|
PLATE LCP TIBIA 3.5MM 15H R
|
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 17H L
|
Facility
|
OP
|
$7,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.44 |
| Max. Negotiated Rate |
$7,575.81 |
| Rate for Payer: Aetna Commercial |
$6,076.43
|
| Rate for Payer: Anthem Medicaid |
$2,713.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.35
|
| Rate for Payer: Cash Price |
$3,945.74
|
| Rate for Payer: Cigna Commercial |
$6,549.92
|
| Rate for Payer: First Health Commercial |
$7,496.90
|
| Rate for Payer: Humana Commercial |
$6,707.75
|
| Rate for Payer: Humana KY Medicaid |
$2,713.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,768.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,313.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,445.11
|
| Rate for Payer: PHCS Commercial |
$7,575.81
|
| Rate for Payer: United Healthcare All Payer |
$6,944.49
|
|
|
PLATE LCP TIBIA 3.5MM 17H L
|
Facility
|
IP
|
$7,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.44 |
| Max. Negotiated Rate |
$7,575.81 |
| Rate for Payer: Aetna Commercial |
$6,076.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.35
|
| Rate for Payer: Cash Price |
$3,945.74
|
| Rate for Payer: Cigna Commercial |
$6,549.92
|
| Rate for Payer: First Health Commercial |
$7,496.90
|
| Rate for Payer: Humana Commercial |
$6,707.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,313.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,445.11
|
| Rate for Payer: PHCS Commercial |
$7,575.81
|
| Rate for Payer: United Healthcare All Payer |
$6,944.49
|
|
|
PLATE LCP TIBIA 3.5MM 17H R
|
Facility
|
IP
|
$7,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.44 |
| Max. Negotiated Rate |
$7,575.81 |
| Rate for Payer: Aetna Commercial |
$6,076.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.35
|
| Rate for Payer: Cash Price |
$3,945.74
|
| Rate for Payer: Cigna Commercial |
$6,549.92
|
| Rate for Payer: First Health Commercial |
$7,496.90
|
| Rate for Payer: Humana Commercial |
$6,707.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,313.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,445.11
|
| Rate for Payer: PHCS Commercial |
$7,575.81
|
| Rate for Payer: United Healthcare All Payer |
$6,944.49
|
|
|
PLATE LCP TIBIA 3.5MM 17H R
|
Facility
|
OP
|
$7,891.47
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,367.44 |
| Max. Negotiated Rate |
$7,575.81 |
| Rate for Payer: Aetna Commercial |
$6,076.43
|
| Rate for Payer: Anthem Medicaid |
$2,713.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,155.35
|
| Rate for Payer: Cash Price |
$3,945.74
|
| Rate for Payer: Cigna Commercial |
$6,549.92
|
| Rate for Payer: First Health Commercial |
$7,496.90
|
| Rate for Payer: Humana Commercial |
$6,707.75
|
| Rate for Payer: Humana KY Medicaid |
$2,713.88
|
| Rate for Payer: Kentucky WC Medicaid |
$2,741.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,471.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,823.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,367.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,768.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,944.49
|
| Rate for Payer: Ohio Health Group HMO |
$5,918.60
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,313.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,865.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,445.11
|
| Rate for Payer: PHCS Commercial |
$7,575.81
|
| Rate for Payer: United Healthcare All Payer |
$6,944.49
|
|
|
PLATE LCP TIBIA 3.5MM 5H L
|
Facility
|
OP
|
$7,589.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.81 |
| Max. Negotiated Rate |
$7,285.79 |
| Rate for Payer: Aetna Commercial |
$5,843.81
|
| Rate for Payer: Anthem Medicaid |
$2,609.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.70
|
| Rate for Payer: Cash Price |
$3,794.68
|
| Rate for Payer: Cigna Commercial |
$6,299.17
|
| Rate for Payer: First Health Commercial |
$7,209.89
|
| Rate for Payer: Humana Commercial |
$6,450.96
|
| Rate for Payer: Humana KY Medicaid |
$2,609.98
|
| Rate for Payer: Kentucky WC Medicaid |
$2,636.54
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,223.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,600.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,662.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,692.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.66
|
| Rate for Payer: PHCS Commercial |
$7,285.79
|
| Rate for Payer: United Healthcare All Payer |
$6,678.64
|
|
|
PLATE LCP TIBIA 3.5MM 5H L
|
Facility
|
IP
|
$7,589.36
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,276.81 |
| Max. Negotiated Rate |
$7,285.79 |
| Rate for Payer: Aetna Commercial |
$5,843.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,919.70
|
| Rate for Payer: Cash Price |
$3,794.68
|
| Rate for Payer: Cigna Commercial |
$6,299.17
|
| Rate for Payer: First Health Commercial |
$7,209.89
|
| Rate for Payer: Humana Commercial |
$6,450.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,223.28
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,600.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,276.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,678.64
|
