|
PLATE MALLEOLAR 5 HOLE
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MALLEOLAR 5 HOLE
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MALLEOLAR 7 HOLE
|
Facility
|
IP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MALLEOLAR 7 HOLE
|
Facility
|
OP
|
$1,930.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.24 |
| Max. Negotiated Rate |
$1,853.57 |
| Rate for Payer: Aetna Commercial |
$1,486.72
|
| Rate for Payer: Anthem Medicaid |
$664.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,506.02
|
| Rate for Payer: Cash Price |
$965.40
|
| Rate for Payer: Cigna Commercial |
$1,602.56
|
| Rate for Payer: First Health Commercial |
$1,834.26
|
| Rate for Payer: Humana Commercial |
$1,641.18
|
| Rate for Payer: Humana KY Medicaid |
$664.00
|
| Rate for Payer: Kentucky WC Medicaid |
$670.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,583.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,424.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$579.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$677.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,699.10
|
| Rate for Payer: Ohio Health Group HMO |
$1,448.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,544.64
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,679.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,332.25
|
| Rate for Payer: PHCS Commercial |
$1,853.57
|
| Rate for Payer: United Healthcare All Payer |
$1,699.10
|
|
|
PLATE MD PR0X LCP 4.5 8H 178 L
|
Facility
|
OP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem Medicaid |
$2,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Humana KY Medicaid |
$2,443.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE MD PR0X LCP 4.5 8H 178 L
|
Facility
|
IP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE MD PROX LCP 4.5 4H 106 L
|
Facility
|
IP
|
$7,005.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.65 |
| Max. Negotiated Rate |
$6,725.29 |
| Rate for Payer: Aetna Commercial |
$5,394.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.30
|
| Rate for Payer: Cash Price |
$3,502.76
|
| Rate for Payer: Cigna Commercial |
$5,814.57
|
| Rate for Payer: First Health Commercial |
$6,655.23
|
| Rate for Payer: Humana Commercial |
$5,954.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.80
|
| Rate for Payer: PHCS Commercial |
$6,725.29
|
| Rate for Payer: United Healthcare All Payer |
$6,164.85
|
|
|
PLATE MD PROX LCP 4.5 4H 106 L
|
Facility
|
OP
|
$7,005.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.65 |
| Max. Negotiated Rate |
$6,725.29 |
| Rate for Payer: Aetna Commercial |
$5,394.24
|
| Rate for Payer: Anthem Medicaid |
$2,409.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.30
|
| Rate for Payer: Cash Price |
$3,502.76
|
| Rate for Payer: Cigna Commercial |
$5,814.57
|
| Rate for Payer: First Health Commercial |
$6,655.23
|
| Rate for Payer: Humana Commercial |
$5,954.68
|
| Rate for Payer: Humana KY Medicaid |
$2,409.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.80
|
| Rate for Payer: PHCS Commercial |
$6,725.29
|
| Rate for Payer: United Healthcare All Payer |
$6,164.85
|
|
|
PLATE MD PROX LCP 4.5 4H 106 R
|
Facility
|
IP
|
$7,005.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.65 |
| Max. Negotiated Rate |
$6,725.29 |
| Rate for Payer: Aetna Commercial |
$5,394.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.30
|
| Rate for Payer: Cash Price |
$3,502.76
|
| Rate for Payer: Cigna Commercial |
$5,814.57
|
| Rate for Payer: First Health Commercial |
$6,655.23
|
| Rate for Payer: Humana Commercial |
$5,954.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.80
|
| Rate for Payer: PHCS Commercial |
$6,725.29
|
| Rate for Payer: United Healthcare All Payer |
$6,164.85
|
|
|
PLATE MD PROX LCP 4.5 4H 106 R
|
Facility
|
OP
|
$7,005.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.65 |
| Max. Negotiated Rate |
$6,725.29 |
| Rate for Payer: Aetna Commercial |
$5,394.24
|
| Rate for Payer: Anthem Medicaid |
$2,409.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.30
|
| Rate for Payer: Cash Price |
$3,502.76
|
| Rate for Payer: Cigna Commercial |
$5,814.57
|
| Rate for Payer: First Health Commercial |
$6,655.23
|
| Rate for Payer: Humana Commercial |
$5,954.68
|
| Rate for Payer: Humana KY Medicaid |
$2,409.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.80
|
| Rate for Payer: PHCS Commercial |
$6,725.29
|
| Rate for Payer: United Healthcare All Payer |
$6,164.85
|
|
|
PLATE MD PROX LCP 4.5 6H 142 L
|
Facility
|
OP
|
$7,056.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.93 |
| Max. Negotiated Rate |
$6,774.17 |
| Rate for Payer: Aetna Commercial |
$5,433.45
|
| Rate for Payer: Anthem Medicaid |
$2,426.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,504.02
|
| Rate for Payer: Cash Price |
$3,528.21
|
| Rate for Payer: Cigna Commercial |
$5,856.84
|
| Rate for Payer: First Health Commercial |
$6,703.61
|
| Rate for Payer: Humana Commercial |
$5,997.97
|
| Rate for Payer: Humana KY Medicaid |
