|
PLATE TIB LK PL-D 3.5M 74M 6 L
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TIB LK PL-D 3.5M 74M 6 R
|
Facility
|
IP
|
$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 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: 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: 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
|
|
|
PLATE TIB LK PL-D 3.5M 74M 6 R
|
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
|
|
|
PLATE TIB LK PL-D 3.5M 83M 5 L
|
Facility
|
OP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem Medicaid |
$1,480.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Humana KY Medicaid |
$1,480.21
|
| Rate for Payer: Kentucky WC Medicaid |
$1,495.28
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,509.91
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE TIB LK PL-D 3.5M 83M 5 L
|
Facility
|
IP
|
$4,304.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$559.55 |
| Max. Negotiated Rate |
$4,132.03 |
| Rate for Payer: Aetna Commercial |
$3,314.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,357.28
|
| Rate for Payer: Cash Price |
$2,152.10
|
| Rate for Payer: Cigna Commercial |
$3,572.49
|
| Rate for Payer: First Health Commercial |
$4,088.99
|
| Rate for Payer: Humana Commercial |
$3,658.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,529.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,176.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,291.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,787.70
|
| Rate for Payer: Ohio Health Group HMO |
$3,228.15
|
| Rate for Payer: Ohio Health Group PPO Differential |
$860.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$559.55
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,334.30
|
| Rate for Payer: PHCS Commercial |
$4,132.03
|
| Rate for Payer: United Healthcare All Payer |
$3,787.70
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 L
|
Facility
|
OP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem Medicaid |
$1,410.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Humana KY Medicaid |
$1,410.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 L
|
Facility
|
IP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 R
|
Facility
|
OP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem Medicaid |
$1,410.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Humana KY Medicaid |
$1,410.88
|
| Rate for Payer: Kentucky WC Medicaid |
$1,425.24
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,439.19
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 R
|
Facility
|
IP
|
$4,102.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$533.34 |
| Max. Negotiated Rate |
$3,938.50 |
| Rate for Payer: Aetna Commercial |
$3,159.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,200.03
|
| Rate for Payer: Cash Price |
$2,051.30
|
| Rate for Payer: Cigna Commercial |
$3,405.16
|
| Rate for Payer: First Health Commercial |
$3,897.47
|
| Rate for Payer: Humana Commercial |
$3,487.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,364.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,027.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,230.78
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,610.29
|
| Rate for Payer: Ohio Health Group HMO |
$3,076.95
|
| Rate for Payer: Ohio Health Group PPO Differential |
$820.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$533.34
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,271.81
|
| Rate for Payer: PHCS Commercial |
$3,938.50
|
| Rate for Payer: United Healthcare All Payer |
$3,610.29
|
|
|
PLATE TIB LK PM-D 3.5*64 4 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 PM-D 3.5*64 4 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 PM-D 3.5*98 7 R
|
Facility
|
OP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Anthem Medicaid |
$1,933.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Humana KY Medicaid |
$1,933.03
|
| Rate for Payer: Kentucky WC Medicaid |
$1,952.70
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,971.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
| Rate for Payer: Aetna Commercial |
$4,328.09
|
|
|
PLATE TIB LK PM-D 3.5*98 7 R
|
Facility
|
IP
|
$5,620.90
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$730.72 |
| Max. Negotiated Rate |
$5,396.06 |
| Rate for Payer: Aetna Commercial |
$4,328.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,384.30
|
| Rate for Payer: Cash Price |
$2,810.45
|
| Rate for Payer: Cigna Commercial |
$4,665.35
|
| Rate for Payer: First Health Commercial |
$5,339.86
|
| Rate for Payer: Humana Commercial |
$4,777.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,609.14
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,148.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,686.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,946.39
|
| Rate for Payer: Ohio Health Group HMO |
$4,215.68
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,124.18
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$730.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,742.48
|
| Rate for Payer: PHCS Commercial |
$5,396.06
|
| Rate for Payer: United Healthcare All Payer |
$4,946.39
|
|
|
PLATE TIB L LT BUTTRESS 4X86MM
|
Facility
|
OP
|
$3,448.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$3,310.51 |
| Rate for Payer: Aetna Commercial |
$2,655.31
|
| Rate for Payer: Anthem Medicaid |
$1,185.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,689.79
