|
PLATE MED PROX TIB 12H L
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 12H R
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 12H R
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 14H L
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 14H L
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 14H R
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 14H R
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 3.5 4H 93MM
|
Facility
|
IP
|
$8,706.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.79 |
| Max. Negotiated Rate |
$8,357.86 |
| Rate for Payer: Aetna Commercial |
$6,703.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,790.76
|
| Rate for Payer: Cash Price |
$4,353.05
|
| Rate for Payer: Cigna Commercial |
$7,226.06
|
| Rate for Payer: First Health Commercial |
$8,270.80
|
| Rate for Payer: Humana Commercial |
$7,400.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,139.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,425.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,611.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,661.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,529.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,741.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,698.89
|
| Rate for Payer: PHCS Commercial |
$8,357.86
|
| Rate for Payer: United Healthcare All Payer |
$7,661.37
|
|
|
PLATE MED PROX TIB 3.5 4H 93MM
|
Facility
|
OP
|
$8,706.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,131.79 |
| Max. Negotiated Rate |
$8,357.86 |
| Rate for Payer: Aetna Commercial |
$6,703.70
|
| Rate for Payer: Anthem Medicaid |
$2,994.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,790.76
|
| Rate for Payer: Cash Price |
$4,353.05
|
| Rate for Payer: Cigna Commercial |
$7,226.06
|
| Rate for Payer: First Health Commercial |
$8,270.80
|
| Rate for Payer: Humana Commercial |
$7,400.18
|
| Rate for Payer: Humana KY Medicaid |
$2,994.03
|
| Rate for Payer: Kentucky WC Medicaid |
$3,024.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,139.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,425.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,611.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,054.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,661.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,529.58
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,741.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,131.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,698.89
|
| Rate for Payer: PHCS Commercial |
$8,357.86
|
| Rate for Payer: United Healthcare All Payer |
$7,661.37
|
|
|
PLATE MED PROX TIB 4H R
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 4H R
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 5H R
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 5H R
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 6H L
|
Facility
|
OP
|
$13,249.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.49 |
| Max. Negotiated Rate |
$12,719.90 |
| Rate for Payer: Aetna Commercial |
$10,202.42
|
| Rate for Payer: Anthem Medicaid |
$4,556.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,334.92
|
| Rate for Payer: Cash Price |
$6,624.95
|
| Rate for Payer: Cigna Commercial |
$10,997.42
|
| Rate for Payer: First Health Commercial |
$12,587.40
|
| Rate for Payer: Humana Commercial |
$11,262.42
|
| Rate for Payer: Humana KY Medicaid |
$4,556.64
|
| Rate for Payer: Kentucky WC Medicaid |
$4,603.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,864.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,778.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,648.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,659.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,937.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,722.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,107.47
|
| Rate for Payer: PHCS Commercial |
$12,719.90
|
| Rate for Payer: United Healthcare All Payer |
$11,659.91
|
|
|
PLATE MED PROX TIB 6H L
|
Facility
|
IP
|
$13,249.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,722.49 |
| Max. Negotiated Rate |
$12,719.90 |
| Rate for Payer: Aetna Commercial |
$10,202.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,334.92
|
| Rate for Payer: Cash Price |
$6,624.95
|
| Rate for Payer: Cigna Commercial |
$10,997.42
|
| Rate for Payer: First Health Commercial |
$12,587.40
|
| Rate for Payer: Humana Commercial |
$11,262.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,864.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,778.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,974.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,659.91
|
| Rate for Payer: Ohio Health Group HMO |
$9,937.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,649.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,722.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,107.47
|
| Rate for Payer: PHCS Commercial |
$12,719.90
|
| Rate for Payer: United Healthcare All Payer |
$11,659.91
|
|
|
PLATE MED PROX TIB 6H R
|
Facility
|
IP
|
$7,724.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.23 |
| Max. Negotiated Rate |
$7,415.85 |
| Rate for Payer: Aetna Commercial |
$5,948.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,025.38
|
| Rate for Payer: Cash Price |
$3,862.42
|
| Rate for Payer: Cigna Commercial |
$6,411.62
|
| Rate for Payer: First Health Commercial |
$7,338.60
|
| Rate for Payer: Humana Commercial |
$6,566.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,334.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,700.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,317.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,797.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,793.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.70
|
| Rate for Payer: PHCS Commercial |
$7,415.85
|
| Rate for Payer: United Healthcare All Payer |
$6,797.86
|
|
|
PLATE MED PROX TIB 6H R
|
Facility
|
OP
|
$7,724.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,004.23 |
| Max. Negotiated Rate |
$7,415.85 |
| Rate for Payer: Aetna Commercial |
$5,948.13
|
| Rate for Payer: Anthem Medicaid |
$2,656.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,025.38
|
| Rate for Payer: Cash Price |
$3,862.42
|
| Rate for Payer: Cigna Commercial |
$6,411.62
|
| Rate for Payer: First Health Commercial |
$7,338.60
|
| Rate for Payer: Humana Commercial |
$6,566.11
|
| Rate for Payer: Humana KY Medicaid |
$2,656.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,683.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,334.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,700.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,317.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,709.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,797.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,793.63
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.97
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,004.23
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,394.70
|
| Rate for Payer: PHCS Commercial |
$7,415.85
|
| Rate for Payer: United Healthcare All Payer |
$6,797.86
|
|
|
PLATE MED PROX TIB 8H R
|
Facility
|
