|
PLATE PROX FEM NCB PP L/L 401M
|
Facility
|
OP
|
$12,219.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,665.98 |
| Max. Negotiated Rate |
$11,731.12 |
| Rate for Payer: Aetna Commercial |
$9,409.34
|
| Rate for Payer: Anthem Medicaid |
$4,202.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,531.54
|
| Rate for Payer: Cash Price |
$6,109.96
|
| Rate for Payer: Cigna Commercial |
$10,142.53
|
| Rate for Payer: First Health Commercial |
$11,608.92
|
| Rate for Payer: Humana Commercial |
$10,386.93
|
| Rate for Payer: Humana KY Medicaid |
$4,202.43
|
| Rate for Payer: Kentucky WC Medicaid |
$4,245.20
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,020.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,018.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,665.98
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,286.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,753.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,164.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,775.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,631.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,431.74
|
| Rate for Payer: PHCS Commercial |
$11,731.12
|
| Rate for Payer: United Healthcare All Payer |
$10,753.53
|
|
|
PLATE PROX FEM NCB PP L/L 401M
|
Facility
|
IP
|
$12,219.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,665.98 |
| Max. Negotiated Rate |
$11,731.12 |
| Rate for Payer: Aetna Commercial |
$9,409.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,531.54
|
| Rate for Payer: Cash Price |
$6,109.96
|
| Rate for Payer: Cigna Commercial |
$10,142.53
|
| Rate for Payer: First Health Commercial |
$11,608.92
|
| Rate for Payer: Humana Commercial |
$10,386.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,020.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,018.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,665.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,753.53
|
| Rate for Payer: Ohio Health Group HMO |
$9,164.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,775.94
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,631.33
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,431.74
|
| Rate for Payer: PHCS Commercial |
$11,731.12
|
| Rate for Payer: United Healthcare All Payer |
$10,753.53
|
|
|
PLATE PROX FEM NCB PP R/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
|
|
|
PLATE PROX FEM NCB PP R/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 R/L 401M
|
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 R/L 401M
|
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 FM LK 4.5M 4 144M L
|
Facility
|
OP
|
$7,916.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,375.08 |
| Max. Negotiated Rate |
$7,600.24 |
| Rate for Payer: Aetna Commercial |
$6,096.03
|
| Rate for Payer: Anthem Medicaid |
$2,722.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,175.20
|
| Rate for Payer: Cash Price |
$3,958.46
|
| Rate for Payer: Cigna Commercial |
$6,571.04
|
| Rate for Payer: First Health Commercial |
$7,521.07
|
| Rate for Payer: Humana Commercial |
$6,729.38
|
| Rate for Payer: Humana KY Medicaid |
$2,722.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,375.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.67
|
| Rate for Payer: PHCS Commercial |
$7,600.24
|
| Rate for Payer: United Healthcare All Payer |
$6,966.89
|
|
|
PLATE PROX FM LK 4.5M 4 144M L
|
Facility
|
IP
|
$7,916.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,375.08 |
| Max. Negotiated Rate |
$7,600.24 |
| Rate for Payer: Aetna Commercial |
$6,096.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,175.20
|
| Rate for Payer: Cash Price |
$3,958.46
|
| Rate for Payer: Cigna Commercial |
$6,571.04
|
| Rate for Payer: First Health Commercial |
$7,521.07
|
| Rate for Payer: Humana Commercial |
$6,729.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,375.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.67
|
| Rate for Payer: PHCS Commercial |
$7,600.24
|
| Rate for Payer: United Healthcare All Payer |
$6,966.89
|
|
|
PLATE PROX FM LK 4.5M 4 144M R
|
Facility
|
IP
|
$7,916.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,375.08 |
| Max. Negotiated Rate |
$7,600.24 |
| Rate for Payer: Aetna Commercial |
$6,096.03
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,175.20
|
| Rate for Payer: Cash Price |
$3,958.46
|
| Rate for Payer: Cigna Commercial |
$6,571.04
|
| Rate for Payer: First Health Commercial |
$7,521.07
|
| Rate for Payer: Humana Commercial |
$6,729.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,375.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.67
|
| Rate for Payer: PHCS Commercial |
$7,600.24
|
| Rate for Payer: United Healthcare All Payer |
$6,966.89
|
|
|
PLATE PROX FM LK 4.5M 4 144M R
|
Facility
|
OP
|
$7,916.92
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,375.08 |
| Max. Negotiated Rate |
$7,600.24 |
| Rate for Payer: Aetna Commercial |
$6,096.03
|
| Rate for Payer: Anthem Medicaid |
$2,722.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,175.20
|
| Rate for Payer: Cash Price |
$3,958.46
|
| Rate for Payer: Cigna Commercial |
$6,571.04
|
| Rate for Payer: First Health Commercial |
$7,521.07
|
| Rate for Payer: Humana Commercial |
$6,729.38
|
| Rate for Payer: Humana KY Medicaid |
