|
PLATE LCP M DS TB 3.5*168 R 8H
|
Facility
|
IP
|
$8,703.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,611.00 |
| Max. Negotiated Rate |
$8,355.21 |
| Rate for Payer: Aetna Commercial |
$6,701.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,788.61
|
| Rate for Payer: Cash Price |
$4,351.67
|
| Rate for Payer: Cigna Commercial |
$7,223.77
|
| Rate for Payer: First Health Commercial |
$8,268.17
|
| Rate for Payer: Humana Commercial |
$7,397.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,136.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,423.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,611.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,658.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,527.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,962.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,571.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,005.30
|
| Rate for Payer: PHCS Commercial |
$8,355.21
|
| Rate for Payer: United Healthcare All Payer |
$7,658.94
|
|
|
PLATE LCP M DS TB 3.5*168 R 8H
|
Facility
|
OP
|
$8,703.34
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,611.00 |
| Max. Negotiated Rate |
$8,355.21 |
| Rate for Payer: Aetna Commercial |
$6,701.57
|
| Rate for Payer: Anthem Medicaid |
$2,993.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,788.61
|
| Rate for Payer: Cash Price |
$4,351.67
|
| Rate for Payer: Cigna Commercial |
$7,223.77
|
| Rate for Payer: First Health Commercial |
$8,268.17
|
| Rate for Payer: Humana Commercial |
$7,397.84
|
| Rate for Payer: Humana KY Medicaid |
$2,993.08
|
| Rate for Payer: Kentucky WC Medicaid |
$3,023.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,136.74
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,423.06
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,611.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,053.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,658.94
|
| Rate for Payer: Ohio Health Group HMO |
$6,527.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,962.67
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,571.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,005.30
|
| Rate for Payer: PHCS Commercial |
$8,355.21
|
| Rate for Payer: United Healthcare All Payer |
$7,658.94
|
|
|
PLATE LCP M DS TIB 3.5*142 R 6
|
Facility
|
OP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem Medicaid |
$3,744.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Humana KY Medicaid |
$3,744.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
|
PLATE LCP M DS TIB 3.5*142 R 6
|
Facility
|
IP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
|
PLATE LCP M DS TIB 3.5*168 L 8
|
Facility
|
IP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
|
PLATE LCP M DS TIB 3.5*168 L 8
|
Facility
|
OP
|
$10,887.16
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,266.15 |
| Max. Negotiated Rate |
$10,451.67 |
| Rate for Payer: Aetna Commercial |
$8,383.11
|
| Rate for Payer: Anthem Medicaid |
$3,744.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,491.98
|
| Rate for Payer: Cash Price |
$5,443.58
|
| Rate for Payer: Cigna Commercial |
$9,036.34
|
| Rate for Payer: First Health Commercial |
$10,342.80
|
| Rate for Payer: Humana Commercial |
$9,254.09
|
| Rate for Payer: Humana KY Medicaid |
$3,744.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,782.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,927.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,034.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,266.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,819.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,580.70
|
| Rate for Payer: Ohio Health Group HMO |
$8,165.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,709.73
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,471.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,512.14
|
| Rate for Payer: PHCS Commercial |
$10,451.67
|
| Rate for Payer: United Healthcare All Payer |
$9,580.70
|
|
|
PLATE LCP PRX TIBIA 3.5MM 4H
|
Facility
|
OP
|
$9,043.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.93 |
| Max. Negotiated Rate |
$8,681.37 |
| Rate for Payer: Aetna Commercial |
$6,963.18
|
| Rate for Payer: Anthem Medicaid |
$3,109.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,053.61
|
| Rate for Payer: Cash Price |
$4,521.54
|
| Rate for Payer: Cigna Commercial |
$7,505.76
|
| Rate for Payer: First Health Commercial |
$8,590.94
|
| Rate for Payer: Humana Commercial |
$7,686.63
|
| Rate for Payer: Humana KY Medicaid |
$3,109.92
|
| Rate for Payer: Kentucky WC Medicaid |
