|
PLATE TIB LK M-D 3.5M 89M 3 L
|
Facility
|
OP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem Medicaid |
$1,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Humana KY Medicaid |
$1,889.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,927.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TIB LK M-D 3.5M 89M 3 L
|
Facility
|
IP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TIB LK M-D 3.5M 89M 3 R
|
Facility
|
IP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TIB LK M-D 3.5M 89M 3 R
|
Facility
|
OP
|
$5,494.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$714.34 |
| Max. Negotiated Rate |
$5,275.10 |
| Rate for Payer: Aetna Commercial |
$4,231.07
|
| Rate for Payer: Anthem Medicaid |
$1,889.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,286.02
|
| Rate for Payer: Cash Price |
$2,747.45
|
| Rate for Payer: Cigna Commercial |
$4,560.77
|
| Rate for Payer: First Health Commercial |
$5,220.16
|
| Rate for Payer: Humana Commercial |
$4,670.66
|
| Rate for Payer: Humana KY Medicaid |
$1,889.70
|
| Rate for Payer: Kentucky WC Medicaid |
$1,908.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,505.82
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,055.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,648.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,927.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,835.51
|
| Rate for Payer: Ohio Health Group HMO |
$4,121.18
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,098.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$714.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,703.42
|
| Rate for Payer: PHCS Commercial |
$5,275.10
|
| Rate for Payer: United Healthcare All Payer |
$4,835.51
|
|
|
PLATE TIB LK PD 3.5*47 3 L
|
Facility
|
OP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem Medicaid |
$1,482.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Humana KY Medicaid |
$1,482.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,512.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE TIB LK PD 3.5*47 3 L
|
Facility
|
IP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE TIB LK P-D 3.5*47 3 R
|
Facility
|
OP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem Medicaid |
$1,482.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Humana KY Medicaid |
$1,482.38
|
| Rate for Payer: Kentucky WC Medicaid |
$1,497.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,512.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE TIB LK P-D 3.5*47 3 R
|
Facility
|
IP
|
$4,310.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.36 |
| Max. Negotiated Rate |
$4,138.08 |
| Rate for Payer: Aetna Commercial |
$3,319.08
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,362.19
|
| Rate for Payer: Cash Price |
$2,155.25
|
| Rate for Payer: Cigna Commercial |
$3,577.72
|
| Rate for Payer: First Health Commercial |
$4,094.98
|
| Rate for Payer: Humana Commercial |
$3,663.92
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,534.61
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,181.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,293.15
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,793.24
|
| Rate for Payer: Ohio Health Group HMO |
$3,232.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$862.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$560.36
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,336.26
|
| Rate for Payer: PHCS Commercial |
$4,138.08
|
| Rate for Payer: United Healthcare All Payer |
$3,793.24
|
|
|
PLATE TIB LK P-D 3.5*72 5 L
|
Facility
|
OP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem Medicaid |
$1,536.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Humana KY Medicaid |
$1,536.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,552.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
PLATE TIB LK P-D 3.5*72 5 L
|
Facility
|
IP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
PLATE TIB LK P-D 3.5*72 5 R
|
Facility
|
OP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem Medicaid |
$1,536.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Humana KY Medicaid |
$1,536.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,552.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,567.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
|
|
PLATE TIB LK P-D 3.5*72 5 R
|
Facility
|
IP
|
$4,468.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$580.84 |
| Max. Negotiated Rate |
$4,289.28 |
| Rate for Payer: Humana Commercial |
$3,797.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,663.76
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,297.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,340.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,931.84
|
| Rate for Payer: Ohio Health Group HMO |
$3,351.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$893.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$580.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,385.08
|
| Rate for Payer: PHCS Commercial |
$4,289.28
|
| Rate for Payer: United Healthcare All Payer |
$3,931.84
|
| Rate for Payer: Aetna Commercial |
$3,440.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,485.04
|
| Rate for Payer: Cash Price |
$2,234.00
|
| Rate for Payer: Cigna Commercial |
$3,708.44
|
| Rate for Payer: First Health Commercial |
$4,244.60
|
|
|
PLATE TIBLK PL-D 3.5M 107M 7 L
|
Facility
|
OP
|
$4,417.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.29 |
| Max. Negotiated Rate |
