|
PLATE PROX FEM 21HOLE R
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE PROX FEM 9HOLE L
|
Facility
|
OP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem Medicaid |
$3,846.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Humana KY Medicaid |
$3,846.18
|
| Rate for Payer: Kentucky WC Medicaid |
$3,885.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,923.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE PROX FEM 9HOLE L
|
Facility
|
IP
|
$11,184.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,453.92 |
| Max. Negotiated Rate |
$10,736.64 |
| Rate for Payer: Aetna Commercial |
$8,611.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,723.52
|
| Rate for Payer: Cash Price |
$5,592.00
|
| Rate for Payer: Cigna Commercial |
$9,282.72
|
| Rate for Payer: First Health Commercial |
$10,624.80
|
| Rate for Payer: Humana Commercial |
$9,506.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,170.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,253.79
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,355.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,841.92
|
| Rate for Payer: Ohio Health Group HMO |
$8,388.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,236.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,453.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,467.04
|
| Rate for Payer: PHCS Commercial |
$10,736.64
|
| Rate for Payer: United Healthcare All Payer |
$9,841.92
|
|
|
PLATE PROX FEM 9HOLE R
|
Facility
|
OP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Anthem Medicaid |
$3,403.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Humana KY Medicaid |
$3,403.10
|
| Rate for Payer: Kentucky WC Medicaid |
$3,437.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,471.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE PROX FEM 9HOLE R
|
Facility
|
IP
|
$9,895.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,286.43 |
| Max. Negotiated Rate |
$9,499.78 |
| Rate for Payer: Aetna Commercial |
$7,619.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,718.57
|
| Rate for Payer: Cash Price |
$4,947.80
|
| Rate for Payer: Cigna Commercial |
$8,213.35
|
| Rate for Payer: First Health Commercial |
$9,400.82
|
| Rate for Payer: Humana Commercial |
$8,411.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,114.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,302.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,968.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,708.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,421.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,979.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,286.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,067.64
|
| Rate for Payer: PHCS Commercial |
$9,499.78
|
| Rate for Payer: United Healthcare All Payer |
$8,708.13
|
|
|
PLATE PROX FEM LK 2H 4.5*99M L
|
Facility
|
IP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
PLATE PROX FEM LK 2H 4.5*99M L
|
Facility
|
OP
|
$7,481.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$972.55 |
| Max. Negotiated Rate |
$7,181.88 |
| Rate for Payer: Aetna Commercial |
$5,760.46
|
| Rate for Payer: Anthem Medicaid |
$2,572.76
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,835.27
|
| Rate for Payer: Cash Price |
$3,740.56
|
| Rate for Payer: Cigna Commercial |
$6,209.33
|
| Rate for Payer: First Health Commercial |
$7,107.06
|
| Rate for Payer: Humana Commercial |
$6,358.95
|
| Rate for Payer: Humana KY Medicaid |
$2,572.76
|
| Rate for Payer: Kentucky WC Medicaid |
$2,598.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,134.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,521.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,244.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,624.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,583.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,610.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,496.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$972.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,319.15
|
| Rate for Payer: PHCS Commercial |
$7,181.88
|
| Rate for Payer: United Healthcare All Payer |
$6,583.39
|
|
|
PLATE PROX FEM LK 4.5M 2 99M L
|
Facility
|
IP
|
$7,633.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.38 |
| Max. Negotiated Rate |
$7,328.35 |
| Rate for Payer: Aetna Commercial |
$5,877.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,954.29
|
| Rate for Payer: Cash Price |
$3,816.85
|
| Rate for Payer: Cigna Commercial |
$6,335.97
|
| Rate for Payer: First Health Commercial |
$7,252.02
|
| Rate for Payer: Humana Commercial |
$6,488.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,259.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,633.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,290.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,717.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,725.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$992.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,366.45
|
| Rate for Payer: PHCS Commercial |
$7,328.35
|
| Rate for Payer: United Healthcare All Payer |
$6,717.66
|
|
|
PLATE PROX FEM LK 4.5M 2 99M L
|
Facility
|
OP
|
$7,633.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.38 |
| Max. Negotiated Rate |
$7,328.35 |
| Rate for Payer: Aetna Commercial |
$5,877.95
|
| Rate for Payer: Anthem Medicaid |
$2,625.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,954.29
|
| Rate for Payer: Cash Price |
$3,816.85
|
| Rate for Payer: Cigna Commercial |
$6,335.97
|
| Rate for Payer: First Health Commercial |
$7,252.02
|
| Rate for Payer: Humana Commercial |
$6,488.64
|
| Rate for Payer: Humana KY Medicaid |
