|
PLATE TIB OPN WDG TI OST 10.00
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
|
|
PLATE TIB OPN WDG TI OST 10.00
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 11.00
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 11.00
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 12.5
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 12.5
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 15.0
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 15.0
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 17.5
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
|
|
PLATE TIB OPN WDG TI OST 17.5
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 5M
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 5M
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 7M
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 7M
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 9M
|
Facility
|
IP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TIB OPN WDG TI OST 9M
|
Facility
|
OP
|
$6,632.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$862.22 |
| Max. Negotiated Rate |
$6,367.20 |
| Rate for Payer: Aetna Commercial |
$5,107.02
|
| Rate for Payer: Anthem Medicaid |
$2,280.92
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,173.35
|
| Rate for Payer: Cash Price |
$3,316.25
|
| Rate for Payer: Cigna Commercial |
$5,504.98
|
| Rate for Payer: First Health Commercial |
$6,300.88
|
| Rate for Payer: Humana Commercial |
$5,637.62
|
| Rate for Payer: Humana KY Medicaid |
$2,280.92
|
| Rate for Payer: Kentucky WC Medicaid |
$2,304.13
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,438.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,894.78
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,989.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,326.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,836.60
|
| Rate for Payer: Ohio Health Group HMO |
$4,974.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,326.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$862.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,056.08
|
| Rate for Payer: PHCS Commercial |
$6,367.20
|
| Rate for Payer: United Healthcare All Payer |
$5,836.60
|
|
|
PLATE TI CLASSIC 4H 135 DEG
|
Facility
|
OP
|
$4,259.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$4,088.86 |
| Rate for Payer: Aetna Commercial |
$3,279.61
|
| Rate for Payer: Anthem Medicaid |
$1,464.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.20
|
| Rate for Payer: Cash Price |
$2,129.61
|
| Rate for Payer: Cigna Commercial |
$3,535.16
|
| Rate for Payer: First Health Commercial |
$4,046.27
|
| Rate for Payer: Humana Commercial |
$3,620.35
|
| Rate for Payer: Humana KY Medicaid |
$1,464.75
|
| Rate for Payer: Kentucky WC Medicaid |
$1,479.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.36
|
| Rate for Payer: PHCS Commercial |
$4,088.86
|
| Rate for Payer: United Healthcare All Payer |
$3,748.12
|
|
|
PLATE TI CLASSIC 4H 135 DEG
|
Facility
|
IP
|
$4,259.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$553.70 |
| Max. Negotiated Rate |
$4,088.86 |
| Rate for Payer: Aetna Commercial |
$3,279.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,322.20
|
| Rate for Payer: Cash Price |
$2,129.61
|
| Rate for Payer: Cigna Commercial |
$3,535.16
|
| Rate for Payer: First Health Commercial |
$4,046.27
|
| Rate for Payer: Humana Commercial |
$3,620.35
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,492.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,143.31
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,277.77
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,748.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,194.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$851.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$553.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,320.36
|
| Rate for Payer: PHCS Commercial |
$4,088.86
|
| Rate for Payer: United Healthcare All Payer |
$3,748.12
|
|
|
PLATE TI CLOVERLEAF 3H 88MM
|
Facility
|
IP
|
$3,308.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$3,176.15 |
| Rate for Payer: Aetna Commercial |
$2,547.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.62
|
| Rate for Payer: Cash Price |
$1,654.24
|
| Rate for Payer: Cigna Commercial |
$2,746.05
|
| Rate for Payer: First Health Commercial |
$3,143.07
|
| Rate for Payer: Humana Commercial |
$2,812.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.63
|
| Rate for Payer: PHCS Commercial |
$3,176.15
|
| Rate for Payer: United Healthcare All Payer |
$2,911.47
|
|
|
PLATE TI CLOVERLEAF 3H 88MM
|
Facility
|
OP
|
$3,308.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$3,176.15 |
| Rate for Payer: Aetna Commercial |
$2,547.54
|
| Rate for Payer: Anthem Medicaid |
$1,137.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.62
|
| Rate for Payer: Cash Price |
$1,654.24
|
| Rate for Payer: Cigna Commercial |
$2,746.05
|
| Rate for Payer: First Health Commercial |
$3,143.07
|