$3,141.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,415.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,673.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,172.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,957.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,782.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,234.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,867.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.73
|
| Rate for Payer: PHCS Commercial |
$8,681.37
|
| Rate for Payer: United Healthcare All Payer |
$7,957.92
|
|
|
PLATE LCP PRX TIBIA 3.5MM 4H
|
Facility
|
IP
|
$9,043.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,712.93 |
| Max. Negotiated Rate |
$8,681.37 |
| Rate for Payer: Aetna Commercial |
$6,963.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,053.61
|
| Rate for Payer: Cash Price |
$4,521.54
|
| Rate for Payer: Cigna Commercial |
$7,505.76
|
| Rate for Payer: First Health Commercial |
$8,590.94
|
| Rate for Payer: Humana Commercial |
$7,686.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,415.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,673.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,712.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,957.92
|
| Rate for Payer: Ohio Health Group HMO |
$6,782.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,234.47
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,867.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,239.73
|
| Rate for Payer: PHCS Commercial |
$8,681.37
|
| Rate for Payer: United Healthcare All Payer |
$7,957.92
|
|
|
PLATE LCP SUP ANT CLV 3.5 5H L
|
Facility
|
IP
|
$5,204.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.28 |
| Max. Negotiated Rate |
$4,996.09 |
| Rate for Payer: Aetna Commercial |
$4,007.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.32
|
| Rate for Payer: Cash Price |
$2,602.13
|
| Rate for Payer: Cigna Commercial |
$4,319.54
|
| Rate for Payer: First Health Commercial |
$4,944.05
|
| Rate for Payer: Humana Commercial |
$4,423.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.94
|
| Rate for Payer: PHCS Commercial |
$4,996.09
|
| Rate for Payer: United Healthcare All Payer |
$4,579.75
|
|
|
PLATE LCP SUP ANT CLV 3.5 5H L
|
Facility
|
OP
|
$5,204.26
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,561.28 |
| Max. Negotiated Rate |
$4,996.09 |
| Rate for Payer: Aetna Commercial |
$4,007.28
|
| Rate for Payer: Anthem Medicaid |
$1,789.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,059.32
|
| Rate for Payer: Cash Price |
$2,602.13
|
| Rate for Payer: Cigna Commercial |
$4,319.54
|
| Rate for Payer: First Health Commercial |
$4,944.05
|
| Rate for Payer: Humana Commercial |
$4,423.62
|
| Rate for Payer: Humana KY Medicaid |
$1,789.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,807.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,267.49
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,840.74
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,561.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,825.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,579.75
|
| Rate for Payer: Ohio Health Group HMO |
$3,903.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,163.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,527.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,590.94
|
| Rate for Payer: PHCS Commercial |
$4,996.09
|
| Rate for Payer: United Healthcare All Payer |
$4,579.75
|
|
|
PLATE LCP SUP ANT CLV 3.5 7H L
|
Facility
|
OP
|
$5,633.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.93 |
| Max. Negotiated Rate |
$5,407.79 |
| Rate for Payer: Aetna Commercial |
$4,337.49
|
| Rate for Payer: Anthem Medicaid |
$1,937.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.83
|
| Rate for Payer: Cash Price |
$2,816.56
|
| Rate for Payer: Cigna Commercial |
$4,675.48
|
| Rate for Payer: First Health Commercial |
$5,351.45
|
| Rate for Payer: Humana Commercial |
$4,788.14
|
| Rate for Payer: Humana KY Medicaid |
$1,937.23
|
| Rate for Payer: Kentucky WC Medicaid |
$1,956.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,619.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,157.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,976.09
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,957.14
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,506.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,900.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,886.85
|
| Rate for Payer: PHCS Commercial |
$5,407.79
|
| Rate for Payer: United Healthcare All Payer |
$4,957.14
|
|
|
PLATE LCP SUP ANT CLV 3.5 7H L
|
Facility
|
IP
|
$5,633.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,689.93 |
| Max. Negotiated Rate |
$5,407.79 |
| Rate for Payer: Aetna Commercial |
$4,337.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,393.83
|
| Rate for Payer: Cash Price |
$2,816.56
|
