|
PLATE PROX FM LK 4.5M 6 180M L
|
Facility
|
IP
|
$7,807.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.92 |
| Max. Negotiated Rate |
$7,494.79 |
| Rate for Payer: Aetna Commercial |
$6,011.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,089.51
|
| Rate for Payer: Cash Price |
$3,903.53
|
| Rate for Payer: Cigna Commercial |
$6,479.87
|
| Rate for Payer: First Health Commercial |
$7,416.72
|
| Rate for Payer: Humana Commercial |
$6,636.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,761.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,870.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,855.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,561.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,420.19
|
| Rate for Payer: PHCS Commercial |
$7,494.79
|
| Rate for Payer: United Healthcare All Payer |
$6,870.22
|
|
|
PLATE PROX FM LK 4.5M 6 180M L
|
Facility
|
OP
|
$7,807.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,014.92 |
| Max. Negotiated Rate |
$7,494.79 |
| Rate for Payer: Aetna Commercial |
$6,011.44
|
| Rate for Payer: Anthem Medicaid |
$2,684.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,089.51
|
| Rate for Payer: Cash Price |
$3,903.53
|
| Rate for Payer: Cigna Commercial |
$6,479.87
|
| Rate for Payer: First Health Commercial |
$7,416.72
|
| Rate for Payer: Humana Commercial |
$6,636.01
|
| Rate for Payer: Humana KY Medicaid |
$2,684.85
|
| Rate for Payer: Kentucky WC Medicaid |
$2,712.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,401.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,761.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,342.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,738.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,870.22
|
| Rate for Payer: Ohio Health Group HMO |
$5,855.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,561.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,014.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,420.19
|
| Rate for Payer: PHCS Commercial |
$7,494.79
|
| Rate for Payer: United Healthcare All Payer |
$6,870.22
|
|
|
PLATE PROX FM LK 4.5M 9 234M L
|
Facility
|
IP
|
$7,987.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.36 |
| Max. Negotiated Rate |
$7,667.88 |
| Rate for Payer: Aetna Commercial |
$6,150.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,230.16
|
| Rate for Payer: Cash Price |
$3,993.69
|
| Rate for Payer: Cigna Commercial |
$6,629.53
|
| Rate for Payer: First Health Commercial |
$7,588.01
|
| Rate for Payer: Humana Commercial |
$6,789.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,549.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,894.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,396.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,028.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,990.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.09
|
| Rate for Payer: PHCS Commercial |
$7,667.88
|
| Rate for Payer: United Healthcare All Payer |
$7,028.89
|
|
|
PLATE PROX FM LK 4.5M 9 234M L
|
Facility
|
OP
|
$7,987.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.36 |
| Max. Negotiated Rate |
$7,667.88 |
| Rate for Payer: Aetna Commercial |
$6,150.28
|
| Rate for Payer: Anthem Medicaid |
$2,746.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,230.16
|
| Rate for Payer: Cash Price |
$3,993.69
|
| Rate for Payer: Cigna Commercial |
$6,629.53
|
| Rate for Payer: First Health Commercial |
$7,588.01
|
| Rate for Payer: Humana Commercial |
$6,789.27
|
| Rate for Payer: Humana KY Medicaid |
$2,746.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,774.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,549.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,894.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,396.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,801.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,028.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,990.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.09
|
| Rate for Payer: PHCS Commercial |
$7,667.88
|
| Rate for Payer: United Healthcare All Payer |
$7,028.89
|
|
|
PLATE PROX FM LK 4.5M 9 234M R
|
Facility
|
IP
|
$7,987.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.36 |
| Max. Negotiated Rate |
$7,667.88 |
| Rate for Payer: Aetna Commercial |
$6,150.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,230.16
|
| Rate for Payer: Cash Price |
$3,993.69
|
| Rate for Payer: Cigna Commercial |
$6,629.53
|
| Rate for Payer: First Health Commercial |
$7,588.01
|
| Rate for Payer: Humana Commercial |
$6,789.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,549.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,894.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,396.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,028.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,990.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.09
|
| Rate for Payer: PHCS Commercial |
$7,667.88
|
| Rate for Payer: United Healthcare All Payer |
$7,028.89
|
|
|
PLATE PROX FM LK 4.5M 9 234M R
|
Facility
|
OP
|
$7,987.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,038.36 |
| Max. Negotiated Rate |
$7,667.88 |
| Rate for Payer: Aetna Commercial |
$6,150.28
|
| Rate for Payer: Anthem Medicaid |
$2,746.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,230.16
|
| Rate for Payer: Cash Price |
$3,993.69
|
| Rate for Payer: Cigna Commercial |
$6,629.53
|
| Rate for Payer: First Health Commercial |
$7,588.01
|
| Rate for Payer: Humana Commercial |
$6,789.27
|
| Rate for Payer: Humana KY Medicaid |
$2,746.86
|
| Rate for Payer: Kentucky WC Medicaid |
$2,774.82