$2,426.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,451.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,786.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,207.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,116.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,475.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,209.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,645.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,139.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,868.94
|
| Rate for Payer: PHCS Commercial |
$6,774.17
|
| Rate for Payer: United Healthcare All Payer |
$6,209.66
|
|
|
PLATE MD PROX LCP 4.5 6H 142 L
|
Facility
|
IP
|
$7,056.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.93 |
| Max. Negotiated Rate |
$6,774.17 |
| Rate for Payer: Aetna Commercial |
$5,433.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,504.02
|
| Rate for Payer: Cash Price |
$3,528.21
|
| Rate for Payer: Cigna Commercial |
$5,856.84
|
| Rate for Payer: First Health Commercial |
$6,703.61
|
| Rate for Payer: Humana Commercial |
$5,997.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,786.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,207.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,116.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,209.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,645.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,139.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,868.94
|
| Rate for Payer: PHCS Commercial |
$6,774.17
|
| Rate for Payer: United Healthcare All Payer |
$6,209.66
|
|
|
PLATE MD PROX LCP 4.5 6H 142 R
|
Facility
|
OP
|
$7,056.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.93 |
| Max. Negotiated Rate |
$6,774.17 |
| Rate for Payer: Aetna Commercial |
$5,433.45
|
| Rate for Payer: Anthem Medicaid |
$2,426.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,504.02
|
| Rate for Payer: Cash Price |
$3,528.21
|
| Rate for Payer: Cigna Commercial |
$5,856.84
|
| Rate for Payer: First Health Commercial |
$6,703.61
|
| Rate for Payer: Humana Commercial |
$5,997.97
|
| Rate for Payer: Humana KY Medicaid |
$2,426.71
|
| Rate for Payer: Kentucky WC Medicaid |
$2,451.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,786.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,207.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,116.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,475.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,209.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,645.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,139.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,868.94
|
| Rate for Payer: PHCS Commercial |
$6,774.17
|
| Rate for Payer: United Healthcare All Payer |
$6,209.66
|
|
|
PLATE MD PROX LCP 4.5 6H 142 R
|
Facility
|
IP
|
$7,056.43
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,116.93 |
| Max. Negotiated Rate |
$6,774.17 |
| Rate for Payer: Aetna Commercial |
$5,433.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,504.02
|
| Rate for Payer: Cash Price |
$3,528.21
|
| Rate for Payer: Cigna Commercial |
$5,856.84
|
| Rate for Payer: First Health Commercial |
$6,703.61
|
| Rate for Payer: Humana Commercial |
$5,997.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,786.27
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,207.65
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,116.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,209.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,292.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,645.14
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,139.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,868.94
|
| Rate for Payer: PHCS Commercial |
$6,774.17
|
| Rate for Payer: United Healthcare All Payer |
$6,209.66
|
|
|
PLATE MD PROX LCP 4.5 8H 178 R
|
Facility
|
OP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem Medicaid |
$2,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Humana KY Medicaid |
$2,443.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE MD PROX LCP 4.5 8H 178 R
|
Facility
|
IP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE MD PRX LCP 4.5 10H 214 L
|
Facility
|
IP
|
$7,148.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.41 |
| Max. Negotiated Rate |
$6,862.12 |
| Rate for Payer: Aetna Commercial |
$5,503.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,575.47
|
| Rate for Payer: Cash Price |
$3,574.02
|
| Rate for Payer: Cigna Commercial |
$5,932.87
|
| Rate for Payer: First Health Commercial |
$6,790.64
|
| Rate for Payer: Humana Commercial |
$6,075.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,861.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,290.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,718.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,218.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,932.15
|
| Rate for Payer: PHCS Commercial |
$6,862.12
|
| Rate for Payer: United Healthcare All Payer |
$6,290.28
|
|
|
PLATE MD PRX LCP 4.5 10H 214 L
|
Facility
|
OP
|
$7,148.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.41 |
| Max. Negotiated Rate |