$2,625.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,651.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,259.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,633.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,290.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,677.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,717.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,725.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$992.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,366.45
|
| Rate for Payer: PHCS Commercial |
$7,328.35
|
| Rate for Payer: United Healthcare All Payer |
$6,717.66
|
|
|
PLATE PROX FEM LK 4.5M 2 99M R
|
Facility
|
OP
|
$7,633.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.38 |
| Max. Negotiated Rate |
$7,328.35 |
| Rate for Payer: Aetna Commercial |
$5,877.95
|
| Rate for Payer: Anthem Medicaid |
$2,625.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,954.29
|
| Rate for Payer: Cash Price |
$3,816.85
|
| Rate for Payer: Cigna Commercial |
$6,335.97
|
| Rate for Payer: First Health Commercial |
$7,252.02
|
| Rate for Payer: Humana Commercial |
$6,488.64
|
| Rate for Payer: Humana KY Medicaid |
$2,625.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,651.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,259.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,633.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,290.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,677.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,717.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,725.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$992.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,366.45
|
| Rate for Payer: PHCS Commercial |
$7,328.35
|
| Rate for Payer: United Healthcare All Payer |
$6,717.66
|
|
|
PLATE PROX FEM LK 4.5M 2 99M R
|
Facility
|
IP
|
$7,633.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$992.38 |
| Max. Negotiated Rate |
$7,328.35 |
| Rate for Payer: Aetna Commercial |
$5,877.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,954.29
|
| Rate for Payer: Cash Price |
$3,816.85
|
| Rate for Payer: Cigna Commercial |
$6,335.97
|
| Rate for Payer: First Health Commercial |
$7,252.02
|
| Rate for Payer: Humana Commercial |
$6,488.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,259.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,633.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,290.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,717.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,725.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,526.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$992.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,366.45
|
| Rate for Payer: PHCS Commercial |
$7,328.35
|
| Rate for Payer: United Healthcare All Payer |
$6,717.66
|
|
|
PLATE PROX FEM NCB PP L/L 238M
|
Facility
|
OP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem Medicaid |
$3,272.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Humana KY Medicaid |
$3,272.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,338.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
PLATE PROX FEM NCB PP L/L 238M
|
Facility
|
IP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
PLATE PROX FEM NCB PP L/L 245M
|
Facility
|
OP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Anthem Medicaid |
$3,272.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Humana KY Medicaid |
$3,272.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,338.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
PLATE PROX FEM NCB PP L/L 245M
|
Facility
|
IP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
PLATE PROX FEM NCB PP L/L 401M
|
Facility
|
OP
|
$11,972.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.41 |
| Max. Negotiated Rate |
$11,493.50 |
| Rate for Payer: Aetna Commercial |
$9,218.75
|
| Rate for Payer: Anthem Medicaid |
$4,117.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,338.47
|
| Rate for Payer: Cash Price |
$5,986.20
|
| Rate for Payer: Cigna Commercial |
$9,937.09
|
| Rate for Payer: First Health Commercial |
$11,373.78
|
| Rate for Payer: Humana Commercial |
$10,176.54
|
| Rate for Payer: Humana KY Medicaid |
$4,117.31
|
| Rate for Payer: Kentucky WC Medicaid |
$4,159.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,817.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,835.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,591.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,199.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,535.71
|
| Rate for Payer: Ohio Health Group HMO |
$8,979.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,711.44
|
| Rate for Payer: PHCS Commercial |
$11,493.50
|
| Rate for Payer: United Healthcare All Payer |
$10,535.71
|
|
|
PLATE PROX FEM NCB PP L/L 401M
|
Facility
|
IP
|
$11,972.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,556.41 |
| Max. Negotiated Rate |
$11,493.50 |
| Rate for Payer: Aetna Commercial |
$9,218.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,338.47
|
| Rate for Payer: Cash Price |
$5,986.20
|
| Rate for Payer: Cigna Commercial |
$9,937.09
|
| Rate for Payer: First Health Commercial |
$11,373.78
|
| Rate for Payer: Humana Commercial |
$10,176.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,817.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,835.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,591.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,535.71
|
| Rate for Payer: Ohio Health Group HMO |
$8,979.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,394.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,556.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,711.44
|
| Rate for Payer: PHCS Commercial |
$11,493.50
|
| Rate for Payer: United Healthcare All Payer |
$10,535.71
|
|
|
PLATE PROX FEM NCB PP R/L 245M
|
Facility
|
IP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
PLATE PROX FEM NCB PP R/L 245M
|
Facility
|
OP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem Medicaid |
$3,272.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Humana KY Medicaid |
