|
PLATE DISTL FEM LAT L 15H 333M
|
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 DISTL FEM LAT L 15H 333M
|
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 DISTL FEM LAT L 18H 386M
|
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 DISTL FEM LAT L 18H 386M
|
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 DISTL FEM LAT R 12H 281M
|
Facility
|
IP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DISTL FEM LAT R 12H 281M
|
Facility
|
OP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem Medicaid |
$2,895.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Humana KY Medicaid |
$2,895.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,953.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DISTL FEM LAT R 15H 333M
|
Facility
|
OP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem Medicaid |
$2,895.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Humana KY Medicaid |
$2,895.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,953.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DISTL FEM LAT R 15H 333M
|
Facility
|
IP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DISTL FEM LAT R 18H 386M
|
Facility
|
OP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem Medicaid |
$2,895.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Humana KY Medicaid |
$2,895.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,925.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,953.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DISTL FEM LAT R 18H 386M
|
Facility
|
IP
|
$8,420.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,526.07 |
| Max. Negotiated Rate |
$8,083.44 |
| Rate for Payer: Aetna Commercial |
$6,483.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,567.80
|
| Rate for Payer: Cash Price |
$4,210.12
|
| Rate for Payer: Cigna Commercial |
$6,988.81
|
| Rate for Payer: First Health Commercial |
$7,999.24
|
| Rate for Payer: Humana Commercial |
$7,157.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,904.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,214.14
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,526.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,409.82
|
| Rate for Payer: Ohio Health Group HMO |
$6,315.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,736.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,325.62
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,809.97
|
| Rate for Payer: PHCS Commercial |
$8,083.44
|
| Rate for Payer: United Healthcare All Payer |
$7,409.82
|
|
|
PLATE DIST MED TIB 10H L
|
Facility
|
IP
|
$10,167.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.18 |
| Max. Negotiated Rate |
$9,760.56 |
| Rate for Payer: Aetna Commercial |
$7,828.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,930.45
|
| Rate for Payer: Cash Price |
$5,083.62
|
| Rate for Payer: Cigna Commercial |
$8,438.82
|
| Rate for Payer: First Health Commercial |
$9,658.89
|
| Rate for Payer: Humana Commercial |
$8,642.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,337.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,503.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,050.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,947.18
|
| Rate for Payer: Ohio Health Group HMO |
$7,625.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,133.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,845.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,015.40
|
| Rate for Payer: PHCS Commercial |
$9,760.56
|
| Rate for Payer: United Healthcare All Payer |
$8,947.18
|
|
|
PLATE DIST MED TIB 10H L
|
Facility
|
OP
|
$10,167.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,050.18 |
| Max. Negotiated Rate |
$9,760.56 |
| Rate for Payer: Aetna Commercial |
$7,828.78
|
| Rate for Payer: Anthem Medicaid |
$3,496.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,930.45
|
| Rate for Payer: Cash Price |
$5,083.62
|
| Rate for Payer: Cigna Commercial |
$8,438.82
|
| Rate for Payer: First Health Commercial |
$9,658.89
|
| Rate for Payer: Humana Commercial |
$8,642.16
|
| Rate for Payer: Humana KY Medicaid |
$3,496.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3,532.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,337.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,503.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,050.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,566.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,947.18
|
| Rate for Payer: Ohio Health Group HMO |
$7,625.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,133.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,845.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,015.40
|
| Rate for Payer: PHCS Commercial |
$9,760.56
|
| Rate for Payer: United Healthcare All Payer |
$8,947.18
|
|
|
PLATE DIST MED TIB 10H R
|
Facility
|
IP
|
$9,403.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,821.18 |
| Max. Negotiated Rate |
$9,027.76 |
| Rate for Payer: Aetna Commercial |
$7,241.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,335.06
|
| Rate for Payer: Cash Price |
$4,701.96
|
| Rate for Payer: Cigna Commercial |
$7,805.25
|
| Rate for Payer: First Health Commercial |
$8,933.72
|
| Rate for Payer: Humana Commercial |
$7,993.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,711.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,940.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,275.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,052.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,523.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,181.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,488.70
|
| Rate for Payer: PHCS Commercial |
$9,027.76
|
| Rate for Payer: United Healthcare All Payer |
$8,275.45
|
|
|
PLATE DIST MED TIB 10H R
|
Facility
|
OP
|
$9,403.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,821.18 |
| Max. Negotiated Rate |
$9,027.76 |
| Rate for Payer: Aetna Commercial |
$7,241.02
|
| Rate for Payer: Anthem Medicaid |
$3,234.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,335.06
|
| Rate for Payer: Cash Price |
$4,701.96
|
| Rate for Payer: Cigna Commercial |
$7,805.25
|
| Rate for Payer: First Health Commercial |
$8,933.72
|
| Rate for Payer: Humana Commercial |
