|
PLATE DIS FIB 2.7/3.5* 90 4H L
|
Facility
|
OP
|
$4,205.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.75 |
| Max. Negotiated Rate |
$4,037.59 |
| Rate for Payer: Aetna Commercial |
$3,238.48
|
| Rate for Payer: Anthem Medicaid |
$1,446.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.54
|
| Rate for Payer: Cash Price |
$2,102.91
|
| Rate for Payer: Cigna Commercial |
$3,490.83
|
| Rate for Payer: First Health Commercial |
$3,995.53
|
| Rate for Payer: Humana Commercial |
$3,574.95
|
| Rate for Payer: Humana KY Medicaid |
$1,446.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,461.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.02
|
| Rate for Payer: PHCS Commercial |
$4,037.59
|
| Rate for Payer: United Healthcare All Payer |
$3,701.12
|
|
|
PLATE DIS FIB 2.7/3.5* 90 4H R
|
Facility
|
OP
|
$4,205.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.75 |
| Max. Negotiated Rate |
$4,037.59 |
| Rate for Payer: Aetna Commercial |
$3,238.48
|
| Rate for Payer: Anthem Medicaid |
$1,446.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.54
|
| Rate for Payer: Cash Price |
$2,102.91
|
| Rate for Payer: Cigna Commercial |
$3,490.83
|
| Rate for Payer: First Health Commercial |
$3,995.53
|
| Rate for Payer: Humana Commercial |
$3,574.95
|
| Rate for Payer: Humana KY Medicaid |
$1,446.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,461.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,475.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.02
|
| Rate for Payer: PHCS Commercial |
$4,037.59
|
| Rate for Payer: United Healthcare All Payer |
$3,701.12
|
|
|
PLATE DIS FIB 2.7/3.5* 90 4H R
|
Facility
|
IP
|
$4,205.82
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,261.75 |
| Max. Negotiated Rate |
$4,037.59 |
| Rate for Payer: Aetna Commercial |
$3,238.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,280.54
|
| Rate for Payer: Cash Price |
$2,102.91
|
| Rate for Payer: Cigna Commercial |
$3,490.83
|
| Rate for Payer: First Health Commercial |
$3,995.53
|
| Rate for Payer: Humana Commercial |
$3,574.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,448.77
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,103.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,261.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,701.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,154.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,364.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,659.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,902.02
|
| Rate for Payer: PHCS Commercial |
$4,037.59
|
| Rate for Payer: United Healthcare All Payer |
$3,701.12
|
|
|
PLATE DIS FIB 2.7/3.5*99 5H L
|
Facility
|
IP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*99 5H L
|
Facility
|
OP
|
$4,749.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,424.74 |
| Max. Negotiated Rate |
$4,559.16 |
| Rate for Payer: Aetna Commercial |
$3,656.82
|
| Rate for Payer: Anthem Medicaid |
$1,633.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,704.31
|
| Rate for Payer: Cash Price |
$2,374.56
|
| Rate for Payer: Cigna Commercial |
$3,941.77
|
| Rate for Payer: First Health Commercial |
$4,511.66
|
| Rate for Payer: Humana Commercial |
$4,036.75
|
| Rate for Payer: Humana KY Medicaid |
$1,633.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,649.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,894.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,504.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,424.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,665.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,179.23
|
| Rate for Payer: Ohio Health Group HMO |
$3,561.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,799.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,131.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,276.89
|
| Rate for Payer: PHCS Commercial |
$4,559.16
|
| Rate for Payer: United Healthcare All Payer |
$4,179.23
|
|
|
PLATE DIS FIB 2.7/3.5*99 5H R
|
Facility
|
OP
|
$4,555.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.52 |
| Max. Negotiated Rate |
$4,372.86 |
| Rate for Payer: Aetna Commercial |
$3,507.40
|
| Rate for Payer: Anthem Medicaid |
$1,566.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,552.95
|
| Rate for Payer: Cash Price |
$2,277.53
|
| Rate for Payer: Cigna Commercial |
$3,780.70
|
| Rate for Payer: First Health Commercial |
$4,327.31
|
| Rate for Payer: Humana Commercial |
$3,871.80
|
| Rate for Payer: Humana KY Medicaid |
$1,566.49
|
| Rate for Payer: Kentucky WC Medicaid |
$1,582.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,735.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,361.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,366.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,597.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,008.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,416.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,962.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,142.99
|
| Rate for Payer: PHCS Commercial |
$4,372.86
|
| Rate for Payer: United Healthcare All Payer |
$4,008.45
|
|
|
PLATE DIS FIB 2.7/3.5*99 5H R
|
Facility
|
IP
|
$4,555.06
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,366.52 |
| Max. Negotiated Rate |
$4,372.86 |
| Rate for Payer: Aetna Commercial |
$3,507.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,552.95
|
| Rate for Payer: Cash Price |
$2,277.53
|
| Rate for Payer: Cigna Commercial |
$3,780.70
|
| Rate for Payer: First Health Commercial |
$4,327.31
|
| Rate for Payer: Humana Commercial |
$3,871.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,735.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,361.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,366.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,008.45
|
| Rate for Payer: Ohio Health Group HMO |
$3,416.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,644.05
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,962.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,142.99
|
| Rate for Payer: PHCS Commercial |
$4,372.86
|
| Rate for Payer: United Healthcare All Payer |
$4,008.45
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57L
|
Facility
|
IP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57L
|
Facility
|
OP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem Medicaid |
$1,856.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Humana KY Medicaid |
$1,856.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57R
|
Facility
|
OP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem Medicaid |
$1,856.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Humana KY Medicaid |
$1,856.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DIS RD 5H S 6H H 2.4*57R
|
Facility
|
IP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57L
|
Facility
|
IP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57L
|
Facility
|
OP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem Medicaid |
$1,856.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Humana KY Medicaid |
$1,856.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57R
|
Facility
|
OP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem Medicaid |
$1,856.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Humana KY Medicaid |
$1,856.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,875.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,893.96
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DIS RD 5H S 7H H 2.4*57R
|
Facility
|
IP
|
$5,398.96
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,619.69 |
| Max. Negotiated Rate |
$5,183.00 |
| Rate for Payer: Aetna Commercial |
$4,157.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,211.19
|
| Rate for Payer: Cash Price |
$2,699.48
|
| Rate for Payer: Cigna Commercial |
$4,481.14
|
| Rate for Payer: First Health Commercial |
$5,129.01
|
| Rate for Payer: Humana Commercial |
$4,589.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,427.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,984.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,619.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,751.08
|
| Rate for Payer: Ohio Health Group HMO |
$4,049.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,319.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,697.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,725.28
|
| Rate for Payer: PHCS Commercial |
$5,183.00
|
| Rate for Payer: United Healthcare All Payer |
$4,751.08
|
|
|
PLATE DISTAL FEM LAT L 3H 122M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT L 3H 122M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT L 6H 174M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT L 6H 174M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT L 9H 227M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT L 9H 227M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT R 3H 122M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT R 3H 122M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT R 6H 174M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE DISTAL FEM LAT R 6H 174M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