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,549.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,894.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,396.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,801.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,028.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,990.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,597.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,038.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,476.09
|
| Rate for Payer: PHCS Commercial |
$7,667.88
|
| Rate for Payer: United Healthcare All Payer |
$7,028.89
|
|
|
PLATE PROX FM LK 4.5M 9 288M R
|
Facility
|
OP
|
$8,646.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.01 |
| Max. Negotiated Rate |
$8,300.35 |
| Rate for Payer: Aetna Commercial |
$6,657.57
|
| Rate for Payer: Anthem Medicaid |
$2,973.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.04
|
| Rate for Payer: Cash Price |
$4,323.10
|
| Rate for Payer: Cigna Commercial |
$7,176.35
|
| Rate for Payer: First Health Commercial |
$8,213.89
|
| Rate for Payer: Humana Commercial |
$7,349.27
|
| Rate for Payer: Humana KY Medicaid |
$2,973.43
|
| Rate for Payer: Kentucky WC Medicaid |
$3,003.69
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,089.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,380.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,593.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,033.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,608.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,484.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.32
|
| Rate for Payer: PHCS Commercial |
$8,300.35
|
| Rate for Payer: United Healthcare All Payer |
$7,608.66
|
|
|
PLATE PROX FM LK 4.5M 9 288M R
|
Facility
|
IP
|
$8,646.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,124.01 |
| Max. Negotiated Rate |
$8,300.35 |
| Rate for Payer: Aetna Commercial |
$6,657.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,744.04
|
| Rate for Payer: Cash Price |
$4,323.10
|
| Rate for Payer: Cigna Commercial |
$7,176.35
|
| Rate for Payer: First Health Commercial |
$8,213.89
|
| Rate for Payer: Humana Commercial |
$7,349.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,089.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,380.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,593.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,608.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,484.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,729.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,124.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,680.32
|
| Rate for Payer: PHCS Commercial |
$8,300.35
|
| Rate for Payer: United Healthcare All Payer |
$7,608.66
|
|
|
PLATE PROX HUM 3.5*3H 71821403
|
Facility
|
OP
|
$6,852.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.79 |
| Max. Negotiated Rate |
$6,578.14 |
| Rate for Payer: Anthem Medicaid |
$2,356.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,344.74
|
| Rate for Payer: Cash Price |
$3,426.11
|
| Rate for Payer: Cigna Commercial |
$5,687.35
|
| Rate for Payer: First Health Commercial |
$6,509.62
|
| Rate for Payer: Humana Commercial |
$5,824.40
|
| Rate for Payer: Humana KY Medicaid |
$2,356.48
|
| Rate for Payer: Kentucky WC Medicaid |
$2,380.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,618.83
|
| Rate for Payer: Aetna Commercial |
$5,276.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,056.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,403.76
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,029.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,139.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,124.19
|
| Rate for Payer: PHCS Commercial |
$6,578.14
|
| Rate for Payer: United Healthcare All Payer |
$6,029.96
|
|
|
PLATE PROX HUM 3.5*3H 71821403
|
Facility
|
IP
|
$6,852.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$890.79 |
| Max. Negotiated Rate |
$6,578.14 |
| Rate for Payer: Aetna Commercial |
$5,276.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,344.74
|
| Rate for Payer: Cash Price |
$3,426.11
|
| Rate for Payer: Cigna Commercial |
$5,687.35
|
| Rate for Payer: First Health Commercial |
$6,509.62
|
| Rate for Payer: Humana Commercial |
$5,824.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,618.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,056.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,055.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,029.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,139.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,370.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$890.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,124.19
|
| Rate for Payer: PHCS Commercial |
$6,578.14
|
| Rate for Payer: United Healthcare All Payer |
$6,029.96
|
|
|
PLATE PROX HUM 3.5 STD 5H 114M
|
Facility
|
IP
|
$9,133.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.35 |
| Max. Negotiated Rate |
$8,768.10 |
| Rate for Payer: Aetna Commercial |
$7,032.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,124.08
|
| Rate for Payer: Cash Price |
$4,566.72
|
| Rate for Payer: Cigna Commercial |
$7,580.76
|
| Rate for Payer: First Health Commercial |
$8,676.77
|
| Rate for Payer: Humana Commercial |
$7,763.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,489.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,740.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,037.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,850.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.37
|
| Rate for Payer: PHCS Commercial |
$8,768.10
|
| Rate for Payer: United Healthcare All Payer |