$2,722.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,750.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,491.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,842.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,375.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,777.26
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,966.89
|
| Rate for Payer: Ohio Health Group HMO |
$5,937.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,333.54
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,887.72
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,462.67
|
| Rate for Payer: PHCS Commercial |
$7,600.24
|
| Rate for Payer: United Healthcare All Payer |
$6,966.89
|
|
|
PLATE PROX FM LK 4.5M 6 180M L
|
Facility
|
OP
|
$8,007.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,402.12 |
| Max. Negotiated Rate |
$7,686.79 |
| Rate for Payer: Aetna Commercial |
$6,165.44
|
| Rate for Payer: Anthem Medicaid |
$2,753.63
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,245.51
|
| Rate for Payer: Cash Price |
$4,003.53
|
| Rate for Payer: Cigna Commercial |
$6,645.87
|
| Rate for Payer: First Health Commercial |
$7,606.72
|
| Rate for Payer: Humana Commercial |
$6,806.01
|
| Rate for Payer: Humana KY Medicaid |
$2,753.63
|
| Rate for Payer: Kentucky WC Medicaid |
$2,781.66
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,402.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,808.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,046.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,005.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,405.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,966.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,524.88
|
| Rate for Payer: PHCS Commercial |
$7,686.79
|
| Rate for Payer: United Healthcare All Payer |
$7,046.22
|
|
|
PLATE PROX FM LK 4.5M 6 180M L
|
Facility
|
IP
|
$8,007.07
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,402.12 |
| Max. Negotiated Rate |
$7,686.79 |
| Rate for Payer: Aetna Commercial |
$6,165.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,245.51
|
| Rate for Payer: Cash Price |
$4,003.53
|
| Rate for Payer: Cigna Commercial |
$6,645.87
|
| Rate for Payer: First Health Commercial |
$7,606.72
|
| Rate for Payer: Humana Commercial |
$6,806.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,565.80
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,909.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,402.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,046.22
|
| Rate for Payer: Ohio Health Group HMO |
$6,005.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,405.66
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,966.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,524.88
|
| Rate for Payer: PHCS Commercial |
$7,686.79
|
| Rate for Payer: United Healthcare All Payer |
$7,046.22
|
|
|
PLATE PROX FM LK 4.5M 9 234M L
|
Facility
|
OP
|
$8,187.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,456.21 |
| Max. Negotiated Rate |
$7,859.88 |
| Rate for Payer: Aetna Commercial |
$6,304.28
|
| Rate for Payer: Anthem Medicaid |
$2,815.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,386.16
|
| Rate for Payer: Cash Price |
$4,093.69
|
| Rate for Payer: Cigna Commercial |
$6,795.53
|
| Rate for Payer: First Health Commercial |
$7,778.01
|
| Rate for Payer: Humana Commercial |
$6,959.27
|
| Rate for Payer: Humana KY Medicaid |
$2,815.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,844.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,713.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,042.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,456.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,872.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,204.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,140.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,549.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,123.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,649.29
|
| Rate for Payer: PHCS Commercial |
$7,859.88
|
| Rate for Payer: United Healthcare All Payer |
$7,204.89
|
|
|
PLATE PROX FM LK 4.5M 9 234M L
|
Facility
|
IP
|
$8,187.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,456.21 |
| Max. Negotiated Rate |
$7,859.88 |
| Rate for Payer: Aetna Commercial |
$6,304.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,386.16
|
| Rate for Payer: Cash Price |
$4,093.69
|
| Rate for Payer: Cigna Commercial |
$6,795.53
|
| Rate for Payer: First Health Commercial |
$7,778.01
|
| Rate for Payer: Humana Commercial |
$6,959.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,713.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,042.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,456.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,204.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,140.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,549.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,123.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,649.29
|
| Rate for Payer: PHCS Commercial |
$7,859.88
|
| Rate for Payer: United Healthcare All Payer |
$7,204.89
|
|
|
PLATE PROX FM LK 4.5M 9 234M R
|
Facility
|
OP
|
$8,187.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,456.21 |
| Max. Negotiated Rate |
$7,859.88 |
