|
PLATE PROFYL M CON 2.3 6H LP L
|
Facility
|
OP
|
$1,867.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.17 |
| Max. Negotiated Rate |
$1,792.54 |
| Rate for Payer: Aetna Commercial |
$1,437.77
|
| Rate for Payer: Anthem Medicaid |
$642.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,456.44
|
| Rate for Payer: Cash Price |
$933.61
|
| Rate for Payer: Cigna Commercial |
$1,549.80
|
| Rate for Payer: First Health Commercial |
$1,773.87
|
| Rate for Payer: Humana Commercial |
$1,587.15
|
| Rate for Payer: Humana KY Medicaid |
$642.14
|
| Rate for Payer: Kentucky WC Medicaid |
$648.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,531.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,378.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$655.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,643.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,400.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,493.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.39
|
| Rate for Payer: PHCS Commercial |
$1,792.54
|
| Rate for Payer: United Healthcare All Payer |
$1,643.16
|
|
|
PLATE PROFYL M CON 2.3 6H LP R
|
Facility
|
OP
|
$1,867.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.17 |
| Max. Negotiated Rate |
$1,792.54 |
| Rate for Payer: Aetna Commercial |
$1,437.77
|
| Rate for Payer: Anthem Medicaid |
$642.14
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,456.44
|
| Rate for Payer: Cash Price |
$933.61
|
| Rate for Payer: Cigna Commercial |
$1,549.80
|
| Rate for Payer: First Health Commercial |
$1,773.87
|
| Rate for Payer: Humana Commercial |
$1,587.15
|
| Rate for Payer: Humana KY Medicaid |
$642.14
|
| Rate for Payer: Kentucky WC Medicaid |
$648.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,531.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,378.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$655.02
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,643.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,400.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,493.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.39
|
| Rate for Payer: PHCS Commercial |
$1,792.54
|
| Rate for Payer: United Healthcare All Payer |
$1,643.16
|
|
|
PLATE PROFYL M CON 2.3 6H LP R
|
Facility
|
IP
|
$1,867.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$560.17 |
| Max. Negotiated Rate |
$1,792.54 |
| Rate for Payer: Aetna Commercial |
$1,437.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$1,456.44
|
| Rate for Payer: Cash Price |
$933.61
|
| Rate for Payer: Cigna Commercial |
$1,549.80
|
| Rate for Payer: First Health Commercial |
$1,773.87
|
| Rate for Payer: Humana Commercial |
$1,587.15
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$1,531.13
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$1,378.02
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$560.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$1,643.16
|
| Rate for Payer: Ohio Health Group HMO |
$1,400.42
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,493.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,624.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,288.39
|
| Rate for Payer: PHCS Commercial |
$1,792.54
|
| Rate for Payer: United Healthcare All Payer |
$1,643.16
|
|
|
PLATE PROFYL M CONDY CMP LE 6H
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE PROFYL M CONDY CMP LE 6H
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE PROFYL M CONDY CMP RI 6H
|
Facility
|
OP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem Medicaid |
$1,337.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Humana KY Medicaid |
$1,337.77
|
| Rate for Payer: Kentucky WC Medicaid |
$1,351.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,364.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE PROFYL M CONDY CMP RI 6H
|
Facility
|
IP
|
$3,890.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.00 |
| Max. Negotiated Rate |
$3,734.40 |
| Rate for Payer: Aetna Commercial |
$2,995.30
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,034.20
|
| Rate for Payer: Cash Price |
$1,945.00
|
| Rate for Payer: Cigna Commercial |
$3,228.70
|
| Rate for Payer: First Health Commercial |
$3,695.50
|
| Rate for Payer: Humana Commercial |
$3,306.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,189.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,870.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,167.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,423.20
|
| Rate for Payer: Ohio Health Group HMO |
$2,917.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,112.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,384.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,684.10
|
| Rate for Payer: PHCS Commercial |
$3,734.40
|
| Rate for Payer: United Healthcare All Payer |
$3,423.20
|
|
|
PLATE PROX FEM 21HOLE L
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE PROX FEM 21HOLE L
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE PROX FEM 21HOLE R
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE PROX FEM 21HOLE R
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE PROX FEM 9HOLE L
