|
PLATE MEDIAL PILON 5H
|
Facility
|
IP
|
$2,204.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.32 |
| Max. Negotiated Rate |
$2,116.22 |
| Rate for Payer: Aetna Commercial |
$1,697.39
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,719.43
|
| Rate for Payer: Cash Price |
$1,102.20
|
| Rate for Payer: Cigna Commercial |
$1,829.65
|
| Rate for Payer: First Health Commercial |
$2,094.18
|
| Rate for Payer: Humana Commercial |
$1,873.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,807.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,626.85
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$661.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,939.87
|
| Rate for Payer: Ohio Health Group HMO |
$1,653.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,763.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,917.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,521.04
|
| Rate for Payer: PHCS Commercial |
$2,116.22
|
| Rate for Payer: United Healthcare All Payer |
$1,939.87
|
|
|
PLATE MEDIAL PILON 7H
|
Facility
|
OP
|
$3,511.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.38 |
| Max. Negotiated Rate |
$3,370.80 |
| Rate for Payer: Aetna Commercial |
$2,703.66
|
| Rate for Payer: Anthem Medicaid |
$1,207.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,738.78
|
| Rate for Payer: Cash Price |
$1,755.62
|
| Rate for Payer: Cigna Commercial |
$2,914.34
|
| Rate for Payer: First Health Commercial |
$3,335.69
|
| Rate for Payer: Humana Commercial |
$2,984.56
|
| Rate for Payer: Humana KY Medicaid |
$1,207.52
|
| Rate for Payer: Kentucky WC Medicaid |
$1,219.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,879.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,591.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,231.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,089.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,633.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,809.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,054.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,422.76
|
| Rate for Payer: PHCS Commercial |
$3,370.80
|
| Rate for Payer: United Healthcare All Payer |
$3,089.90
|
|
|
PLATE MEDIAL PILON 7H
|
Facility
|
IP
|
$3,511.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,053.38 |
| Max. Negotiated Rate |
$3,370.80 |
| Rate for Payer: Aetna Commercial |
$2,703.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,738.78
|
| Rate for Payer: Cash Price |
$1,755.62
|
| Rate for Payer: Cigna Commercial |
$2,914.34
|
| Rate for Payer: First Health Commercial |
$3,335.69
|
| Rate for Payer: Humana Commercial |
$2,984.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,879.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,591.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,053.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,089.90
|
| Rate for Payer: Ohio Health Group HMO |
$2,633.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,809.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,054.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,422.76
|
| Rate for Payer: PHCS Commercial |
$3,370.80
|
| Rate for Payer: United Healthcare All Payer |
$3,089.90
|
|
|
PLATE MEDIAL PILON 9H
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.50 |
| Max. Negotiated Rate |
$2,942.40 |
| Rate for Payer: Aetna Commercial |
$2,360.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,390.70
|
| Rate for Payer: Cash Price |
$1,532.50
|
| Rate for Payer: Cigna Commercial |
$2,543.95
|
| Rate for Payer: First Health Commercial |
$2,911.75
|
| Rate for Payer: Humana Commercial |
$2,605.25
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,513.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,261.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$919.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,697.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,298.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,666.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.85
|
| Rate for Payer: PHCS Commercial |
$2,942.40
|
| Rate for Payer: United Healthcare All Payer |
$2,697.20
|
|
|
PLATE MEDIAL PILON 9H
|
Facility
|
OP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.50 |
| Max. Negotiated Rate |
$2,942.40 |
| Rate for Payer: Aetna Commercial |
$2,360.05
|
| Rate for Payer: Anthem Medicaid |
$1,054.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,390.70
|
| Rate for Payer: Cash Price |
$1,532.50
|
| Rate for Payer: Cigna Commercial |
$2,543.95
|
| Rate for Payer: First Health Commercial |
$2,911.75
|
| Rate for Payer: Humana Commercial |
$2,605.25
|
| Rate for Payer: Humana KY Medicaid |
$1,054.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,064.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,513.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,261.97
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$919.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,075.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,697.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,298.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,452.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,666.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,114.85
|
| Rate for Payer: PHCS Commercial |
$2,942.40
|
| Rate for Payer: United Healthcare All Payer |
$2,697.20
|
|
|