$7,993.33
|
| Rate for Payer: Humana KY Medicaid |
$3,234.01
|
| Rate for Payer: Kentucky WC Medicaid |
$3,266.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,711.21
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,940.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,821.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,298.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,275.45
|
| Rate for Payer: Ohio Health Group HMO |
$7,052.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,523.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,181.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,488.70
|
| Rate for Payer: PHCS Commercial |
$9,027.76
|
| Rate for Payer: United Healthcare All Payer |
$8,275.45
|
|
|
PLATE DIST MED TIB 12H
|
Facility
|
IP
|
$8,615.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.57 |
| Max. Negotiated Rate |
$8,270.62 |
| Rate for Payer: Aetna Commercial |
$6,633.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.88
|
| Rate for Payer: Cash Price |
$4,307.62
|
| Rate for Payer: Cigna Commercial |
$7,150.64
|
| Rate for Payer: First Health Commercial |
$8,184.47
|
| Rate for Payer: Humana Commercial |
$7,322.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.57
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.51
|
| Rate for Payer: PHCS Commercial |
$8,270.62
|
| Rate for Payer: United Healthcare All Payer |
$7,581.40
|
|
|
PLATE DIST MED TIB 12H
|
Facility
|
OP
|
$8,615.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,584.57 |
| Max. Negotiated Rate |
$8,270.62 |
| Rate for Payer: Aetna Commercial |
$6,633.73
|
| Rate for Payer: Anthem Medicaid |
$2,962.78
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,719.88
|
| Rate for Payer: Cash Price |
$4,307.62
|
| Rate for Payer: Cigna Commercial |
$7,150.64
|
| Rate for Payer: First Health Commercial |
$8,184.47
|
| Rate for Payer: Humana Commercial |
$7,322.95
|
| Rate for Payer: Humana KY Medicaid |
$2,962.78
|
| Rate for Payer: Kentucky WC Medicaid |
$2,992.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,064.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,358.04
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,584.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,022.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,581.40
|
| Rate for Payer: Ohio Health Group HMO |
$6,461.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,892.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,495.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,944.51
|
| Rate for Payer: PHCS Commercial |
$8,270.62
|
| Rate for Payer: United Healthcare All Payer |
$7,581.40
|
|
|
PLATE DIST MED TIB 14H R
|
Facility
|
IP
|
$11,097.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.17 |
| Max. Negotiated Rate |
$10,653.34 |
| Rate for Payer: Aetna Commercial |
$8,544.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.84
|
| Rate for Payer: Cash Price |
$5,548.62
|
| Rate for Payer: Cigna Commercial |
$9,210.70
|
| Rate for Payer: First Health Commercial |
$10,542.37
|
| Rate for Payer: Humana Commercial |
$9,432.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,657.09
|
| Rate for Payer: PHCS Commercial |
$10,653.34
|
| Rate for Payer: United Healthcare All Payer |
$9,765.56
|
|
|
PLATE DIST MED TIB 14H R
|
Facility
|
OP
|
$11,097.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,329.17 |
| Max. Negotiated Rate |
$10,653.34 |
| Rate for Payer: Aetna Commercial |
$8,544.87
|
| Rate for Payer: Anthem Medicaid |
$3,816.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,655.84
|
| Rate for Payer: Cash Price |
$5,548.62
|
| Rate for Payer: Cigna Commercial |
$9,210.70
|
| Rate for Payer: First Health Commercial |
$10,542.37
|
| Rate for Payer: Humana Commercial |
$9,432.65
|
| Rate for Payer: Humana KY Medicaid |
$3,816.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,855.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,099.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,189.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,329.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,892.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,765.56
|
| Rate for Payer: Ohio Health Group HMO |
$8,322.92
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,877.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,654.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,657.09
|
| Rate for Payer: PHCS Commercial |
$10,653.34
|
| Rate for Payer: United Healthcare All Payer |
$9,765.56
|
|
|
PLATE DIST TIB LCK 6H 114 LEFT
|
Facility
|
OP
|
$9,577.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,873.19 |
| Max. Negotiated Rate |
$9,194.21 |
| Rate for Payer: Aetna Commercial |
$7,374.52
|
| Rate for Payer: Anthem Medicaid |
$3,293.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,470.29
|
| Rate for Payer: Cash Price |
$4,788.65
|
| Rate for Payer: Cigna Commercial |
$7,949.16
|
| Rate for Payer: First Health Commercial |
$9,098.43
|
| Rate for Payer: Humana Commercial |
$8,140.70
|
| Rate for Payer: Humana KY Medicaid |
$3,293.63
|
| Rate for Payer: Kentucky WC Medicaid |
$3,327.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,853.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,068.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,873.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,359.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,428.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,182.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,661.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,332.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,608.34
|
| Rate for Payer: PHCS Commercial |
$9,194.21
|
| Rate for Payer: United Healthcare All Payer |
$8,428.02
|
|
|
PLATE DIST TIB LCK 6H 114 LEFT
|
Facility
|
IP
|
$9,577.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,873.19 |
| Max. Negotiated Rate |
$9,194.21 |
| Rate for Payer: Aetna Commercial |
$7,374.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,470.29
|
| Rate for Payer: Cash Price |
$4,788.65
|
| Rate for Payer: Cigna Commercial |
$7,949.16
|
| Rate for Payer: First Health Commercial |
$9,098.43
|
| Rate for Payer: Humana Commercial |