IP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE MED PROX TIB 8H R
|
Facility
|
OP
|
$12,946.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.10 |
| Max. Negotiated Rate |
$12,429.07 |
| Rate for Payer: Aetna Commercial |
$9,969.15
|
| Rate for Payer: Anthem Medicaid |
$4,452.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,098.62
|
| Rate for Payer: Cash Price |
$6,473.48
|
| Rate for Payer: Cigna Commercial |
$10,745.97
|
| Rate for Payer: First Health Commercial |
$12,299.60
|
| Rate for Payer: Humana Commercial |
$11,004.91
|
| Rate for Payer: Humana KY Medicaid |
$4,452.46
|
| Rate for Payer: Kentucky WC Medicaid |
$4,497.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,616.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,554.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,884.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,541.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,393.32
|
| Rate for Payer: Ohio Health Group HMO |
$9,710.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,589.39
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,683.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,013.55
|
| Rate for Payer: PHCS Commercial |
$12,429.07
|
| Rate for Payer: United Healthcare All Payer |
$11,393.32
|
|
|
PLATE META LARGE 3H
|
Facility
|
IP
|
$3,085.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.12 |
| Max. Negotiated Rate |
$2,962.08 |
| Rate for Payer: Aetna Commercial |
$2,375.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.69
|
| Rate for Payer: Cash Price |
$1,542.75
|
| Rate for Payer: Cigna Commercial |
$2,560.96
|
| Rate for Payer: First Health Commercial |
$2,931.22
|
| Rate for Payer: Humana Commercial |
$2,622.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,530.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,277.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,715.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,314.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$956.50
|
| Rate for Payer: PHCS Commercial |
$2,962.08
|
| Rate for Payer: United Healthcare All Payer |
$2,715.24
|
|
|
PLATE META LARGE 3H
|
Facility
|
OP
|
$3,085.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$401.12 |
| Max. Negotiated Rate |
$2,962.08 |
| Rate for Payer: Aetna Commercial |
$2,375.84
|
| Rate for Payer: Anthem Medicaid |
$1,061.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,406.69
|
| Rate for Payer: Cash Price |
$1,542.75
|
| Rate for Payer: Cigna Commercial |
$2,560.96
|
| Rate for Payer: First Health Commercial |
$2,931.22
|
| Rate for Payer: Humana Commercial |
$2,622.68
|
| Rate for Payer: Humana KY Medicaid |
$1,061.10
|
| Rate for Payer: Kentucky WC Medicaid |
$1,071.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,530.11
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,277.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$925.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,082.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,715.24
|
| Rate for Payer: Ohio Health Group HMO |
$2,314.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$617.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$401.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$956.50
|
| Rate for Payer: PHCS Commercial |
$2,962.08
|
| Rate for Payer: United Healthcare All Payer |
$2,715.24
|
|
|
PLATE META LARGE 5H
|
Facility
|
OP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,985.60 |
| Rate for Payer: Aetna Commercial |
$2,394.70
|
| Rate for Payer: Anthem Medicaid |
$1,069.53
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.80
|
| Rate for Payer: Cash Price |
$1,555.00
|
| Rate for Payer: Cigna Commercial |
$2,581.30
|
| Rate for Payer: First Health Commercial |
$2,954.50
|
| Rate for Payer: Humana Commercial |
$2,643.50
|
| Rate for Payer: Humana KY Medicaid |
$1,069.53
|
| Rate for Payer: Kentucky WC Medicaid |
$1,080.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,090.99
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.10
|
| Rate for Payer: PHCS Commercial |
$2,985.60
|
| Rate for Payer: United Healthcare All Payer |
$2,736.80
|
|
|
PLATE META LARGE 5H
|
Facility
|
IP
|
$3,110.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$404.30 |
| Max. Negotiated Rate |
$2,985.60 |
| Rate for Payer: Aetna Commercial |
$2,394.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,425.80
|
| Rate for Payer: Cash Price |
$1,555.00
|
| Rate for Payer: Cigna Commercial |
$2,581.30
|
| Rate for Payer: First Health Commercial |
$2,954.50
|
| Rate for Payer: Humana Commercial |
$2,643.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,550.20
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,295.18
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$933.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,736.80
|
| Rate for Payer: Ohio Health Group HMO |
$2,332.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$622.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$404.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$964.10
|
| Rate for Payer: PHCS Commercial |
$2,985.60
|
| Rate for Payer: United Healthcare All Payer |
$2,736.80
|
|
|
PLATE META LARGE 7H
|
Facility
|
OP
|
$3,183.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.86 |
| Max. Negotiated Rate |
$3,056.16 |
| Rate for Payer: Aetna Commercial |
$2,451.30
|
| Rate for Payer: Anthem Medicaid |
$1,094.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,483.13
|
| Rate for Payer: Cash Price |
$1,591.75
|
| Rate for Payer: Cigna Commercial |
$2,642.30
|
| Rate for Payer: First Health Commercial |
$3,024.32
|
| Rate for Payer: Humana Commercial |
$2,705.98
|
| Rate for Payer: Humana KY Medicaid |
$1,094.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,105.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,610.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,349.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,116.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,801.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,387.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.88
|
| Rate for Payer: PHCS Commercial |
$3,056.16
|
| Rate for Payer: United Healthcare All Payer |
$2,801.48
|
|
|
PLATE META LARGE 7H
|
Facility
|
IP
|
$3,183.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$413.86 |
| Max. Negotiated Rate |
$3,056.16 |
| Rate for Payer: Aetna Commercial |
$2,451.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,483.13
|
| Rate for Payer: Cash Price |
$1,591.75
|
| Rate for Payer: Cigna Commercial |
$2,642.30
|
| Rate for Payer: First Health Commercial |
$3,024.32
|
| Rate for Payer: Humana Commercial |
$2,705.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,610.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,349.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$955.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,801.48
|
| Rate for Payer: Ohio Health Group HMO |
$2,387.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$636.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$413.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$986.88
|
| Rate for Payer: PHCS Commercial |
$3,056.16
|
| Rate for Payer: United Healthcare All Payer |
$2,801.48
|
|