PLATE MEDL DIS TIB 3.5*246 14H
|
Facility
|
OP
|
$11,039.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,311.82 |
| Max. Negotiated Rate |
$10,597.81 |
| Rate for Payer: Aetna Commercial |
$8,500.33
|
| Rate for Payer: Anthem Medicaid |
$3,796.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,610.72
|
| Rate for Payer: Cash Price |
$5,519.70
|
| Rate for Payer: Cigna Commercial |
$9,162.69
|
| Rate for Payer: First Health Commercial |
$10,487.42
|
| Rate for Payer: Humana Commercial |
$9,383.48
|
| Rate for Payer: Humana KY Medicaid |
$3,796.45
|
| Rate for Payer: Kentucky WC Medicaid |
$3,835.08
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,052.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,147.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,311.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,872.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,714.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,279.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,831.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,604.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,617.18
|
| Rate for Payer: PHCS Commercial |
$10,597.81
|
| Rate for Payer: United Healthcare All Payer |
$9,714.66
|
|
|
PLATE MEDL DIS TIB 3.5*246 14H
|
Facility
|
IP
|
$11,039.39
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,311.82 |
| Max. Negotiated Rate |
$10,597.81 |
| Rate for Payer: Aetna Commercial |
$8,500.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,610.72
|
| Rate for Payer: Cash Price |
$5,519.70
|
| Rate for Payer: Cigna Commercial |
$9,162.69
|
| Rate for Payer: First Health Commercial |
$10,487.42
|
| Rate for Payer: Humana Commercial |
$9,383.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,052.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,147.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,311.82
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,714.66
|
| Rate for Payer: Ohio Health Group HMO |
$8,279.54
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,831.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,604.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,617.18
|
| Rate for Payer: PHCS Commercial |
$10,597.81
|
| Rate for Payer: United Healthcare All Payer |
$9,714.66
|
|
|
PLATE MED PROX TIB 10H R
|
Facility
|
IP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 10H R
|
Facility
|
OP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem Medicaid |
$4,539.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Humana KY Medicaid |
$4,539.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,585.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,630.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 12H L
|
Facility
|
OP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem Medicaid |
$4,539.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Humana KY Medicaid |
$4,539.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,585.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,630.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 12H L
|
Facility
|
IP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 12H R
|
Facility
|
IP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 12H R
|
Facility
|
OP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem Medicaid |
$4,539.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Humana KY Medicaid |
$4,539.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,585.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,630.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 14H L
|
Facility
|
OP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem Medicaid |
$4,539.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Humana KY Medicaid |
$4,539.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,585.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,630.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 14H L
|
Facility
|
IP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 14H R
|
Facility
|
OP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem Medicaid |
$4,539.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Humana KY Medicaid |
$4,539.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,585.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,630.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 14H R
|
Facility
|
IP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 3.5 4H 93MM
|
Facility
|
OP
|
$8,906.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.83 |
| Max. Negotiated Rate |
$8,549.86 |
| Rate for Payer: Aetna Commercial |
$6,857.70
|
| Rate for Payer: Anthem Medicaid |
$3,062.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,946.76
|
| Rate for Payer: Cash Price |
$4,453.05
|
| Rate for Payer: Cigna Commercial |
$7,392.06
|
| Rate for Payer: First Health Commercial |
$8,460.80
|
| Rate for Payer: Humana Commercial |
$7,570.19
|
| Rate for Payer: Humana KY Medicaid |
$3,062.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,093.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,303.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,572.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,671.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,124.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,837.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,679.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,124.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,748.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,145.21