$4,240.90 |
| Rate for Payer: Aetna Commercial |
$3,401.55
|
| Rate for Payer: Anthem Medicaid |
$1,519.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,445.73
|
| Rate for Payer: Cash Price |
$2,208.80
|
| Rate for Payer: Cigna Commercial |
$3,666.61
|
| Rate for Payer: First Health Commercial |
$4,196.72
|
| Rate for Payer: Humana Commercial |
$3,754.96
|
| Rate for Payer: Humana KY Medicaid |
$1,519.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,534.67
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.28
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,549.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.46
|
| Rate for Payer: PHCS Commercial |
$4,240.90
|
| Rate for Payer: United Healthcare All Payer |
$3,887.49
|
|
|
PLATE TIBLK PL-D 3.5M 107M 7 L
|
Facility
|
IP
|
$4,417.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$574.29 |
| Max. Negotiated Rate |
$4,240.90 |
| Rate for Payer: Aetna Commercial |
$3,401.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,445.73
|
| Rate for Payer: Cash Price |
$2,208.80
|
| Rate for Payer: Cigna Commercial |
$3,666.61
|
| Rate for Payer: First Health Commercial |
$4,196.72
|
| Rate for Payer: Humana Commercial |
$3,754.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,622.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,260.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,325.28
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,887.49
|
| Rate for Payer: Ohio Health Group HMO |
$3,313.20
|
| Rate for Payer: Ohio Health Group PPO Differential |
$883.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$574.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,369.46
|
| Rate for Payer: PHCS Commercial |
$4,240.90
|
| Rate for Payer: United Healthcare All Payer |
$3,887.49
|
|
|
PLATE TIB LK PL-D 3.5M 131M 9L
|
Facility
|
IP
|
$4,549.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.49 |
| Max. Negotiated Rate |
$4,367.90 |
| Rate for Payer: Aetna Commercial |
$3,503.42
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,548.92
|
| Rate for Payer: Cash Price |
$2,274.95
|
| Rate for Payer: Cigna Commercial |
$3,776.42
|
| Rate for Payer: First Health Commercial |
$4,322.40
|
| Rate for Payer: Humana Commercial |
$3,867.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,730.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,364.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,003.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.47
|
| Rate for Payer: PHCS Commercial |
$4,367.90
|
| Rate for Payer: United Healthcare All Payer |
$4,003.91
|
|
|
PLATE TIB LK PL-D 3.5M 131M 9L
|
Facility
|
OP
|
$4,549.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$591.49 |
| Max. Negotiated Rate |
$4,367.90 |
| Rate for Payer: Aetna Commercial |
$3,503.42
|
| Rate for Payer: Anthem Medicaid |
$1,564.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,548.92
|
| Rate for Payer: Cash Price |
$2,274.95
|
| Rate for Payer: Cigna Commercial |
$3,776.42
|
| Rate for Payer: First Health Commercial |
$4,322.40
|
| Rate for Payer: Humana Commercial |
$3,867.42
|
| Rate for Payer: Humana KY Medicaid |
$1,564.71
|
| Rate for Payer: Kentucky WC Medicaid |
$1,580.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,730.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,357.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,364.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,596.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,003.91
|
| Rate for Payer: Ohio Health Group HMO |
$3,412.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$909.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$591.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,410.47
|
| Rate for Payer: PHCS Commercial |
$4,367.90
|
| Rate for Payer: United Healthcare All Payer |
$4,003.91
|
|
|
PLATE TIB LK PL-D 3.5M 59M 3 L
|
Facility
|
OP
|
$4,077.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.06 |
| Max. Negotiated Rate |
$3,914.30 |
| Rate for Payer: Aetna Commercial |
$3,139.60
|
| Rate for Payer: Anthem Medicaid |
$1,402.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,180.37
|
| Rate for Payer: Cash Price |
$2,038.70
|
| Rate for Payer: Cigna Commercial |
$3,384.24
|
| Rate for Payer: First Health Commercial |
$3,873.53
|
| Rate for Payer: Humana Commercial |
$3,465.79
|
| Rate for Payer: Humana KY Medicaid |
$1,402.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,416.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,343.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,009.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,223.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,430.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,588.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,058.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$815.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$530.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,263.99
|
| Rate for Payer: PHCS Commercial |
$3,914.30
|
| Rate for Payer: United Healthcare All Payer |
$3,588.11
|
|
|
PLATE TIB LK PL-D 3.5M 59M 3 L
|
Facility
|
IP
|
$4,077.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.06 |
| Max. Negotiated Rate |
$3,914.30 |
| Rate for Payer: Aetna Commercial |
$3,139.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,180.37
|
| Rate for Payer: Cash Price |
$2,038.70
|
| Rate for Payer: Cigna Commercial |
$3,384.24
|
| Rate for Payer: First Health Commercial |