|
Facility
|
OP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem Medicaid |
$3,929.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Humana KY Medicaid |
$3,929.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,969.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,008.66
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE PROX FEM 9HOLE L
|
Facility
|
IP
|
$11,427.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,428.16 |
| Max. Negotiated Rate |
$10,970.11 |
| Rate for Payer: Aetna Commercial |
$8,798.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,913.22
|
| Rate for Payer: Cash Price |
$5,713.60
|
| Rate for Payer: Cigna Commercial |
$9,484.58
|
| Rate for Payer: First Health Commercial |
$10,855.84
|
| Rate for Payer: Humana Commercial |
$9,713.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,370.30
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,433.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,428.16
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,055.94
|
| Rate for Payer: Ohio Health Group HMO |
$8,570.40
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,141.76
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,941.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,884.77
|
| Rate for Payer: PHCS Commercial |
$10,970.11
|
| Rate for Payer: United Healthcare All Payer |
$10,055.94
|
|
|
PLATE PROX FEM 9HOLE R
|
Facility
|
OP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem Medicaid |
$3,471.88
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Humana KY Medicaid |
$3,471.88
|
| Rate for Payer: Kentucky WC Medicaid |
$3,507.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,541.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE PROX FEM 9HOLE R
|
Facility
|
IP
|
$10,095.60
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,028.68 |
| Max. Negotiated Rate |
$9,691.78 |
| Rate for Payer: Aetna Commercial |
$7,773.61
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,874.57
|
| Rate for Payer: Cash Price |
$5,047.80
|
| Rate for Payer: Cigna Commercial |
$8,379.35
|
| Rate for Payer: First Health Commercial |
$9,590.82
|
| Rate for Payer: Humana Commercial |
$8,581.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,278.39
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,450.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,028.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,884.13
|
| Rate for Payer: Ohio Health Group HMO |
$7,571.70
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,076.48
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,783.17
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,965.96
|
| Rate for Payer: PHCS Commercial |
$9,691.78
|
| Rate for Payer: United Healthcare All Payer |
$8,884.13
|
|
|
PLATE PROX FEM LK 2H 4.5*99M L
|
Facility
|
IP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
PLATE PROX FEM LK 2H 4.5*99M L
|
Facility
|
OP
|
$7,681.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,304.34 |
| Max. Negotiated Rate |
$7,373.88 |
| Rate for Payer: Aetna Commercial |
$5,914.46
|
| Rate for Payer: Anthem Medicaid |
$2,641.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,991.27
|
| Rate for Payer: Cash Price |
$3,840.56
|
| Rate for Payer: Cigna Commercial |
$6,375.33
|
| Rate for Payer: First Health Commercial |
$7,297.06
|
| Rate for Payer: Humana Commercial |
$6,528.95
|
| Rate for Payer: Humana KY Medicaid |
$2,641.54
|
| Rate for Payer: Kentucky WC Medicaid |
$2,668.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,298.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,668.67
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,304.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,694.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,759.39
|
| Rate for Payer: Ohio Health Group HMO |
$5,760.84
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,144.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,682.57
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,299.97
|
| Rate for Payer: PHCS Commercial |
$7,373.88
|
| Rate for Payer: United Healthcare All Payer |
$6,759.39
|
|
|
PLATE PROX FEM LK 4.5M 2 99M L
|
Facility
|
IP
|
$7,833.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.11 |
| Max. Negotiated Rate |
$7,520.35 |
| Rate for Payer: Aetna Commercial |
$6,031.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,110.29
|
| Rate for Payer: Cash Price |
$3,916.85
|
| Rate for Payer: Cigna Commercial |
$6,501.97
|
| Rate for Payer: First Health Commercial |
$7,442.02
|
| Rate for Payer: Humana Commercial |
$6,658.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,423.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,781.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,893.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,875.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,266.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,815.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,405.25
|
| Rate for Payer: PHCS Commercial |
$7,520.35
|
| Rate for Payer: United Healthcare All Payer |
$6,893.66
|
|
|
PLATE PROX FEM LK 4.5M 2 99M L