| Rate for Payer: Cigna Commercial |
$4,675.48
|
| Rate for Payer: First Health Commercial |
$5,351.45
|
| Rate for Payer: Humana Commercial |
$4,788.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,619.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,157.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,689.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,957.14
|
| Rate for Payer: Ohio Health Group HMO |
$4,224.83
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,506.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,900.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,886.85
|
| Rate for Payer: PHCS Commercial |
$5,407.79
|
| Rate for Payer: United Healthcare All Payer |
$4,957.14
|
|
|
PLATE LCP SUP CLAV 3.5 7H L
|
Facility
|
OP
|
$5,476.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,643.00 |
| Max. Negotiated Rate |
$5,257.59 |
| Rate for Payer: Aetna Commercial |
$4,217.03
|
| Rate for Payer: Anthem Medicaid |
$1,883.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,271.79
|
| Rate for Payer: Cash Price |
$2,738.33
|
| Rate for Payer: Cigna Commercial |
$4,545.63
|
| Rate for Payer: First Health Commercial |
$5,202.83
|
| Rate for Payer: Humana Commercial |
$4,655.16
|
| Rate for Payer: Humana KY Medicaid |
$1,883.42
|
| Rate for Payer: Kentucky WC Medicaid |
$1,902.59
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,490.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,041.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,643.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,921.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,819.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,107.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,381.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,764.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,778.90
|
| Rate for Payer: PHCS Commercial |
$5,257.59
|
| Rate for Payer: United Healthcare All Payer |
$4,819.46
|
|
|
PLATE LCP SUP CLAV 3.5 7H L
|
Facility
|
IP
|
$5,476.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,643.00 |
| Max. Negotiated Rate |
$5,257.59 |
| Rate for Payer: Aetna Commercial |
$4,217.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,271.79
|
| Rate for Payer: Cash Price |
$2,738.33
|
| Rate for Payer: Cigna Commercial |
$4,545.63
|
| Rate for Payer: First Health Commercial |
$5,202.83
|
| Rate for Payer: Humana Commercial |
$4,655.16
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,490.86
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,041.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,643.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,819.46
|
| Rate for Payer: Ohio Health Group HMO |
$4,107.49
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,381.33
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,764.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,778.90
|
| Rate for Payer: PHCS Commercial |
$5,257.59
|
| Rate for Payer: United Healthcare All Payer |
$4,819.46
|
|
|
PLATE LCP TIBIA 3.5MM 11H L
|
Facility
|
OP
|
$7,735.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.60 |
| Max. Negotiated Rate |
$7,425.92 |
| Rate for Payer: Aetna Commercial |
$5,956.20
|
| Rate for Payer: Anthem Medicaid |
$2,660.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.56
|
| Rate for Payer: Cash Price |
$3,867.66
|
| Rate for Payer: Cigna Commercial |
$6,420.32
|
| Rate for Payer: First Health Commercial |
$7,348.56
|
| Rate for Payer: Humana Commercial |
$6,575.03
|
| Rate for Payer: Humana KY Medicaid |
$2,660.18
|
| Rate for Payer: Kentucky WC Medicaid |
$2,687.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,713.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,807.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,188.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,729.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,337.38
|
| Rate for Payer: PHCS Commercial |
$7,425.92
|
| Rate for Payer: United Healthcare All Payer |
$6,807.09
|
|
|
PLATE LCP TIBIA 3.5MM 11H L
|
Facility
|
IP
|
$7,735.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,320.60 |
| Max. Negotiated Rate |
$7,425.92 |
| Rate for Payer: Aetna Commercial |
$5,956.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,033.56
|
| Rate for Payer: Cash Price |
$3,867.66
|
| Rate for Payer: Cigna Commercial |
$6,420.32
|
| Rate for Payer: First Health Commercial |
$7,348.56
|
| Rate for Payer: Humana Commercial |
$6,575.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,342.97
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,708.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,320.60
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,807.09
|
| Rate for Payer: Ohio Health Group HMO |