| Rate for Payer: Aetna Commercial |
$6,304.28
|
| Rate for Payer: Anthem Medicaid |
$2,815.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,386.16
|
| Rate for Payer: Cash Price |
$4,093.69
|
| Rate for Payer: Cigna Commercial |
$6,795.53
|
| Rate for Payer: First Health Commercial |
$7,778.01
|
| Rate for Payer: Humana Commercial |
$6,959.27
|
| Rate for Payer: Humana KY Medicaid |
$2,815.64
|
| Rate for Payer: Kentucky WC Medicaid |
$2,844.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,713.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,042.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,456.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,872.13
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,204.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,140.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,549.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,123.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,649.29
|
| Rate for Payer: PHCS Commercial |
$7,859.88
|
| Rate for Payer: United Healthcare All Payer |
$7,204.89
|
|
|
PLATE PROX FM LK 4.5M 9 234M R
|
Facility
|
IP
|
$8,187.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,456.21 |
| Max. Negotiated Rate |
$7,859.88 |
| Rate for Payer: Aetna Commercial |
$6,304.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,386.16
|
| Rate for Payer: Cash Price |
$4,093.69
|
| Rate for Payer: Cigna Commercial |
$6,795.53
|
| Rate for Payer: First Health Commercial |
$7,778.01
|
| Rate for Payer: Humana Commercial |
$6,959.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,713.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,042.29
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,456.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,204.89
|
| Rate for Payer: Ohio Health Group HMO |
$6,140.53
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,549.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,123.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,649.29
|
| Rate for Payer: PHCS Commercial |
$7,859.88
|
| Rate for Payer: United Healthcare All Payer |
$7,204.89
|
|
|
PLATE PROX FM LK 4.5M 9 288M R
|
Facility
|
OP
|
$8,846.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,653.86 |
| Max. Negotiated Rate |
$8,492.35 |
| Rate for Payer: Aetna Commercial |
$6,811.57
|
| Rate for Payer: Anthem Medicaid |
$3,042.21
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,900.04
|
| Rate for Payer: Cash Price |
$4,423.10
|
| Rate for Payer: Cigna Commercial |
$7,342.35
|
| Rate for Payer: First Health Commercial |
$8,403.89
|
| Rate for Payer: Humana Commercial |
$7,519.27
|
| Rate for Payer: Humana KY Medicaid |
$3,042.21
|
| Rate for Payer: Kentucky WC Medicaid |
$3,073.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,653.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,103.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,696.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.88
|
| Rate for Payer: PHCS Commercial |
$8,492.35
|
| Rate for Payer: United Healthcare All Payer |
$7,784.66
|
|
|
PLATE PROX FM LK 4.5M 9 288M R
|
Facility
|
IP
|
$8,846.20
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,653.86 |
| Max. Negotiated Rate |
$8,492.35 |
| Rate for Payer: Aetna Commercial |
$6,811.57
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,900.04
|
| Rate for Payer: Cash Price |
$4,423.10
|
| Rate for Payer: Cigna Commercial |
$7,342.35
|
| Rate for Payer: First Health Commercial |
$8,403.89
|
| Rate for Payer: Humana Commercial |
$7,519.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,253.88
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,528.50
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,653.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,784.66
|
| Rate for Payer: Ohio Health Group HMO |
$6,634.65
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,076.96
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,696.19
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,103.88
|
| Rate for Payer: PHCS Commercial |
$8,492.35
|
| Rate for Payer: United Healthcare All Payer |
$7,784.66
|
|
|
PLATE PROX HUM 3.5*3H 71821403
|
Facility
|
OP
|
$7,052.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$6,770.14 |
| Rate for Payer: Aetna Commercial |
$5,430.22
|
| Rate for Payer: Anthem Medicaid |
$2,425.26
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.74
|
| Rate for Payer: Cash Price |
$3,526.11
|
| Rate for Payer: Cigna Commercial |
$5,853.35
|
| Rate for Payer: First Health Commercial |
$6,699.62
|
| Rate for Payer: Humana Commercial |
$5,994.40
|
| Rate for Payer: Humana KY Medicaid |
$2,425.26
|
| Rate for Payer: Kentucky WC Medicaid |
$2,449.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,473.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,641.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.04
|
| Rate for Payer: PHCS Commercial |
$6,770.14
|
| Rate for Payer: United Healthcare All Payer |
$6,205.96
|
|
|
PLATE PROX HUM 3.5*3H 71821403
|
Facility
|
IP
|
$7,052.23
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.67 |
| Max. Negotiated Rate |
$6,770.14 |
| Rate for Payer: Aetna Commercial |
$5,430.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,500.74
|
| Rate for Payer: Cash Price |
$3,526.11
|
| Rate for Payer: Cigna Commercial |