$8,037.43
|
|
|
PLATE PROX HUM 3.5 STD 5H 114M
|
Facility
|
OP
|
$9,133.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,187.35 |
| Max. Negotiated Rate |
$8,768.10 |
| Rate for Payer: Aetna Commercial |
$7,032.75
|
| Rate for Payer: Anthem Medicaid |
$3,140.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,124.08
|
| Rate for Payer: Cash Price |
$4,566.72
|
| Rate for Payer: Cigna Commercial |
$7,580.76
|
| Rate for Payer: First Health Commercial |
$8,676.77
|
| Rate for Payer: Humana Commercial |
$7,763.42
|
| Rate for Payer: Humana KY Medicaid |
$3,140.99
|
| Rate for Payer: Kentucky WC Medicaid |
$3,172.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,489.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,740.48
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,204.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,037.43
|
| Rate for Payer: Ohio Health Group HMO |
$6,850.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,826.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,187.35
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,831.37
|
| Rate for Payer: PHCS Commercial |
$8,768.10
|
| Rate for Payer: United Healthcare All Payer |
$8,037.43
|
|
|
PLATE PROX HUMERUS LT 6 HOLE
|
Facility
|
IP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
PLATE PROX HUMERUS LT 6 HOLE
|
Facility
|
OP
|
$10,081.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,310.63 |
| Max. Negotiated Rate |
$9,678.48 |
| Rate for Payer: Aetna Commercial |
$7,762.95
|
| Rate for Payer: Anthem Medicaid |
$3,467.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,863.76
|
| Rate for Payer: Cash Price |
$5,040.88
|
| Rate for Payer: Cigna Commercial |
$8,367.85
|
| Rate for Payer: First Health Commercial |
$9,577.66
|
| Rate for Payer: Humana Commercial |
$8,569.49
|
| Rate for Payer: Humana KY Medicaid |
$3,467.11
|
| Rate for Payer: Kentucky WC Medicaid |
$3,502.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,267.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,440.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,024.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,536.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,871.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,561.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,016.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,310.63
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,125.34
|
| Rate for Payer: PHCS Commercial |
$9,678.48
|
| Rate for Payer: United Healthcare All Payer |
$8,871.94
|
|
|
PLATE PROX HUMERUS RT 4 HOLES
|
Facility
|
OP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.60 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Anthem Medicaid |
$1,141.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Humana KY Medicaid |
$1,141.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,153.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,164.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.20
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
PLATE PROX HUMERUS RT 4 HOLES
|
Facility
|
IP
|
$3,320.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$431.60 |
| Max. Negotiated Rate |
$3,187.20 |
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,589.60
|
| Rate for Payer: Cash Price |
$1,660.00
|
| Rate for Payer: Cigna Commercial |
$2,755.60
|
| Rate for Payer: First Health Commercial |
$3,154.00
|
| Rate for Payer: Humana Commercial |
$2,822.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,722.40
|
| Rate for Payer: Aetna Commercial |
$2,556.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,450.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$996.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,921.60
|
| Rate for Payer: Ohio Health Group HMO |
$2,490.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$664.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$431.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,029.20
|
| Rate for Payer: PHCS Commercial |
$3,187.20
|
| Rate for Payer: United Healthcare All Payer |
$2,921.60
|
|
|
PLATE PROX HUM HI 3H 80M LT
|
Facility
|
IP
|
$10,833.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,408.37 |
| Max. Negotiated Rate |
$10,400.26 |
| Rate for Payer: Aetna Commercial |
$8,341.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,450.21
|
| Rate for Payer: Cash Price |
$5,416.80
|
| Rate for Payer: Cigna Commercial |
$8,991.89
|
| Rate for Payer: First Health Commercial |
$10,291.92
|
| Rate for Payer: Humana Commercial |
$9,208.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,883.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,250.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,533.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,125.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,166.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,408.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,358.42
|
| Rate for Payer: PHCS Commercial |
$10,400.26
|
| Rate for Payer: United Healthcare All Payer |
$9,533.57
|
|
|
PLATE PROX HUM HI 3H 80M LT
|
Facility
|
OP
|
$10,833.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,408.37 |
| Max. Negotiated Rate |
$10,400.26 |
| Rate for Payer: Aetna Commercial |
$8,341.87
|
| Rate for Payer: Anthem Medicaid |
$3,725.68
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,450.21
|
| Rate for Payer: Cash Price |
$5,416.80
|
| Rate for Payer: Cigna Commercial |
$8,991.89
|
| Rate for Payer: First Health Commercial |
$10,291.92
|
| Rate for Payer: Humana Commercial |
$9,208.56
|
| Rate for Payer: Humana KY Medicaid |
$3,725.68
|
| Rate for Payer: Kentucky WC Medicaid |
