|
PLATE CONDY LCP 4.5 14H 314M R
|
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 16H 350M L
|
Facility
|
OP
|
$7,867.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.31 |
| Max. Negotiated Rate |
$7,553.00 |
| Rate for Payer: Aetna Commercial |
$6,058.14
|
| Rate for Payer: Anthem Medicaid |
$2,705.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,136.81
|
| Rate for Payer: Cash Price |
$3,933.86
|
| Rate for Payer: Cigna Commercial |
$6,530.20
|
| Rate for Payer: First Health Commercial |
$7,474.32
|
| Rate for Payer: Humana Commercial |
$6,687.55
|
| Rate for Payer: Humana KY Medicaid |
$2,705.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,733.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,451.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,806.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,360.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,759.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,923.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,900.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,294.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,844.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,428.72
|
| Rate for Payer: PHCS Commercial |
$7,553.00
|
| Rate for Payer: United Healthcare All Payer |
$6,923.58
|
|
|
PLATE CONDY LCP 4.5 16H 350M L
|
Facility
|
IP
|
$7,867.71
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.31 |
| Max. Negotiated Rate |
$7,553.00 |
| Rate for Payer: Aetna Commercial |
$6,058.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,136.81
|
| Rate for Payer: Cash Price |
$3,933.86
|
| Rate for Payer: Cigna Commercial |
$6,530.20
|
| Rate for Payer: First Health Commercial |
$7,474.32
|
| Rate for Payer: Humana Commercial |
$6,687.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,451.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,806.37
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,360.31
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,923.58
|
| Rate for Payer: Ohio Health Group HMO |
$5,900.78
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,294.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,844.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,428.72
|
| Rate for Payer: PHCS Commercial |
$7,553.00
|
| Rate for Payer: United Healthcare All Payer |
$6,923.58
|
|
|
PLATE CONDY LCP 4.5 18H 386M L
|
Facility
|
OP
|
$7,966.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.84 |
| Max. Negotiated Rate |
$7,647.50 |
| Rate for Payer: Aetna Commercial |
$6,133.94
|
| Rate for Payer: Anthem Medicaid |
$2,739.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,213.60
|
| Rate for Payer: Cash Price |
$3,983.08
|
| Rate for Payer: Cigna Commercial |
$6,611.90
|
| Rate for Payer: First Health Commercial |
$7,567.84
|
| Rate for Payer: Humana Commercial |
$6,771.23
|
| Rate for Payer: Humana KY Medicaid |
$2,739.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,767.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,532.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,879.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,794.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,010.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,974.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,372.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,930.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,496.64
|
| Rate for Payer: PHCS Commercial |
$7,647.50
|
| Rate for Payer: United Healthcare All Payer |
$7,010.21
|
|
|
PLATE CONDY LCP 4.5 18H 386M L
|
Facility
|
IP
|
$7,966.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.84 |
| Max. Negotiated Rate |
$7,647.50 |
| Rate for Payer: Aetna Commercial |
$6,133.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,213.60
|
| Rate for Payer: Cash Price |
$3,983.08
|
| Rate for Payer: Cigna Commercial |
$6,611.90
|
| Rate for Payer: First Health Commercial |
$7,567.84
|
| Rate for Payer: Humana Commercial |
$6,771.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,532.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,879.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,010.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,974.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,372.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,930.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,496.64
|
| Rate for Payer: PHCS Commercial |
$7,647.50
|
| Rate for Payer: United Healthcare All Payer |
$7,010.21
|
|
|
PLATE CONDY LCP 4.5 18H 386M R
|
Facility
|
IP
|
$7,966.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.84 |
| Max. Negotiated Rate |
$7,647.50 |
| Rate for Payer: Aetna Commercial |
$6,133.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,213.60
|
| Rate for Payer: Cash Price |
$3,983.08
|
| Rate for Payer: Cigna Commercial |
$6,611.90
|
| Rate for Payer: First Health Commercial |
$7,567.84
|
| Rate for Payer: Humana Commercial |
