|
PLATE PROX HUM HI 7H 140M LT
|
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: Aetna Commercial |
$9,578.49
|
| 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
|
|
|
PLATE PROX HUM HI 7H 140M 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 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 LO 3H 73M LT
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
PLATE PROX HUM LO 3H 73M LT
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
PLATE PROX HUM LO 3H 73M RT
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
PLATE PROX HUM LO 3H 73M RT
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
PLATE PROX HUM LO 4H 83M LT
|
Facility
|
IP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
|
|
PLATE PROX HUM LO 4H 83M LT
|
Facility
|
OP
|
$10,950.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.55 |
| Max. Negotiated Rate |
$10,512.38 |
| Rate for Payer: Aetna Commercial |
$8,431.81
|
| Rate for Payer: Anthem Medicaid |
$3,765.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,541.31
|
| Rate for Payer: Cash Price |
$5,475.20
|
| Rate for Payer: Cigna Commercial |
$9,088.83
|
| Rate for Payer: First Health Commercial |
$10,402.88
|
| Rate for Payer: Humana Commercial |
$9,307.84
|
| Rate for Payer: Humana KY Medicaid |
$3,765.84
|
| Rate for Payer: Kentucky WC Medicaid |
$3,804.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,979.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,081.40
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,285.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,841.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,636.35
|
| Rate for Payer: Ohio Health Group HMO |
$8,212.80
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,190.08
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,423.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,394.62
|
| Rate for Payer: PHCS Commercial |
$10,512.38
|
| Rate for Payer: United Healthcare All Payer |
$9,636.35
|
|
|
PLATE PROX HUM LO 4H 83M RT
|
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 HUM LO 4H 83M RT
|
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 HUM LO 7H 133M LT
|
Facility
|
OP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem Medicaid |
$4,272.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Humana KY Medicaid |
$4,272.96
|
| Rate for Payer: Kentucky WC Medicaid |
$4,316.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,358.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
PLATE PROX HUM LO 7H 133M LT
|
Facility
|
IP
|
$12,425.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,615.25 |
| Max. Negotiated Rate |
$11,928.00 |
| Rate for Payer: Aetna Commercial |
$9,567.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,691.50
|
| Rate for Payer: Cash Price |
$6,212.50
|
| Rate for Payer: Cigna Commercial |
$10,312.75
|
| Rate for Payer: First Health Commercial |
$11,803.75
|
| Rate for Payer: Humana Commercial |
$10,561.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,188.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,169.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,727.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,934.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,318.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,485.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,615.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,851.75
|
| Rate for Payer: PHCS Commercial |
$11,928.00
|
| Rate for Payer: United Healthcare All Payer |
$10,934.00
|
|
|
PLATE PROX HUM LO 7H 133M RT
|
Facility
|
OP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem Medicaid |
$4,298.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Humana KY Medicaid |
$4,298.06
|
| Rate for Payer: Kentucky WC Medicaid |
$4,341.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,384.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
PLATE PROX HUM LO 7H 133M RT
|
Facility
|
IP
|
$12,498.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,624.74 |
| Max. Negotiated Rate |
$11,998.08 |
| Rate for Payer: Aetna Commercial |
$9,623.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,748.44
|
| Rate for Payer: Cash Price |
$6,249.00
|
| Rate for Payer: Cigna Commercial |
$10,373.34
|
| Rate for Payer: First Health Commercial |
$11,873.10
|
| Rate for Payer: Humana Commercial |
$10,623.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,248.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,223.52
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,749.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,998.24
|
| Rate for Payer: Ohio Health Group HMO |
$9,373.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,499.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,874.38
|
| Rate for Payer: PHCS Commercial |
$11,998.08
|
| Rate for Payer: United Healthcare All Payer |
$10,998.24
|
|
|
PLATE PROXIMAL HUM LG LT
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE PROXIMAL HUM LG LT
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
|
|
PLATE PROXIMAL HUM LG RT
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE PROXIMAL HUM LG RT
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE PROXIMAL HUM SM LT
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE PROXIMAL HUM SM LT
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE PROXIMAL HUM SM RT
|
Facility
|
OP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem Medicaid |
$2,588.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Humana KY Medicaid |
$2,588.45
|
| Rate for Payer: Kentucky WC Medicaid |
$2,614.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,640.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE PROXIMAL HUM SM RT
|
Facility
|
IP
|
$7,526.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$978.48 |
| Max. Negotiated Rate |
$7,225.68 |
| Rate for Payer: Aetna Commercial |
$5,795.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,870.86
|
| Rate for Payer: Cash Price |
$3,763.38
|
| Rate for Payer: Cigna Commercial |
$6,247.20
|
| Rate for Payer: First Health Commercial |
$7,150.41
|
| Rate for Payer: Humana Commercial |
$6,397.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,171.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,554.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,258.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,623.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,645.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,505.35
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$978.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,333.29
|
| Rate for Payer: PHCS Commercial |
$7,225.68
|
| Rate for Payer: United Healthcare All Payer |
$6,623.54
|
|
|
PLATE PROXIMAL LAT HUM 10H L
|
Facility
|
IP
|
$9,087.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.43 |
| Max. Negotiated Rate |
$8,724.41 |
| Rate for Payer: Aetna Commercial |
$6,997.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,088.59
|
| Rate for Payer: Cash Price |
$4,543.96
|
| Rate for Payer: Cigna Commercial |
$7,542.98
|
| Rate for Payer: First Health Commercial |
$8,633.53
|
| Rate for Payer: Humana Commercial |
$7,724.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,452.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,706.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,726.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,997.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,815.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,817.26
|
| Rate for Payer: PHCS Commercial |
$8,724.41
|
| Rate for Payer: United Healthcare All Payer |
$7,997.38
|
|
|
PLATE PROXIMAL LAT HUM 10H L
|
Facility
|
OP
|
$9,087.93
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,181.43 |
| Max. Negotiated Rate |
$8,724.41 |
| Rate for Payer: Aetna Commercial |
$6,997.71
|
| Rate for Payer: Anthem Medicaid |
$3,125.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,088.59
|
| Rate for Payer: Cash Price |
$4,543.96
|
| Rate for Payer: Cigna Commercial |
$7,542.98
|
| Rate for Payer: First Health Commercial |
$8,633.53
|
| Rate for Payer: Humana Commercial |
$7,724.74
|
| Rate for Payer: Humana KY Medicaid |
$3,125.34
|
| Rate for Payer: Kentucky WC Medicaid |
$3,157.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,452.10
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,706.89
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,726.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,188.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,997.38
|
| Rate for Payer: Ohio Health Group HMO |
$6,815.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,817.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,181.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,817.26
|
| Rate for Payer: PHCS Commercial |
$8,724.41
|
| Rate for Payer: United Healthcare All Payer |
$7,997.38
|
|
