiated Rate |
$7,367.26 |
| Rate for Payer: Aetna Commercial |
$5,909.16
|
| Rate for Payer: Anthem Medicaid |
$2,639.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,985.90
|
| Rate for Payer: Cash Price |
$3,837.11
|
| Rate for Payer: Cigna Commercial |
$6,369.61
|
| Rate for Payer: First Health Commercial |
$7,290.52
|
| Rate for Payer: Humana Commercial |
$6,523.10
|
| Rate for Payer: Humana KY Medicaid |
$2,639.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,292.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,663.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,753.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,755.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,139.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,676.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,295.22
|
| Rate for Payer: PHCS Commercial |
$7,367.26
|
| Rate for Payer: United Healthcare All Payer |
$6,753.32
|
|
|
PLATE CONDY LCP 4.5 12H 278M R
|
Facility
|
IP
|
$7,674.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.27 |
| Max. Negotiated Rate |
$7,367.26 |
| Rate for Payer: Aetna Commercial |
$5,909.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,985.90
|
| Rate for Payer: Cash Price |
$3,837.11
|
| Rate for Payer: Cigna Commercial |
$6,369.61
|
| Rate for Payer: First Health Commercial |
$7,290.52
|
| Rate for Payer: Humana Commercial |
$6,523.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,292.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,663.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,753.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,755.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,139.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,676.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,295.22
|
| Rate for Payer: PHCS Commercial |
$7,367.26
|
| Rate for Payer: United Healthcare All Payer |
$6,753.32
|
|
|
PLATE CONDY LCP 4.5 12H 278M R
|
Facility
|
OP
|
$7,674.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,302.27 |
| Max. Negotiated Rate |
$7,367.26 |
| Rate for Payer: Aetna Commercial |
$5,909.16
|
| Rate for Payer: Anthem Medicaid |
$2,639.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,985.90
|
| Rate for Payer: Cash Price |
$3,837.11
|
| Rate for Payer: Cigna Commercial |
$6,369.61
|
| Rate for Payer: First Health Commercial |
$7,290.52
|
| Rate for Payer: Humana Commercial |
$6,523.10
|
| Rate for Payer: Humana KY Medicaid |
$2,639.17
|
| Rate for Payer: Kentucky WC Medicaid |
$2,666.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,292.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,663.58
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,302.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,692.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,753.32
|
| Rate for Payer: Ohio Health Group HMO |
$5,755.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,139.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,676.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,295.22
|
| Rate for Payer: PHCS Commercial |
$7,367.26
|
| Rate for Payer: United Healthcare All Payer |
$6,753.32
|
|
|
PLATE CONDY LCP 4.5 14H 314M L
|
Facility
|
OP
|
$7,772.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.80 |
| Max. Negotiated Rate |
$7,461.76 |
| Rate for Payer: Aetna Commercial |
$5,984.96
|
| Rate for Payer: Anthem Medicaid |
$2,673.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,062.68
|
| Rate for Payer: Cash Price |
$3,886.33
|
| Rate for Payer: Cigna Commercial |
$6,451.32
|
| Rate for Payer: First Health Commercial |
$7,384.04
|
| Rate for Payer: Humana Commercial |
$6,606.77
|
| Rate for Payer: Humana KY Medicaid |
$2,673.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,700.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,373.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,736.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,726.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,839.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,829.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,218.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,762.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,363.14
|
| Rate for Payer: PHCS Commercial |
$7,461.76
|
| Rate for Payer: United Healthcare All Payer |
$6,839.95
|
|
|
PLATE CONDY LCP 4.5 14H 314M L
|
Facility
|
IP
|
$7,772.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.80 |
| Max. Negotiated Rate |
$7,461.76 |
| Rate for Payer: Aetna Commercial |
$5,984.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,062.68
|
| Rate for Payer: Cash Price |
$3,886.33
|
| Rate for Payer: Cigna Commercial |
$6,451.32
|
| Rate for Payer: First Health Commercial |
$7,384.04
|
| Rate for Payer: Humana Commercial |
$6,606.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,373.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,736.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,839.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,829.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,218.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,762.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,363.14
|
| Rate for Payer: PHCS Commercial |
$7,461.76
|
| Rate for Payer: United Healthcare All Payer |
$6,839.95
|
|
|
PLATE CONDY LCP 4.5 14H 314M R
|
Facility
|
OP
|
$7,772.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,331.80 |
| Max. Negotiated Rate |
$7,461.76 |
| Rate for Payer: Aetna Commercial |
$5,984.96
|
| Rate for Payer: Anthem Medicaid |
$2,673.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,062.68
|
| Rate for Payer: Cash Price |
$3,886.33
|
| Rate for Payer: Cigna Commercial |
$6,451.32
|
| Rate for Payer: First Health Commercial |
$7,384.04
|
| Rate for Payer: Humana Commercial |
$6,606.77
|
| Rate for Payer: Humana KY Medicaid |
$2,673.02
|
| Rate for Payer: Kentucky WC Medicaid |
$2,700.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,373.59
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,736.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,331.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,726.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,839.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,829.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,218.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,762.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,363.14
|
| Rate for Payer: PHCS Commercial |
$7,461.76
|
| Rate for Payer: United Healthcare All Payer |
$6,839.95
|
|