$5,801.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,188.26
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,729.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,337.38
|
| Rate for Payer: PHCS Commercial |
$7,425.92
|
| Rate for Payer: United Healthcare All Payer |
$6,807.09
|
|
|
PLATE LCP TIBIA 3.5MM 11H R
|
Facility
|
OP
|
$7,589.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.83 |
| Max. Negotiated Rate |
$7,285.86 |
| Rate for Payer: Aetna Commercial |
$5,843.87
|
| Rate for Payer: Anthem Medicaid |
$2,610.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.76
|
| Rate for Payer: Cash Price |
$3,794.72
|
| Rate for Payer: Cigna Commercial |
$6,299.24
|
| Rate for Payer: First Health Commercial |
$7,209.97
|
| Rate for Payer: Humana Commercial |
$6,451.02
|
| Rate for Payer: Humana KY Medicaid |
$2,610.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,636.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,223.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,601.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,662.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,692.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.71
|
| Rate for Payer: PHCS Commercial |
$7,285.86
|
| Rate for Payer: United Healthcare All Payer |
$6,678.71
|
|
|
PLATE LCP TIBIA 3.5MM 11H R
|
Facility
|
IP
|
$7,589.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.83 |
| Max. Negotiated Rate |
$7,285.86 |
| Rate for Payer: Aetna Commercial |
$5,843.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.76
|
| Rate for Payer: Cash Price |
$3,794.72
|
| Rate for Payer: Cigna Commercial |
$6,299.24
|
| Rate for Payer: First Health Commercial |
$7,209.97
|
| Rate for Payer: Humana Commercial |
$6,451.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,223.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,601.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,692.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.71
|
| Rate for Payer: PHCS Commercial |
$7,285.86
|
| Rate for Payer: United Healthcare All Payer |
$6,678.71
|
|
|
PLATE LCP TIBIA 3.5MM 13H L
|
Facility
|
OP
|
$7,786.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,335.87 |
| Max. Negotiated Rate |
$7,474.79 |
| Rate for Payer: Aetna Commercial |
$5,995.40
|
| Rate for Payer: Anthem Medicaid |
$2,677.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,073.27
|
| Rate for Payer: Cash Price |
$3,893.12
|
| Rate for Payer: Cigna Commercial |
$6,462.58
|
| Rate for Payer: First Health Commercial |
$7,396.93
|
| Rate for Payer: Humana Commercial |
$6,618.30
|
| Rate for Payer: Humana KY Medicaid |
$2,677.69
|
| Rate for Payer: Kentucky WC Medicaid |
$2,704.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,384.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,746.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,335.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,731.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,851.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,839.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,228.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,774.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,372.51
|
| Rate for Payer: PHCS Commercial |
$7,474.79
|
| Rate for Payer: United Healthcare All Payer |
$6,851.89
|
|
|
PLATE LCP TIBIA 3.5MM 13H L
|
Facility
|
IP
|
$7,786.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,335.87 |
| Max. Negotiated Rate |
$7,474.79 |
| Rate for Payer: Aetna Commercial |
$5,995.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,073.27
|
| Rate for Payer: Cash Price |
$3,893.12
|
| Rate for Payer: Cigna Commercial |
$6,462.58
|
| Rate for Payer: First Health Commercial |
$7,396.93
|
| Rate for Payer: Humana Commercial |
$6,618.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,384.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,746.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,335.87
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,851.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,839.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,228.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,774.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,372.51
|
| Rate for Payer: PHCS Commercial |
$7,474.79
|
| Rate for Payer: United Healthcare All Payer |
$6,851.89
|
|
|
PLATE LCP TIBIA 3.5MM 13H R
|
Facility
|
OP
|
$7,589.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.83 |
| Max. Negotiated Rate |
$7,285.86 |
| Rate for Payer: Aetna Commercial |
$5,843.87
|
| Rate for Payer: Anthem Medicaid |
$2,610.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.76
|
| Rate for Payer: Cash Price |
$3,794.72
|
| Rate for Payer: Cigna Commercial |
$6,299.24
|
| Rate for Payer: First Health Commercial |