$3,873.53
|
| Rate for Payer: Humana Commercial |
$3,465.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,343.47
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,009.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,223.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,588.11
|
| Rate for Payer: Ohio Health Group HMO |
$3,058.05
|
| Rate for Payer: Ohio Health Group PPO Differential |
$815.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$530.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,263.99
|
| Rate for Payer: PHCS Commercial |
$3,914.30
|
| Rate for Payer: United Healthcare All Payer |
$3,588.11
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 L
|
Facility
|
OP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Humana KY Medicaid |
$1,309.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem Medicaid |
$1,309.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 L
|
Facility
|
IP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 R
|
Facility
|
OP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem Medicaid |
$1,309.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Humana KY Medicaid |
$1,309.06
|
| Rate for Payer: Kentucky WC Medicaid |
$1,322.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,335.32
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 R
|
Facility
|
IP
|
$3,806.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$494.84 |
| Max. Negotiated Rate |
$3,654.24 |
| Rate for Payer: Aetna Commercial |
$2,931.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,969.07
|
| Rate for Payer: Cash Price |
$1,903.25
|
| Rate for Payer: Cigna Commercial |
$3,159.40
|
| Rate for Payer: First Health Commercial |
$3,616.18
|
| Rate for Payer: Humana Commercial |
$3,235.52
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,121.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,809.20
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,141.95
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,349.72
|
| Rate for Payer: Ohio Health Group HMO |
$2,854.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$761.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$494.84
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,180.02
|
| Rate for Payer: PHCS Commercial |
$3,654.24
|
| Rate for Payer: United Healthcare All Payer |
$3,349.72
|
|
|
PLATE TIB LK PL-D 3.5M 71M 4 L
|
Facility
|
OP
|
$4,190.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.80 |
| Max. Negotiated Rate |
$4,023.17 |
| Rate for Payer: Aetna Commercial |
$3,226.92
|
| Rate for Payer: Anthem Medicaid |
$1,441.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.82
|
| Rate for Payer: Cash Price |
$2,095.40
|
| Rate for Payer: Cigna Commercial |
$3,478.36
|
| Rate for Payer: First Health Commercial |
$3,981.26
|
| Rate for Payer: Humana Commercial |
$3,562.18
|
| Rate for Payer: Humana KY Medicaid |
$1,441.22
|
| Rate for Payer: Kentucky WC Medicaid |
$1,455.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,470.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.15
|
| Rate for Payer: PHCS Commercial |
$4,023.17
|
| Rate for Payer: United Healthcare All Payer |
$3,687.90
|
|
|
PLATE TIB LK PL-D 3.5M 71M 4 L
|
Facility
|
IP
|
$4,190.80
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$544.80 |
| Max. Negotiated Rate |
$4,023.17 |
| Rate for Payer: Aetna Commercial |
$3,226.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,268.82
|
| Rate for Payer: Cash Price |
$2,095.40
|
| Rate for Payer: Cigna Commercial |
$3,478.36
|
| Rate for Payer: First Health Commercial |
$3,981.26
|
| Rate for Payer: Humana Commercial |
$3,562.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,436.46
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,092.81
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,257.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,687.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,143.10
|
| Rate for Payer: Ohio Health Group PPO Differential |
$838.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$544.80
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,299.15
|
| Rate for Payer: PHCS Commercial |
$4,023.17
|
| Rate for Payer: United Healthcare All Payer |
$3,687.90
|
|
|
PLATE TIB LK PL-D 3.5M 74M 6 L
|
Facility
|
OP
|
$3,957.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$514.50 |
| Max. Negotiated Rate |
$3,799.39 |
| Rate for Payer: Aetna Commercial |
$3,047.43
|
| Rate for Payer: Anthem Medicaid |
$1,361.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,087.01
|
| Rate for Payer: Cash Price |
$1,978.85
|
| Rate for Payer: Cigna Commercial |
$3,284.89
|
| Rate for Payer: First Health Commercial |
$3,759.82
|
| Rate for Payer: Humana Commercial |
$3,364.04
|
| Rate for Payer: Humana KY Medicaid |
$1,361.05
|
| Rate for Payer: Kentucky WC Medicaid |
$1,374.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,245.31
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,920.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,187.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,388.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,482.78
|
| Rate for Payer: Ohio Health Group HMO |
$2,968.28
|
| Rate for Payer: Ohio Health Group PPO Differential |
$791.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$514.50
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,226.89
|
| Rate for Payer: PHCS Commercial |
$3,799.39
|
| Rate for Payer: United Healthcare All Payer |
$3,482.78
|
|