| Rate for Payer: Ohio Health Group HMO |
$5,692.02
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,071.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,602.74
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,236.66
|
| Rate for Payer: PHCS Commercial |
$7,285.79
|
| Rate for Payer: United Healthcare All Payer |
$6,678.64
|
|
|
PLATE LCP TIBIA 3.5MM 5H 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 5H 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 7H L
|
Facility
|
IP
|
$7,640.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,292.08 |
| Max. Negotiated Rate |
$7,334.67 |
| Rate for Payer: Aetna Commercial |
$5,883.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,959.42
|
| Rate for Payer: Cash Price |
$3,820.14
|
| Rate for Payer: Cigna Commercial |
$6,341.43
|
| Rate for Payer: First Health Commercial |
$7,258.27
|
| Rate for Payer: Humana Commercial |
$6,494.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,265.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,638.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,292.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,723.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,730.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,112.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,647.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,271.79
|
| Rate for Payer: PHCS Commercial |
$7,334.67
|
| Rate for Payer: United Healthcare All Payer |
$6,723.45
|
|
|
PLATE LCP TIBIA 3.5MM 7H L
|
Facility
|
OP
|
$7,640.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,292.08 |
| Max. Negotiated Rate |
$7,334.67 |
| Rate for Payer: Aetna Commercial |
$5,883.02
|
| Rate for Payer: Anthem Medicaid |
$2,627.49
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,959.42
|
| Rate for Payer: Cash Price |
$3,820.14
|
| Rate for Payer: Cigna Commercial |
$6,341.43
|
| Rate for Payer: First Health Commercial |
$7,258.27
|
| Rate for Payer: Humana Commercial |
$6,494.24
|
| Rate for Payer: Humana KY Medicaid |
$2,627.49
|
| Rate for Payer: Kentucky WC Medicaid |
$2,654.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,265.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,638.53
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,292.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,680.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,723.45
|
| Rate for Payer: Ohio Health Group HMO |
$5,730.21
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,112.22
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,647.04
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,271.79
|
| Rate for Payer: PHCS Commercial |
$7,334.67
|
| Rate for Payer: United Healthcare All Payer |
$6,723.45
|
|
|
PLATE LCP TIBIA 3.5MM 7H 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 7H 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 9H L
|
Facility
|
IP
|
$7,687.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.34 |
| Max. Negotiated Rate |
$7,380.29 |
| Rate for Payer: Aetna Commercial |
$5,919.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,996.48
|
| Rate for Payer: Cash Price |
$3,843.90
|
| Rate for Payer: Cigna Commercial |
$6,380.87
|
| Rate for Payer: First Health Commercial |
$7,303.41
|
| Rate for Payer: Humana Commercial |
$6,534.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,304.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,673.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,306.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,765.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,765.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,150.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,688.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,304.58
|
| Rate for Payer: PHCS Commercial |
$7,380.29
|
| Rate for Payer: United Healthcare All Payer |
$6,765.26
|
|
|
PLATE LCP TIBIA 3.5MM 9H L
|
Facility
|
OP
|
$7,687.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.34 |
| Max. Negotiated Rate |
$7,380.29 |
| Rate for Payer: Aetna Commercial |
$5,919.61
|
| Rate for Payer: Anthem Medicaid |
$2,643.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,996.48
|
| Rate for Payer: Cash Price |
$3,843.90
|
| Rate for Payer: Cigna Commercial |
$6,380.87
|
| Rate for Payer: First Health Commercial |
$7,303.41
|
| Rate for Payer: Humana Commercial |
$6,534.63
|
| Rate for Payer: Humana KY Medicaid |
$2,643.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,670.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,304.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,673.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,306.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,765.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,765.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,150.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,688.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,304.58
|
| Rate for Payer: PHCS Commercial |
$7,380.29
|
| Rate for Payer: United Healthcare All Payer |
$6,765.26
|
|
|
PLATE LCP TIBIA 3.5MM 9H R
|
Facility
|
OP
|
$7,687.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.34 |
| Max. Negotiated Rate |
$7,380.29 |