$6,771.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,532.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,879.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,010.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,974.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,372.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,930.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,496.64
|
| Rate for Payer: PHCS Commercial |
$7,647.50
|
| Rate for Payer: United Healthcare All Payer |
$7,010.21
|
|
|
PLATE CONDY LCP 4.5 18H 386M R
|
Facility
|
OP
|
$7,966.15
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,389.84 |
| Max. Negotiated Rate |
$7,647.50 |
| Rate for Payer: Aetna Commercial |
$6,133.94
|
| Rate for Payer: Anthem Medicaid |
$2,739.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,213.60
|
| Rate for Payer: Cash Price |
$3,983.08
|
| Rate for Payer: Cigna Commercial |
$6,611.90
|
| Rate for Payer: First Health Commercial |
$7,567.84
|
| Rate for Payer: Humana Commercial |
$6,771.23
|
| Rate for Payer: Humana KY Medicaid |
$2,739.56
|
| Rate for Payer: Kentucky WC Medicaid |
$2,767.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,532.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,879.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,389.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,794.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,010.21
|
| Rate for Payer: Ohio Health Group HMO |
$5,974.61
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,372.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,930.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,496.64
|
| Rate for Payer: PHCS Commercial |
$7,647.50
|
| Rate for Payer: United Healthcare All Payer |
$7,010.21
|
|
|
PLATE CONDY LCP 4.5 6H 170M R
|
Facility
|
OP
|
$7,334.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.43 |
| Max. Negotiated Rate |
$7,041.39 |
| Rate for Payer: Aetna Commercial |
$5,647.78
|
| Rate for Payer: Anthem Medicaid |
$2,522.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,721.13
|
| Rate for Payer: Cash Price |
$3,667.39
|
| Rate for Payer: Cigna Commercial |
$6,087.87
|
| Rate for Payer: First Health Commercial |
$6,968.04
|
| Rate for Payer: Humana Commercial |
$6,234.56
|
| Rate for Payer: Humana KY Medicaid |
$2,522.43
|
| Rate for Payer: Kentucky WC Medicaid |
$2,548.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,413.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,573.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,501.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,381.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.00
|
| Rate for Payer: PHCS Commercial |
$7,041.39
|
| Rate for Payer: United Healthcare All Payer |
$6,454.61
|
|
|
PLATE CONDY LCP 4.5 6H 170M R
|
Facility
|
IP
|
$7,334.78
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,200.43 |
| Max. Negotiated Rate |
$7,041.39 |
| Rate for Payer: Aetna Commercial |
$5,647.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,721.13
|
| Rate for Payer: Cash Price |
$3,667.39
|
| Rate for Payer: Cigna Commercial |
$6,087.87
|
| Rate for Payer: First Health Commercial |
$6,968.04
|
| Rate for Payer: Humana Commercial |
$6,234.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,014.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,413.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,200.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,454.61
|
| Rate for Payer: Ohio Health Group HMO |
$5,501.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,867.82
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,381.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,061.00
|
| Rate for Payer: PHCS Commercial |
$7,041.39
|
| Rate for Payer: United Healthcare All Payer |
$6,454.61
|
|
|
PLATE CONDY LCP 4.5 8H 206M R
|
Facility
|
IP
|
$7,419.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.89 |
| Max. Negotiated Rate |
$7,122.85 |
| Rate for Payer: Aetna Commercial |
$5,713.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.32
|
| Rate for Payer: Cash Price |
$3,709.82
|
| Rate for Payer: Cigna Commercial |
$6,158.30
|
| Rate for Payer: First Health Commercial |
$7,048.66
|
| Rate for Payer: Humana Commercial |
$6,306.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,475.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,564.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,935.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.55
|
| Rate for Payer: PHCS Commercial |
$7,122.85
|
| Rate for Payer: United Healthcare All Payer |
$6,529.28
|
|
|
PLATE CONDY LCP 4.5 8H 206M R
|
Facility
|
OP
|
$7,419.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.89 |
| Max. Negotiated Rate |
$7,122.85 |
| Rate for Payer: Aetna Commercial |
$5,713.12
|
| Rate for Payer: Anthem Medicaid |
$2,551.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.32
|
| Rate for Payer: Cash Price |
$3,709.82
|
| Rate for Payer: Cigna Commercial |
$6,158.30
|