| Rate for Payer: Humana Commercial |
$2,812.22
|
| Rate for Payer: Humana KY Medicaid |
$1,137.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,160.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.63
|
| Rate for Payer: PHCS Commercial |
$3,176.15
|
| Rate for Payer: United Healthcare All Payer |
$2,911.47
|
|
|
PLATE TI CLOVERLEAF 4H 104MM
|
Facility
|
IP
|
$3,308.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$3,176.15 |
| Rate for Payer: Aetna Commercial |
$2,547.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.62
|
| Rate for Payer: Cash Price |
$1,654.24
|
| Rate for Payer: Cigna Commercial |
$2,746.05
|
| Rate for Payer: First Health Commercial |
$3,143.07
|
| Rate for Payer: Humana Commercial |
$2,812.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.63
|
| Rate for Payer: PHCS Commercial |
$3,176.15
|
| Rate for Payer: United Healthcare All Payer |
$2,911.47
|
|
|
PLATE TI CLOVERLEAF 4H 104MM
|
Facility
|
OP
|
$3,308.49
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$430.10 |
| Max. Negotiated Rate |
$3,176.15 |
| Rate for Payer: Aetna Commercial |
$2,547.54
|
| Rate for Payer: Anthem Medicaid |
$1,137.79
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,580.62
|
| Rate for Payer: Cash Price |
$1,654.24
|
| Rate for Payer: Cigna Commercial |
$2,746.05
|
| Rate for Payer: First Health Commercial |
$3,143.07
|
| Rate for Payer: Humana Commercial |
$2,812.22
|
| Rate for Payer: Humana KY Medicaid |
$1,137.79
|
| Rate for Payer: Kentucky WC Medicaid |
$1,149.37
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,712.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,441.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$992.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,160.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,911.47
|
| Rate for Payer: Ohio Health Group HMO |
$2,481.37
|
| Rate for Payer: Ohio Health Group PPO Differential |
$661.70
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$430.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,025.63
|
| Rate for Payer: PHCS Commercial |
$3,176.15
|
| Rate for Payer: United Healthcare All Payer |
$2,911.47
|
|
|
PLATE TI LCP 1/3 TB CL 10H 117
|
Facility
|
IP
|
$1,993.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.19 |
| Max. Negotiated Rate |
$1,914.04 |
| Rate for Payer: Aetna Commercial |
$1,535.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,555.16
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$1,654.85
|
| Rate for Payer: First Health Commercial |
$1,894.10
|
| Rate for Payer: Humana Commercial |
$1,694.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,495.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.07
|
| Rate for Payer: PHCS Commercial |
$1,914.04
|
| Rate for Payer: United Healthcare All Payer |
$1,754.54
|
|
|
PLATE TI LCP 1/3 TB CL 10H 117
|
Facility
|
OP
|
$1,993.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$259.19 |
| Max. Negotiated Rate |
$1,914.04 |
| Rate for Payer: Aetna Commercial |
$1,535.22
|
| Rate for Payer: Anthem Medicaid |
$685.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,555.16
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$1,654.85
|
| Rate for Payer: First Health Commercial |
$1,894.10
|
| Rate for Payer: Humana Commercial |
$1,694.72
|
| Rate for Payer: Humana KY Medicaid |
$685.66
|
| Rate for Payer: Kentucky WC Medicaid |
$692.64
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,634.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,471.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$598.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$699.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,754.54
|
| Rate for Payer: Ohio Health Group HMO |
$1,495.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$259.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$618.07
|
| Rate for Payer: PHCS Commercial |
$1,914.04
|
| Rate for Payer: United Healthcare All Payer |
$1,754.54
|
|
|
PLATE TI LCP 1/3 TB CL 12H 141
|
Facility
|
IP
|
$1,990.85
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.81 |
| Max. Negotiated Rate |
$1,911.22 |
| Rate for Payer: Aetna Commercial |
$1,532.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,552.86
|
| Rate for Payer: Cash Price |
$995.42
|
| Rate for Payer: Cigna Commercial |
$1,652.41
|
| Rate for Payer: First Health Commercial |
$1,891.31
|
| Rate for Payer: Humana Commercial |
$1,692.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,632.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,469.25
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$597.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,751.95
|
| Rate for Payer: Ohio Health Group HMO |
$1,493.14
|
| Rate for Payer: Ohio Health Group PPO Differential |
$398.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$258.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$617.16
|
| Rate for Payer: PHCS Commercial |
$1,911.22
|
| Rate for Payer: United Healthcare All Payer |
$1,751.95
|
|