|
| Rate for Payer: Cash Price |
$1,724.22
|
| Rate for Payer: Cigna Commercial |
$2,862.21
|
| Rate for Payer: First Health Commercial |
$3,276.03
|
| Rate for Payer: Humana Commercial |
$2,931.18
|
| Rate for Payer: Humana KY Medicaid |
$1,185.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,197.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,827.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,544.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,209.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,034.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,586.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.02
|
| Rate for Payer: PHCS Commercial |
$3,310.51
|
| Rate for Payer: United Healthcare All Payer |
$3,034.64
|
|
|
PLATE TIB L LT BUTTRESS 4X86MM
|
Facility
|
IP
|
$3,448.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$3,310.51 |
| Rate for Payer: Aetna Commercial |
$2,655.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,689.79
|
| Rate for Payer: Cash Price |
$1,724.22
|
| Rate for Payer: Cigna Commercial |
$2,862.21
|
| Rate for Payer: First Health Commercial |
$3,276.03
|
| Rate for Payer: Humana Commercial |
$2,931.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,827.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,544.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,034.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,586.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.02
|
| Rate for Payer: PHCS Commercial |
$3,310.51
|
| Rate for Payer: United Healthcare All Payer |
$3,034.64
|
|
|
PLATE TIB L RT BUTTRESS 4X86MM
|
Facility
|
OP
|
$3,448.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$3,310.51 |
| Rate for Payer: Aetna Commercial |
$2,655.31
|
| Rate for Payer: Anthem Medicaid |
$1,185.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,689.79
|
| Rate for Payer: Cash Price |
$1,724.22
|
| Rate for Payer: Cigna Commercial |
$2,862.21
|
| Rate for Payer: First Health Commercial |
$3,276.03
|
| Rate for Payer: Humana Commercial |
$2,931.18
|
| Rate for Payer: Humana KY Medicaid |
$1,185.92
|
| Rate for Payer: Kentucky WC Medicaid |
$1,197.99
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,827.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,544.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,209.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,034.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,586.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.02
|
| Rate for Payer: PHCS Commercial |
$3,310.51
|
| Rate for Payer: United Healthcare All Payer |
$3,034.64
|
|
|
PLATE TIB L RT BUTTRESS 4X86MM
|
Facility
|
IP
|
$3,448.45
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$3,310.51 |
| Rate for Payer: Aetna Commercial |
$2,655.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,689.79
|
| Rate for Payer: Cash Price |
$1,724.22
|
| Rate for Payer: Cigna Commercial |
$2,862.21
|
| Rate for Payer: First Health Commercial |
$3,276.03
|
| Rate for Payer: Humana Commercial |
$2,931.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,827.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,544.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,034.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,034.64
|
| Rate for Payer: Ohio Health Group HMO |
$2,586.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$689.69
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$448.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,069.02
|
| Rate for Payer: PHCS Commercial |
$3,310.51
|
| Rate for Payer: United Healthcare All Payer |
$3,034.64
|
|
|
PLATE TIB MED POSTR L 4H 64M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB MED POSTR L 4H 64M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB MED POSTR L 6H 86M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB MED POSTR L 6H 86M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB MED POSTR R 4H 64M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB MED POSTR R 4H 64M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB MED POSTR R 6H 86M
|
Facility
|
IP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
|
PLATE TIB MED POSTR R 6H 86M
|
Facility
|
OP
|
$7,015.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.05 |
| Max. Negotiated Rate |
$6,735.12 |
| Rate for Payer: Aetna Commercial |
$5,402.13
|
| Rate for Payer: Anthem Medicaid |
$2,412.72
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,472.28
|
| Rate for Payer: Cash Price |
$3,507.88
|
| Rate for Payer: Cigna Commercial |
$5,823.07
|
| Rate for Payer: First Health Commercial |
$6,664.96
|
| Rate for Payer: Humana Commercial |
$5,963.39
|
| Rate for Payer: Humana KY Medicaid |
$2,412.72
|
| Rate for Payer: Kentucky WC Medicaid |
$2,437.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,752.92
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,177.62
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,104.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,461.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,173.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,261.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,403.15
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$912.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,174.88
|
| Rate for Payer: PHCS Commercial |
$6,735.12
|
| Rate for Payer: United Healthcare All Payer |
$6,173.86
|
|