| Rate for Payer: First Health Commercial |
$7,048.66
|
| Rate for Payer: Humana Commercial |
$6,306.69
|
| Rate for Payer: Humana KY Medicaid |
$2,551.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,475.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,564.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,935.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.55
|
| Rate for Payer: PHCS Commercial |
$7,122.85
|
| Rate for Payer: United Healthcare All Payer |
$6,529.28
|
|
|
PLATE CONDYLR LCP 4.5 8H 206 L
|
Facility
|
IP
|
$7,419.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.89 |
| Max. Negotiated Rate |
$7,122.85 |
| Rate for Payer: Aetna Commercial |
$5,713.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.32
|
| Rate for Payer: Cash Price |
$3,709.82
|
| Rate for Payer: Cigna Commercial |
$6,158.30
|
| Rate for Payer: First Health Commercial |
$7,048.66
|
| Rate for Payer: Humana Commercial |
$6,306.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,475.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,564.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,935.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.55
|
| Rate for Payer: PHCS Commercial |
$7,122.85
|
| Rate for Payer: United Healthcare All Payer |
$6,529.28
|
|
|
PLATE CONDYLR LCP 4.5 8H 206 L
|
Facility
|
OP
|
$7,419.64
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,225.89 |
| Max. Negotiated Rate |
$7,122.85 |
| Rate for Payer: Aetna Commercial |
$5,713.12
|
| Rate for Payer: Anthem Medicaid |
$2,551.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,787.32
|
| Rate for Payer: Cash Price |
$3,709.82
|
| Rate for Payer: Cigna Commercial |
$6,158.30
|
| Rate for Payer: First Health Commercial |
$7,048.66
|
| Rate for Payer: Humana Commercial |
$6,306.69
|
| Rate for Payer: Humana KY Medicaid |
$2,551.61
|
| Rate for Payer: Kentucky WC Medicaid |
$2,577.58
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,084.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,475.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,225.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,602.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,529.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,564.73
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,935.71
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,455.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,119.55
|
| Rate for Payer: PHCS Commercial |
$7,122.85
|
| Rate for Payer: United Healthcare All Payer |
$6,529.28
|
|
|
PLATE CORONOID LEFT
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE CORONOID LEFT
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE CORONOID LT
|
Facility
|
IP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE CORONOID LT
|
Facility
|
OP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem Medicaid |
$1,774.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Humana KY Medicaid |
$1,774.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,793.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE CORONOID RIGHT
|
Facility
|
OP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem Medicaid |
$1,364.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Humana KY Medicaid |
$1,364.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,378.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,392.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE CORONOID RIGHT
|
Facility
|
IP
|
$3,968.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,190.62 |
| Max. Negotiated Rate |
$3,810.00 |
| Rate for Payer: Aetna Commercial |
$3,055.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,095.62
|
| Rate for Payer: Cash Price |
$1,984.38
|
| Rate for Payer: Cigna Commercial |
$3,294.06
|
| Rate for Payer: First Health Commercial |
$3,770.31
|
| Rate for Payer: Humana Commercial |
$3,373.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,254.38
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,928.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,190.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,492.50
|
| Rate for Payer: Ohio Health Group HMO |
$2,976.56
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,175.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,452.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,738.44
|
| Rate for Payer: PHCS Commercial |
$3,810.00
|
| Rate for Payer: United Healthcare All Payer |
$3,492.50
|
|
|
PLATE CORONOID RT
|
Facility
|
IP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE CORONOID RT
|
Facility
|
OP
|
$5,161.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,548.38 |
| Max. Negotiated Rate |
$4,954.80 |
| Rate for Payer: Aetna Commercial |
$3,974.16
|
| Rate for Payer: Anthem Medicaid |
$1,774.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,025.78
|
| Rate for Payer: Cash Price |
$2,580.62
|
| Rate for Payer: Cigna Commercial |
$4,283.84
|
| Rate for Payer: First Health Commercial |
$4,903.19
|