$6,862.12 |
| Rate for Payer: Aetna Commercial |
$5,503.99
|
| Rate for Payer: Anthem Medicaid |
$2,458.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,575.47
|
| Rate for Payer: Cash Price |
$3,574.02
|
| Rate for Payer: Cigna Commercial |
$5,932.87
|
| Rate for Payer: First Health Commercial |
$6,790.64
|
| Rate for Payer: Humana Commercial |
$6,075.83
|
| Rate for Payer: Humana KY Medicaid |
$2,458.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,483.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,861.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,507.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,290.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,718.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,218.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,932.15
|
| Rate for Payer: PHCS Commercial |
$6,862.12
|
| Rate for Payer: United Healthcare All Payer |
$6,290.28
|
|
|
PLATE MD PRX LCP 4.5 10H 214 R
|
Facility
|
OP
|
$7,148.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.41 |
| Max. Negotiated Rate |
$6,862.12 |
| Rate for Payer: Aetna Commercial |
$5,503.99
|
| Rate for Payer: Anthem Medicaid |
$2,458.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,575.47
|
| Rate for Payer: Cash Price |
$3,574.02
|
| Rate for Payer: Cigna Commercial |
$5,932.87
|
| Rate for Payer: First Health Commercial |
$6,790.64
|
| Rate for Payer: Humana Commercial |
$6,075.83
|
| Rate for Payer: Humana KY Medicaid |
$2,458.21
|
| Rate for Payer: Kentucky WC Medicaid |
$2,483.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,861.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,507.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,290.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,718.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,218.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,932.15
|
| Rate for Payer: PHCS Commercial |
$6,862.12
|
| Rate for Payer: United Healthcare All Payer |
$6,290.28
|
|
|
PLATE MD PRX LCP 4.5 10H 214 R
|
Facility
|
IP
|
$7,148.04
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,144.41 |
| Max. Negotiated Rate |
$6,862.12 |
| Rate for Payer: Aetna Commercial |
$5,503.99
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,575.47
|
| Rate for Payer: Cash Price |
$3,574.02
|
| Rate for Payer: Cigna Commercial |
$5,932.87
|
| Rate for Payer: First Health Commercial |
$6,790.64
|
| Rate for Payer: Humana Commercial |
$6,075.83
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,861.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,275.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,144.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,290.28
|
| Rate for Payer: Ohio Health Group HMO |
$5,361.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,718.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,218.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,932.15
|
| Rate for Payer: PHCS Commercial |
$6,862.12
|
| Rate for Payer: United Healthcare All Payer |
$6,290.28
|
|
|
PLATE MD PRX LCP 4.5 12H 250 L
|
Facility
|
OP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem Medicaid |
$2,474.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Humana KY Medicaid |
$2,474.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,499.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE MD PRX LCP 4.5 12H 250 L
|
Facility
|
IP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE MD PRX LCP 4.5 12H 250 R
|
Facility
|
OP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem Medicaid |
$2,474.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Humana KY Medicaid |
$2,474.57
|
| Rate for Payer: Kentucky WC Medicaid |
$2,499.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,524.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE MD PRX LCP 4.5 12H 250 R
|
Facility
|
IP
|
$7,195.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,158.68 |
| Max. Negotiated Rate |
$6,907.78 |
| Rate for Payer: Aetna Commercial |
$5,540.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,612.57
|
| Rate for Payer: Cash Price |
$3,597.80
|
| Rate for Payer: Cigna Commercial |
$5,972.35
|
| Rate for Payer: First Health Commercial |
$6,835.82
|
| Rate for Payer: Humana Commercial |
$6,116.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,900.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,310.35
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,158.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,332.13
|
| Rate for Payer: Ohio Health Group HMO |
$5,396.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,756.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,260.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,964.96
|
| Rate for Payer: PHCS Commercial |
$6,907.78
|
| Rate for Payer: United Healthcare All Payer |
$6,332.13
|
|
|
PLATE MD PRX LCP 4.5 14H 286 L
|
Facility
|
OP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem Medicaid |
$2,490.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Humana KY Medicaid |
$2,490.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