| Rate for Payer: Aetna Commercial |
$5,919.61
|
| Rate for Payer: Anthem Medicaid |
$2,643.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,996.48
|
| Rate for Payer: Cash Price |
$3,843.90
|
| Rate for Payer: Cigna Commercial |
$6,380.87
|
| Rate for Payer: First Health Commercial |
$7,303.41
|
| Rate for Payer: Humana Commercial |
$6,534.63
|
| Rate for Payer: Humana KY Medicaid |
$2,643.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,670.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,304.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,673.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,306.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,696.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,765.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,765.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,150.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,688.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,304.58
|
| Rate for Payer: PHCS Commercial |
$7,380.29
|
| Rate for Payer: United Healthcare All Payer |
$6,765.26
|
|
|
PLATE LCP TIBIA 3.5MM 9H R
|
Facility
|
IP
|
$7,687.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,306.34 |
| Max. Negotiated Rate |
$7,380.29 |
| Rate for Payer: Aetna Commercial |
$5,919.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,996.48
|
| Rate for Payer: Cash Price |
$3,843.90
|
| Rate for Payer: Cigna Commercial |
$6,380.87
|
| Rate for Payer: First Health Commercial |
$7,303.41
|
| Rate for Payer: Humana Commercial |
$6,534.63
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,304.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,673.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,306.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,765.26
|
| Rate for Payer: Ohio Health Group HMO |
$5,765.85
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,150.24
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,688.39
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,304.58
|
| Rate for Payer: PHCS Commercial |
$7,380.29
|
| Rate for Payer: United Healthcare All Payer |
$6,765.26
|
|
|
PLATE LD FM LK 4.5M 10H 230M L
|
Facility
|
OP
|
$8,368.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,510.47 |
| Max. Negotiated Rate |
$8,033.51 |
| Rate for Payer: Aetna Commercial |
$6,443.54
|
| Rate for Payer: Anthem Medicaid |
$2,877.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,527.23
|
| Rate for Payer: Cash Price |
$4,184.12
|
| Rate for Payer: Cigna Commercial |
$6,945.64
|
| Rate for Payer: First Health Commercial |
$7,949.83
|
| Rate for Payer: Humana Commercial |
$7,113.00
|
| Rate for Payer: Humana KY Medicaid |
$2,877.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,907.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,861.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,175.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,510.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,935.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,364.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,694.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,280.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,774.09
|
| Rate for Payer: PHCS Commercial |
$8,033.51
|
| Rate for Payer: United Healthcare All Payer |
$7,364.05
|
|
|
PLATE LD FM LK 4.5M 10H 230M L
|
Facility
|
IP
|
$8,368.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,510.47 |
| Max. Negotiated Rate |
$8,033.51 |
| Rate for Payer: Aetna Commercial |
$6,443.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,527.23
|
| Rate for Payer: Cash Price |
$4,184.12
|
| Rate for Payer: Cigna Commercial |
$6,945.64
|
| Rate for Payer: First Health Commercial |
$7,949.83
|
| Rate for Payer: Humana Commercial |
$7,113.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,861.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,175.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,510.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,364.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,694.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,280.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,774.09
|
| Rate for Payer: PHCS Commercial |
$8,033.51
|
| Rate for Payer: United Healthcare All Payer |
$7,364.05
|
|
|
PLATE LD FM LK 4.5M 10H 230M R
|
Facility
|
OP
|
$8,368.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,510.47 |
| Max. Negotiated Rate |
$8,033.51 |
| Rate for Payer: Aetna Commercial |
$6,443.54
|
| Rate for Payer: Anthem Medicaid |
$2,877.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,527.23
|
| Rate for Payer: Cash Price |
$4,184.12
|
| Rate for Payer: Cigna Commercial |
$6,945.64
|
| Rate for Payer: First Health Commercial |
$7,949.83
|
| Rate for Payer: Humana Commercial |
$7,113.00
|
| Rate for Payer: Humana KY Medicaid |
$2,877.84
|
| Rate for Payer: Kentucky WC Medicaid |
$2,907.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,861.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,175.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,510.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,935.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,364.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,694.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,280.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,774.09