| Rate for Payer: Humana Commercial |
$4,387.06
|
| Rate for Payer: Humana KY Medicaid |
$1,774.95
|
| Rate for Payer: Kentucky WC Medicaid |
$1,793.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,232.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,809.00
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,548.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,810.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,541.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,870.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,129.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,490.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,561.26
|
| Rate for Payer: PHCS Commercial |
$4,954.80
|
| Rate for Payer: United Healthcare All Payer |
$4,541.90
|
|
|
PLATE CRVED RECON 3.5 10X118MM
|
Facility
|
IP
|
$3,914.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.26 |
| Max. Negotiated Rate |
$3,757.62 |
| Rate for Payer: Aetna Commercial |
$3,013.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.07
|
| Rate for Payer: Cash Price |
$1,957.09
|
| Rate for Payer: Cigna Commercial |
$3,248.78
|
| Rate for Payer: First Health Commercial |
$3,718.48
|
| Rate for Payer: Humana Commercial |
$3,327.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,209.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,888.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,444.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,935.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,131.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,405.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.79
|
| Rate for Payer: PHCS Commercial |
$3,757.62
|
| Rate for Payer: United Healthcare All Payer |
$3,444.49
|
|
|
PLATE CRVED RECON 3.5 10X118MM
|
Facility
|
OP
|
$3,914.19
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,174.26 |
| Max. Negotiated Rate |
$3,757.62 |
| Rate for Payer: Aetna Commercial |
$3,013.93
|
| Rate for Payer: Anthem Medicaid |
$1,346.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,053.07
|
| Rate for Payer: Cash Price |
$1,957.09
|
| Rate for Payer: Cigna Commercial |
$3,248.78
|
| Rate for Payer: First Health Commercial |
$3,718.48
|
| Rate for Payer: Humana Commercial |
$3,327.06
|
| Rate for Payer: Humana KY Medicaid |
$1,346.09
|
| Rate for Payer: Kentucky WC Medicaid |
$1,359.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,209.64
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,888.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,174.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,373.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,444.49
|
| Rate for Payer: Ohio Health Group HMO |
$2,935.64
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,131.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,405.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,700.79
|
| Rate for Payer: PHCS Commercial |
$3,757.62
|
| Rate for Payer: United Healthcare All Payer |
$3,444.49
|
|
|
PLATE CRVED RECON 3.5 12X142MM
|
Facility
|
OP
|
$4,006.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.93 |
| Max. Negotiated Rate |
$3,846.18 |
| Rate for Payer: Aetna Commercial |
$3,084.96
|
| Rate for Payer: Anthem Medicaid |
$1,377.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,125.02
|
| Rate for Payer: Cash Price |
$2,003.22
|
| Rate for Payer: Cigna Commercial |
$3,325.35
|
| Rate for Payer: First Health Commercial |
$3,806.12
|
| Rate for Payer: Humana Commercial |
$3,405.47
|
| Rate for Payer: Humana KY Medicaid |
$1,377.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,391.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,405.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,205.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,485.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,764.44
|
| Rate for Payer: PHCS Commercial |
$3,846.18
|
| Rate for Payer: United Healthcare All Payer |
$3,525.67
|
|
|
PLATE CRVED RECON 3.5 12X142MM
|
Facility
|
IP
|
$4,006.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,201.93 |
| Max. Negotiated Rate |
$3,846.18 |
| Rate for Payer: Aetna Commercial |
$3,084.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,125.02
|
| Rate for Payer: Cash Price |
$2,003.22
|
| Rate for Payer: Cigna Commercial |
$3,325.35
|
| Rate for Payer: First Health Commercial |
$3,806.12
|
| Rate for Payer: Humana Commercial |
$3,405.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,285.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,956.75
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,201.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,525.67
|
| Rate for Payer: Ohio Health Group HMO |
$3,004.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,205.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,485.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,764.44
|
| Rate for Payer: PHCS Commercial |
$3,846.18
|
| Rate for Payer: United Healthcare All Payer |
$3,525.67
|
|