$8,140.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,853.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,068.05
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,873.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,428.02
|
| Rate for Payer: Ohio Health Group HMO |
$7,182.98
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,661.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,332.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,608.34
|
| Rate for Payer: PHCS Commercial |
$9,194.21
|
| Rate for Payer: United Healthcare All Payer |
$8,428.02
|
|
|
PLATE DIST TIB LCK 6H 115 LEFT
|
Facility
|
OP
|
$9,090.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,727.12 |
| Max. Negotiated Rate |
$8,726.77 |
| Rate for Payer: Aetna Commercial |
$6,999.60
|
| Rate for Payer: Anthem Medicaid |
$3,126.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,090.50
|
| Rate for Payer: Cash Price |
$4,545.20
|
| Rate for Payer: Cigna Commercial |
$7,545.02
|
| Rate for Payer: First Health Commercial |
$8,635.87
|
| Rate for Payer: Humana Commercial |
$7,726.83
|
| Rate for Payer: Humana KY Medicaid |
$3,126.19
|
| Rate for Payer: Kentucky WC Medicaid |
$3,158.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,454.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,708.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,188.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,999.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,817.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,272.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,908.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,272.37
|
| Rate for Payer: PHCS Commercial |
$8,726.77
|
| Rate for Payer: United Healthcare All Payer |
$7,999.54
|
|
|
PLATE DIST TIB LCK 6H 115 LEFT
|
Facility
|
IP
|
$9,090.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,727.12 |
| Max. Negotiated Rate |
$8,726.77 |
| Rate for Payer: Aetna Commercial |
$6,999.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,090.50
|
| Rate for Payer: Cash Price |
$4,545.20
|
| Rate for Payer: Cigna Commercial |
$7,545.02
|
| Rate for Payer: First Health Commercial |
$8,635.87
|
| Rate for Payer: Humana Commercial |
$7,726.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,454.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,708.71
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,727.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,999.54
|
| Rate for Payer: Ohio Health Group HMO |
$6,817.79
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,272.31
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,908.64
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,272.37
|
| Rate for Payer: PHCS Commercial |
$8,726.77
|
| Rate for Payer: United Healthcare All Payer |
$7,999.54
|
|
|
PLATE DIST TIB LCK 9H 156 LEFT
|
Facility
|
IP
|
$8,756.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,626.82 |
| Max. Negotiated Rate |
$8,405.81 |
| Rate for Payer: Aetna Commercial |
$6,742.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,829.72
|
| Rate for Payer: Cash Price |
$4,378.02
|
| Rate for Payer: Cigna Commercial |
$7,267.52
|
| Rate for Payer: First Health Commercial |
$8,318.25
|
| Rate for Payer: Humana Commercial |
$7,442.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,179.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,461.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,626.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,004.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,617.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,041.67
|
| Rate for Payer: PHCS Commercial |
$8,405.81
|
| Rate for Payer: United Healthcare All Payer |
$7,705.32
|
|
|
PLATE DIST TIB LCK 9H 156 LEFT
|
Facility
|
OP
|
$8,756.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,626.82 |
| Max. Negotiated Rate |
$8,405.81 |
| Rate for Payer: Aetna Commercial |
$6,742.16
|
| Rate for Payer: Anthem Medicaid |
$3,011.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,829.72
|
| Rate for Payer: Cash Price |
$4,378.02
|
| Rate for Payer: Cigna Commercial |
$7,267.52
|
| Rate for Payer: First Health Commercial |
$8,318.25
|
| Rate for Payer: Humana Commercial |
$7,442.64
|
| Rate for Payer: Humana KY Medicaid |
$3,011.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,041.85
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,179.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,461.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,626.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,071.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,705.32
|
| Rate for Payer: Ohio Health Group HMO |
$6,567.04
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,004.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,617.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,041.67
|
| Rate for Payer: PHCS Commercial |
$8,405.81
|
| Rate for Payer: United Healthcare All Payer |
$7,705.32
|
|
|
PLATE DIST TIB LD L 12H 206M
|
Facility
|
OP
|
$8,256.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,476.80 |
| Max. Negotiated Rate |
$7,925.76 |
| Rate for Payer: Aetna Commercial |
$6,357.12
|
| Rate for Payer: Anthem Medicaid |
$2,839.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,439.68
|
| Rate for Payer: Cash Price |
$4,128.00
|
| Rate for Payer: Cigna Commercial |
$6,852.48
|
| Rate for Payer: First Health Commercial |
$7,843.20
|
| Rate for Payer: Humana Commercial |
$7,017.60
|
| Rate for Payer: Humana KY Medicaid |
$2,839.24
|
| Rate for Payer: Kentucky WC Medicaid |
$2,868.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,769.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,092.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,476.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,896.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,265.28
|
| Rate for Payer: Ohio Health Group HMO |
$6,192.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,604.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,182.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,696.64
|
| Rate for Payer: PHCS Commercial |
$7,925.76
|
| Rate for Payer: United Healthcare All Payer |
$7,265.28
|
|