|
| Rate for Payer: PHCS Commercial |
$8,033.51
|
| Rate for Payer: United Healthcare All Payer |
$7,364.05
|
|
|
PLATE LD FM LK 4.5M 10H 230M R
|
Facility
|
IP
|
$8,368.24
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,510.47 |
| Max. Negotiated Rate |
$8,033.51 |
| Rate for Payer: Aetna Commercial |
$6,443.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,527.23
|
| Rate for Payer: Cash Price |
$4,184.12
|
| Rate for Payer: Cigna Commercial |
$6,945.64
|
| Rate for Payer: First Health Commercial |
$7,949.83
|
| Rate for Payer: Humana Commercial |
$7,113.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,861.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,175.76
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,510.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,364.05
|
| Rate for Payer: Ohio Health Group HMO |
$6,276.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,694.59
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,280.37
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,774.09
|
| Rate for Payer: PHCS Commercial |
$8,033.51
|
| Rate for Payer: United Healthcare All Payer |
$7,364.05
|
|
|
PLATE LD FM LK 4.5M 13H 286M L
|
Facility
|
OP
|
$8,624.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.45 |
| Max. Negotiated Rate |
$8,279.84 |
| Rate for Payer: Aetna Commercial |
$6,641.12
|
| Rate for Payer: Anthem Medicaid |
$2,966.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,727.37
|
| Rate for Payer: Cash Price |
$4,312.42
|
| Rate for Payer: Cigna Commercial |
$7,158.61
|
| Rate for Payer: First Health Commercial |
$8,193.59
|
| Rate for Payer: Humana Commercial |
$7,331.11
|
| Rate for Payer: Humana KY Medicaid |
$2,966.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,996.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,072.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,365.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,025.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,589.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,951.13
|
| Rate for Payer: PHCS Commercial |
$8,279.84
|
| Rate for Payer: United Healthcare All Payer |
$7,589.85
|
|
|
PLATE LD FM LK 4.5M 13H 286M L
|
Facility
|
IP
|
$8,624.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.45 |
| Max. Negotiated Rate |
$8,279.84 |
| Rate for Payer: Aetna Commercial |
$6,641.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,727.37
|
| Rate for Payer: Cash Price |
$4,312.42
|
| Rate for Payer: Cigna Commercial |
$7,158.61
|
| Rate for Payer: First Health Commercial |
$8,193.59
|
| Rate for Payer: Humana Commercial |
$7,331.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,072.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,365.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,589.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,951.13
|
| Rate for Payer: PHCS Commercial |
$8,279.84
|
| Rate for Payer: United Healthcare All Payer |
$7,589.85
|
|
|
PLATE LD FM LK 4.5M 13H 286M R
|
Facility
|
IP
|
$8,624.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.45 |
| Max. Negotiated Rate |
$8,279.84 |
| Rate for Payer: Aetna Commercial |
$6,641.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,727.37
|
| Rate for Payer: Cash Price |
$4,312.42
|
| Rate for Payer: Cigna Commercial |
$7,158.61
|
| Rate for Payer: First Health Commercial |
$8,193.59
|
| Rate for Payer: Humana Commercial |
$7,331.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,072.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,365.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,589.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,951.13
|
| Rate for Payer: PHCS Commercial |
$8,279.84
|
| Rate for Payer: United Healthcare All Payer |
$7,589.85
|
|
|
PLATE LD FM LK 4.5M 13H 286M R
|
Facility
|
OP
|
$8,624.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,587.45 |
| Max. Negotiated Rate |
$8,279.84 |
| Rate for Payer: Aetna Commercial |
$6,641.12
|
| Rate for Payer: Anthem Medicaid |
$2,966.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,727.37
|
| Rate for Payer: Cash Price |
$4,312.42
|
| Rate for Payer: Cigna Commercial |
$7,158.61
|
| Rate for Payer: First Health Commercial |
$8,193.59
|
| Rate for Payer: Humana Commercial |
$7,331.11
|
| Rate for Payer: Humana KY Medicaid |
$2,966.08
|
| Rate for Payer: Kentucky WC Medicaid |
$2,996.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,072.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,365.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,587.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,025.59
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,589.85
|
| Rate for Payer: Ohio Health Group HMO |
$6,468.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,899.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,503.60
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,951.13
|
| Rate for Payer: PHCS Commercial |
$8,279.84
|
| Rate for Payer: United Healthcare All Payer |
$7,589.85
|
|