$3,763.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,883.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,995.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,250.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,800.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,533.57
|
| Rate for Payer: Ohio Health Group HMO |
$8,125.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,166.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,408.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,358.42
|
| Rate for Payer: PHCS Commercial |
$10,400.26
|
| Rate for Payer: United Healthcare All Payer |
$9,533.57
|
|
|
PLATE PROX HUM HI 3H 80M RT
|
Facility
|
OP
|
$12,439.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,617.15 |
| Max. Negotiated Rate |
$11,942.02 |
| Rate for Payer: Anthem Medicaid |
$4,277.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,702.89
|
| Rate for Payer: Cash Price |
$6,219.80
|
| Rate for Payer: Cigna Commercial |
$10,324.87
|
| Rate for Payer: First Health Commercial |
$11,817.62
|
| Rate for Payer: Humana Commercial |
$10,573.66
|
| Rate for Payer: Humana KY Medicaid |
$4,277.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,321.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,200.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,180.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,731.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,363.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,946.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,487.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,617.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,856.28
|
| Rate for Payer: PHCS Commercial |
$11,942.02
|
| Rate for Payer: United Healthcare All Payer |
$10,946.85
|
| Rate for Payer: Aetna Commercial |
$9,578.49
|
|
|
PLATE PROX HUM HI 3H 80M RT
|
Facility
|
IP
|
$12,439.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,617.15 |
| Max. Negotiated Rate |
$11,942.02 |
| Rate for Payer: Aetna Commercial |
$9,578.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,702.89
|
| Rate for Payer: Cash Price |
$6,219.80
|
| Rate for Payer: Cigna Commercial |
$10,324.87
|
| Rate for Payer: First Health Commercial |
$11,817.62
|
| Rate for Payer: Humana Commercial |
$10,573.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,200.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,180.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,731.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,946.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,487.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,617.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,856.28
|
| Rate for Payer: PHCS Commercial |
$11,942.02
|
| Rate for Payer: United Healthcare All Payer |
$10,946.85
|
|
|
PLATE PROX HUM HI 4H 90M LT
|
Facility
|
IP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
PLATE PROX HUM HI 4H 90M LT
|
Facility
|
OP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem Medicaid |
$3,826.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Humana KY Medicaid |
$3,826.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,865.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,902.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
PLATE PROX HUM HI 4H 90M RT
|
Facility
|
OP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem Medicaid |
$3,826.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Humana KY Medicaid |
$3,826.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,865.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,902.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
PLATE PROX HUM HI 4H 90M RT
|
Facility
|
IP
|
$11,125.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,446.33 |
| Max. Negotiated Rate |
$10,680.58 |
| Rate for Payer: Aetna Commercial |
$8,566.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,677.97
|
| Rate for Payer: Cash Price |
$5,562.80
|
| Rate for Payer: Cigna Commercial |
$9,234.25
|
| Rate for Payer: First Health Commercial |
$10,569.32
|
| Rate for Payer: Humana Commercial |
$9,456.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,122.99
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,210.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,337.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,790.53
|
| Rate for Payer: Ohio Health Group HMO |
$8,344.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,225.12
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,446.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,448.94
|
| Rate for Payer: PHCS Commercial |
$10,680.58
|
| Rate for Payer: United Healthcare All Payer |
$9,790.53
|
|
|
PLATE PROX HUM HI 7H 140M LT
|
Facility
|
IP
|
$12,439.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,617.15 |
| Max. Negotiated Rate |
$11,942.02 |
| Rate for Payer: Aetna Commercial |
$9,578.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,702.89
|
| Rate for Payer: Cash Price |
$6,219.80
|
| Rate for Payer: Cigna Commercial |
$10,324.87
|
| Rate for Payer: First Health Commercial |
$11,817.62
|
| Rate for Payer: Humana Commercial |
$10,573.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,200.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,180.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,731.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,946.85
|
| Rate for Payer: Ohio Health Group HMO |
$9,329.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,487.92
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,617.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,856.28
|
| Rate for Payer: PHCS Commercial |
$11,942.02
|
| Rate for Payer: United Healthcare All Payer |
$10,946.85
|
|