$5,853.35
|
| Rate for Payer: First Health Commercial |
$6,699.62
|
| Rate for Payer: Humana Commercial |
$5,994.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,782.83
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,204.55
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,115.67
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,205.96
|
| Rate for Payer: Ohio Health Group HMO |
$5,289.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,641.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,135.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,866.04
|
| Rate for Payer: PHCS Commercial |
$6,770.14
|
| Rate for Payer: United Healthcare All Payer |
$6,205.96
|
|
|
PLATE PROX HUM 3.5 STD 5H 114M
|
Facility
|
IP
|
$9,333.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,800.03 |
| Max. Negotiated Rate |
$8,960.10 |
| Rate for Payer: Aetna Commercial |
$7,186.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,280.08
|
| Rate for Payer: Cash Price |
$4,666.72
|
| Rate for Payer: Cigna Commercial |
$7,746.76
|
| Rate for Payer: First Health Commercial |
$8,866.77
|
| Rate for Payer: Humana Commercial |
$7,933.42
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,653.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,888.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,213.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,000.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,120.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,440.07
|
| Rate for Payer: PHCS Commercial |
$8,960.10
|
| Rate for Payer: United Healthcare All Payer |
$8,213.43
|
|
|
PLATE PROX HUM 3.5 STD 5H 114M
|
Facility
|
OP
|
$9,333.44
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,800.03 |
| Max. Negotiated Rate |
$8,960.10 |
| Rate for Payer: Aetna Commercial |
$7,186.75
|
| Rate for Payer: Anthem Medicaid |
$3,209.77
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,280.08
|
| Rate for Payer: Cash Price |
$4,666.72
|
| Rate for Payer: Cigna Commercial |
$7,746.76
|
| Rate for Payer: First Health Commercial |
$8,866.77
|
| Rate for Payer: Humana Commercial |
$7,933.42
|
| Rate for Payer: Humana KY Medicaid |
$3,209.77
|
| Rate for Payer: Kentucky WC Medicaid |
$3,242.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,653.42
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,888.08
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,800.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.17
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,213.43
|
| Rate for Payer: Ohio Health Group HMO |
$7,000.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,466.75
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,120.09
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,440.07
|
| Rate for Payer: PHCS Commercial |
$8,960.10
|
| Rate for Payer: United Healthcare All Payer |
$8,213.43
|
|
|
PLATE PROX HUMERUS LT 6 HOLE
|
Facility
|
OP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem Medicaid |
$3,535.89
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Humana KY Medicaid |
$3,535.89
|
| Rate for Payer: Kentucky WC Medicaid |
$3,571.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,606.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
PLATE PROX HUMERUS LT 6 HOLE
|
Facility
|
IP
|
$10,281.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,084.53 |
| Max. Negotiated Rate |
$9,870.48 |
| Rate for Payer: Aetna Commercial |
$7,916.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,019.77
|
| Rate for Payer: Cash Price |
$5,140.88
|
| Rate for Payer: Cigna Commercial |
$8,533.85
|
| Rate for Payer: First Health Commercial |
$9,767.66
|
| Rate for Payer: Humana Commercial |
$8,739.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,431.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,587.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,084.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,047.94
|
| Rate for Payer: Ohio Health Group HMO |
$7,711.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,225.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,945.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,094.41
|
| Rate for Payer: PHCS Commercial |
$9,870.48
|
| Rate for Payer: United Healthcare All Payer |
$9,047.94
|
|
|
PLATE PROX HUMERUS RT 4 HOLES
|
Facility
|
IP
|
$3,200.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$960.00 |
| Max. Negotiated Rate |
$3,072.00 |
| Rate for Payer: Aetna Commercial |
$2,464.00
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,496.00
|
| Rate for Payer: Cash Price |
$1,600.00
|
| Rate for Payer: Cigna Commercial |
$2,656.00
|
| Rate for Payer: First Health Commercial |
$3,040.00
|
| Rate for Payer: Humana Commercial |
$2,720.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,624.00
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,361.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$960.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,816.00
|
| Rate for Payer: Ohio Health Group HMO |
$2,400.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,560.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,784.00
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,208.00
|
| Rate for Payer: PHCS Commercial |
$3,072.00
|
| Rate for Payer: United Healthcare All Payer |
$2,816.00
|
|