|
Facility
|
OP
|
$7,833.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.11 |
| Max. Negotiated Rate |
$7,520.35 |
| Rate for Payer: Aetna Commercial |
$6,031.95
|
| Rate for Payer: Anthem Medicaid |
$2,694.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,110.29
|
| Rate for Payer: Cash Price |
$3,916.85
|
| Rate for Payer: Cigna Commercial |
$6,501.97
|
| Rate for Payer: First Health Commercial |
$7,442.02
|
| Rate for Payer: Humana Commercial |
$6,658.65
|
| Rate for Payer: Humana KY Medicaid |
$2,694.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,721.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,423.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,781.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,748.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,893.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,875.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,266.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,815.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,405.25
|
| Rate for Payer: PHCS Commercial |
$7,520.35
|
| Rate for Payer: United Healthcare All Payer |
$6,893.66
|
|
|
PLATE PROX FEM LK 4.5M 2 99M R
|
Facility
|
IP
|
$7,833.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.11 |
| Max. Negotiated Rate |
$7,520.35 |
| Rate for Payer: Aetna Commercial |
$6,031.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,110.29
|
| Rate for Payer: Cash Price |
$3,916.85
|
| Rate for Payer: Cigna Commercial |
$6,501.97
|
| Rate for Payer: First Health Commercial |
$7,442.02
|
| Rate for Payer: Humana Commercial |
$6,658.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,423.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,781.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.11
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,893.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,875.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,266.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,815.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,405.25
|
| Rate for Payer: PHCS Commercial |
$7,520.35
|
| Rate for Payer: United Healthcare All Payer |
$6,893.66
|
|
|
PLATE PROX FEM LK 4.5M 2 99M R
|
Facility
|
OP
|
$7,833.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,350.11 |
| Max. Negotiated Rate |
$7,520.35 |
| Rate for Payer: Aetna Commercial |
$6,031.95
|
| Rate for Payer: Anthem Medicaid |
$2,694.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,110.29
|
| Rate for Payer: Cash Price |
$3,916.85
|
| Rate for Payer: Cigna Commercial |
$6,501.97
|
| Rate for Payer: First Health Commercial |
$7,442.02
|
| Rate for Payer: Humana Commercial |
$6,658.65
|
| Rate for Payer: Humana KY Medicaid |
$2,694.01
|
| Rate for Payer: Kentucky WC Medicaid |
$2,721.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,423.63
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,781.27
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,350.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,748.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,893.66
|
| Rate for Payer: Ohio Health Group HMO |
$5,875.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,266.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,815.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,405.25
|
| Rate for Payer: PHCS Commercial |
$7,520.35
|
| Rate for Payer: United Healthcare All Payer |
$6,893.66
|
|
|
PLATE PROX FEM NCB PP L/L 238M
|
Facility
|
IP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
|
PLATE PROX FEM NCB PP L/L 238M
|
Facility
|
OP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem Medicaid |
$3,341.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Humana KY Medicaid |
$3,341.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
|
PLATE PROX FEM NCB PP L/L 245M
|
Facility
|
IP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
|
PLATE PROX FEM NCB PP L/L 245M
|
Facility
|
OP
|
$9,716.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,914.80 |
| Max. Negotiated Rate |
$9,327.36 |
| Rate for Payer: Aetna Commercial |
$7,481.32
|
| Rate for Payer: Anthem Medicaid |
$3,341.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,578.48
|
| Rate for Payer: Cash Price |
$4,858.00
|
| Rate for Payer: Cigna Commercial |
$8,064.28
|
| Rate for Payer: First Health Commercial |
$9,230.20
|
| Rate for Payer: Humana Commercial |
$8,258.60
|
| Rate for Payer: Humana KY Medicaid |
$3,341.33
|
| Rate for Payer: Kentucky WC Medicaid |
$3,375.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,967.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,170.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,914.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,408.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,550.08
|
| Rate for Payer: Ohio Health Group HMO |
$7,287.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,772.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,452.92
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,704.04
|
| Rate for Payer: PHCS Commercial |
$9,327.36
|
| Rate for Payer: United Healthcare All Payer |
$8,550.08
|
|