$7,209.97
|
| Rate for Payer: Humana Commercial |
$6,451.02
|
| Rate for Payer: Humana KY Medicaid |
$2,610.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,636.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,223.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,601.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,662.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,692.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.71
|
| Rate for Payer: PHCS Commercial |
$7,285.86
|
| Rate for Payer: United Healthcare All Payer |
$6,678.71
|
|
|
PLATE LCP TIBIA 3.5MM 13H R
|
Facility
|
IP
|
$7,589.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.83 |
| Max. Negotiated Rate |
$7,285.86 |
| Rate for Payer: Aetna Commercial |
$5,843.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.76
|
| Rate for Payer: Cash Price |
$3,794.72
|
| Rate for Payer: Cigna Commercial |
$6,299.24
|
| Rate for Payer: First Health Commercial |
$7,209.97
|
| Rate for Payer: Humana Commercial |
$6,451.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,223.34
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,601.01
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.71
|
| Rate for Payer: Ohio Health Group HMO |
$5,692.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.55
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.71
|
| Rate for Payer: PHCS Commercial |
$7,285.86
|
| Rate for Payer: United Healthcare All Payer |
$6,678.71
|
|
|
PLATE LCP TIBIA 3.5MM 15H L
|
Facility
|
IP
|
$7,847.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.20 |
| Max. Negotiated Rate |
$7,533.46 |
| Rate for Payer: Aetna Commercial |
$6,042.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,120.93
|
| Rate for Payer: Cash Price |
$3,923.67
|
| Rate for Payer: Cigna Commercial |
$6,513.30
|
| Rate for Payer: First Health Commercial |
$7,454.98
|
| Rate for Payer: Humana Commercial |
$6,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,434.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,791.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,354.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,905.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,885.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,277.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,827.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,414.67
|
| Rate for Payer: PHCS Commercial |
$7,533.46
|
| Rate for Payer: United Healthcare All Payer |
$6,905.67
|
|
|
PLATE LCP TIBIA 3.5MM 15H L
|
Facility
|
OP
|
$7,847.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.20 |
| Max. Negotiated Rate |
$7,533.46 |
| Rate for Payer: Aetna Commercial |
$6,042.46
|
| Rate for Payer: Anthem Medicaid |
$2,698.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,120.93
|
| Rate for Payer: Cash Price |
$3,923.67
|
| Rate for Payer: Cigna Commercial |
$6,513.30
|
| Rate for Payer: First Health Commercial |
$7,454.98
|
| Rate for Payer: Humana Commercial |
$6,670.25
|
| Rate for Payer: Humana KY Medicaid |
$2,698.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,726.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,434.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,791.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,354.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,752.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,905.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,885.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,277.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,827.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,414.67
|
| Rate for Payer: PHCS Commercial |
$7,533.46
|
| Rate for Payer: United Healthcare All Payer |
$6,905.67
|
|
|
PLATE LCP TIBIA 3.5MM 15H R
|
Facility
|
IP
|
$7,847.35
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,354.20 |
| Max. Negotiated Rate |
$7,533.46 |
| Rate for Payer: Aetna Commercial |
$6,042.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,120.93
|
| Rate for Payer: Cash Price |
$3,923.67
|
| Rate for Payer: Cigna Commercial |
$6,513.30
|
| Rate for Payer: First Health Commercial |
$7,454.98
|
| Rate for Payer: Humana Commercial |
$6,670.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,434.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,791.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,354.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,905.67
|
| Rate for Payer: Ohio Health Group HMO |
$5,885.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,277.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,827.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,414.67
|
| Rate for Payer: PHCS Commercial |
$7,533.46
|
| Rate for Payer: United Healthcare All Payer |
$6,905.67
|
|