$3,272.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,338.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
|
|
PLATE PROX FEM NCB PP R/L 401M
|
Facility
|
OP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem Medicaid |
$3,272.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Humana KY Medicaid |
$3,272.55
|
| Rate for Payer: Kentucky WC Medicaid |
$3,305.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,338.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
PLATE PROX FEM NCB PP R/L 401M
|
Facility
|
IP
|
$9,516.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,237.08 |
| Max. Negotiated Rate |
$9,135.36 |
| Rate for Payer: Aetna Commercial |
$7,327.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,422.48
|
| Rate for Payer: Cash Price |
$4,758.00
|
| Rate for Payer: Cigna Commercial |
$7,898.28
|
| Rate for Payer: First Health Commercial |
$9,040.20
|
| Rate for Payer: Humana Commercial |
$8,088.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,803.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,022.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,854.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,374.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,137.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,903.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,237.08
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,949.96
|
| Rate for Payer: PHCS Commercial |
$9,135.36
|
| Rate for Payer: United Healthcare All Payer |
$8,374.08
|
|
|
PLATE PROX FM LK 4.5M 4 144M L
|
Facility
|
OP
|
$7,716.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.20 |
| Max. Negotiated Rate |
$7,408.24 |
| Rate for Payer: Aetna Commercial |
$5,942.03
|
| Rate for Payer: Anthem Medicaid |
$2,653.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,019.20
|
| Rate for Payer: Cash Price |
$3,858.46
|
| Rate for Payer: Cigna Commercial |
$6,405.04
|
| Rate for Payer: First Health Commercial |
$7,331.07
|
| Rate for Payer: Humana Commercial |
$6,559.38
|
| Rate for Payer: Humana KY Medicaid |
$2,653.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,680.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,327.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,695.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,315.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,707.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,790.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,787.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,543.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.25
|
| Rate for Payer: PHCS Commercial |
$7,408.24
|
| Rate for Payer: United Healthcare All Payer |
$6,790.89
|
|
|
PLATE PROX FM LK 4.5M 4 144M L
|
Facility
|
IP
|
$7,716.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.20 |
| Max. Negotiated Rate |
$7,408.24 |
| Rate for Payer: Aetna Commercial |
$5,942.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,019.20
|
| Rate for Payer: Cash Price |
$3,858.46
|
| Rate for Payer: Cigna Commercial |
$6,405.04
|
| Rate for Payer: First Health Commercial |
$7,331.07
|
| Rate for Payer: Humana Commercial |
$6,559.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,327.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,695.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,315.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,790.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,787.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,543.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.25
|
| Rate for Payer: PHCS Commercial |
$7,408.24
|
| Rate for Payer: United Healthcare All Payer |
$6,790.89
|
|
|
PLATE PROX FM LK 4.5M 4 144M R
|
Facility
|
IP
|
$7,716.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.20 |
| Max. Negotiated Rate |
$7,408.24 |
| Rate for Payer: Aetna Commercial |
$5,942.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,019.20
|
| Rate for Payer: Cash Price |
$3,858.46
|
| Rate for Payer: Cigna Commercial |
$6,405.04
|
| Rate for Payer: First Health Commercial |
$7,331.07
|
| Rate for Payer: Humana Commercial |
$6,559.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,327.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,695.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,315.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,790.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,787.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,543.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.25
|
| Rate for Payer: PHCS Commercial |
$7,408.24
|
| Rate for Payer: United Healthcare All Payer |
$6,790.89
|
|
|
PLATE PROX FM LK 4.5M 4 144M R
|
Facility
|
OP
|
$7,716.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,003.20 |
| Max. Negotiated Rate |
$7,408.24 |
| Rate for Payer: Anthem Medicaid |
$2,653.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,019.20
|
| Rate for Payer: Cash Price |
$3,858.46
|
| Rate for Payer: Cigna Commercial |
$6,405.04
|
| Rate for Payer: First Health Commercial |
$7,331.07
|
| Rate for Payer: Humana Commercial |
$6,559.38
|
| Rate for Payer: Humana KY Medicaid |
$2,653.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,680.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,327.87
|
| Rate for Payer: Aetna Commercial |
$5,942.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,695.09
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,315.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,707.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,790.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,787.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,543.38
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,003.20
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,392.25
|
| Rate for Payer: PHCS Commercial |
$7,408.24
|
| Rate for Payer: United Healthcare All Payer |
$6,790.89
|
|