|
| Rate for Payer: PHCS Commercial |
$8,549.86
|
| Rate for Payer: United Healthcare All Payer |
$7,837.37
|
|
|
PLATE MED PROX TIB 3.5 4H 93MM
|
Facility
|
IP
|
$8,906.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,671.83 |
| Max. Negotiated Rate |
$8,549.86 |
| Rate for Payer: Aetna Commercial |
$6,857.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,946.76
|
| Rate for Payer: Cash Price |
$4,453.05
|
| Rate for Payer: Cigna Commercial |
$7,392.06
|
| Rate for Payer: First Health Commercial |
$8,460.80
|
| Rate for Payer: Humana Commercial |
$7,570.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,303.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,572.70
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,671.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,837.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,679.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,124.88
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,748.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,145.21
|
| Rate for Payer: PHCS Commercial |
$8,549.86
|
| Rate for Payer: United Healthcare All Payer |
$7,837.37
|
|
|
PLATE MED PROX TIB 4H R
|
Facility
|
IP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 4H R
|
Facility
|
OP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem Medicaid |
$4,539.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Humana KY Medicaid |
$4,539.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,585.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,630.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 5H R
|
Facility
|
OP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem Medicaid |
$4,539.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Humana KY Medicaid |
$4,539.41
|
| Rate for Payer: Kentucky WC Medicaid |
$4,585.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,630.49
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 5H R
|
Facility
|
IP
|
$13,199.81
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,959.94 |
| Max. Negotiated Rate |
$12,671.82 |
| Rate for Payer: Aetna Commercial |
$10,163.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,295.85
|
| Rate for Payer: Cash Price |
$6,599.90
|
| Rate for Payer: Cigna Commercial |
$10,955.84
|
| Rate for Payer: First Health Commercial |
$12,539.82
|
| Rate for Payer: Humana Commercial |
$11,219.84
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,823.84
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,741.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,959.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,615.83
|
| Rate for Payer: Ohio Health Group HMO |
$9,899.86
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,559.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,483.83
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,107.87
|
| Rate for Payer: PHCS Commercial |
$12,671.82
|
| Rate for Payer: United Healthcare All Payer |
$11,615.83
|
|
|
PLATE MED PROX TIB 6H L
|
Facility
|
OP
|
$13,504.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,051.33 |
| Max. Negotiated Rate |
$12,964.24 |
| Rate for Payer: Aetna Commercial |
$10,398.40
|
| Rate for Payer: Anthem Medicaid |
$4,644.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,533.45
|
| Rate for Payer: Cash Price |
$6,752.21
|
| Rate for Payer: Cigna Commercial |
$11,208.67
|
| Rate for Payer: First Health Commercial |
$12,829.20
|
| Rate for Payer: Humana Commercial |
$11,478.76
|
| Rate for Payer: Humana KY Medicaid |
$4,644.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,691.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,073.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,966.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,051.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,737.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,883.89
|
| Rate for Payer: Ohio Health Group HMO |
$10,128.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,803.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,748.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,318.05
|
| Rate for Payer: PHCS Commercial |
$12,964.24
|
| Rate for Payer: United Healthcare All Payer |
$11,883.89
|
|
|
PLATE MED PROX TIB 6H L
|
Facility
|
IP
|
$13,504.42
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,051.33 |
| Max. Negotiated Rate |
$12,964.24 |
| Rate for Payer: Aetna Commercial |
$10,398.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,533.45
|
| Rate for Payer: Cash Price |
$6,752.21
|
| Rate for Payer: Cigna Commercial |
$11,208.67
|
| Rate for Payer: First Health Commercial |
$12,829.20
|
| Rate for Payer: Humana Commercial |
$11,478.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,073.62
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,966.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,051.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,883.89
|
| Rate for Payer: Ohio Health Group HMO |
$10,128.32
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,803.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,748.85
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,318.05
|
| Rate for Payer: PHCS Commercial |
$12,964.24
|
| Rate for Payer: United Healthcare All Payer |
$11,883.89
|
|
