|
PLATE PROX HUMERUS RT 4 HOLES
|
Facility
|
OP
|
$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 Medicaid |
$1,100.48
|
| 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: Humana KY Medicaid |
$1,100.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,111.68
|
| 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: Molina Healthcare Medicaid |
$1,122.56
|
| 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
|
|
|
PLATE PROX HUM HI 3H 80M LT
|
Facility
|
IP
|
$11,074.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,322.46 |
| Max. Negotiated Rate |
$10,631.88 |
| Rate for Payer: Aetna Commercial |
$8,527.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,638.41
|
| Rate for Payer: Cash Price |
$5,537.44
|
| Rate for Payer: Cigna Commercial |
$9,192.15
|
| Rate for Payer: First Health Commercial |
$10,521.14
|
| Rate for Payer: Humana Commercial |
$9,413.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,081.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,173.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,322.46
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,745.89
|
| Rate for Payer: Ohio Health Group HMO |
$8,306.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,859.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,635.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,641.67
|
| Rate for Payer: PHCS Commercial |
$10,631.88
|
| Rate for Payer: United Healthcare All Payer |
$9,745.89
|
|
|
PLATE PROX HUM HI 3H 80M LT
|
Facility
|
OP
|
$11,074.88
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,322.46 |
| Max. Negotiated Rate |
$10,631.88 |
| Rate for Payer: Aetna Commercial |
$8,527.66
|
| Rate for Payer: Anthem Medicaid |
$3,808.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,638.41
|
| Rate for Payer: Cash Price |
$5,537.44
|
| Rate for Payer: Cigna Commercial |
$9,192.15
|
| Rate for Payer: First Health Commercial |
$10,521.14
|
| Rate for Payer: Humana Commercial |
$9,413.65
|
| Rate for Payer: Humana KY Medicaid |
$3,808.65
|
| Rate for Payer: Kentucky WC Medicaid |
$3,847.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,081.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,173.26
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,322.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,885.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,745.89
|
| Rate for Payer: Ohio Health Group HMO |
$8,306.16
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,859.90
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,635.15
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,641.67
|
| Rate for Payer: PHCS Commercial |
$10,631.88
|
| Rate for Payer: United Healthcare All Payer |
$9,745.89
|
|
|
PLATE PROX HUM HI 3H 80M RT
|
Facility
|
OP
|
$12,689.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,806.90 |
| Max. Negotiated Rate |
$12,182.09 |
| Rate for Payer: Aetna Commercial |
$9,771.05
|
| Rate for Payer: Anthem Medicaid |
$4,363.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,897.95
|
| Rate for Payer: Cash Price |
$6,344.84
|
| Rate for Payer: Cigna Commercial |
$10,532.43
|
| Rate for Payer: First Health Commercial |
$12,055.20
|
| Rate for Payer: Humana Commercial |
$10,786.23
|
| Rate for Payer: Humana KY Medicaid |
$4,363.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,408.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,405.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,364.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,806.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,451.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,166.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,517.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,151.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,040.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,755.88
|
| Rate for Payer: PHCS Commercial |
$12,182.09
|
| Rate for Payer: United Healthcare All Payer |
$11,166.92
|
|
|
PLATE PROX HUM HI 3H 80M RT
|
Facility
|
IP
|
$12,689.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,806.90 |
| Max. Negotiated Rate |
$12,182.09 |
| Rate for Payer: Aetna Commercial |
$9,771.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,897.95
|
| Rate for Payer: Cash Price |
$6,344.84
|
| Rate for Payer: Cigna Commercial |
$10,532.43
|
| Rate for Payer: First Health Commercial |
$12,055.20
|
| Rate for Payer: Humana Commercial |
$10,786.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,405.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,364.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,806.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,166.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,517.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,151.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,040.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,755.88
|
| Rate for Payer: PHCS Commercial |
$12,182.09
|
| Rate for Payer: United Healthcare All Payer |
$11,166.92
|
|
|
PLATE PROX HUM HI 4H 90M LT
|
Facility
|
OP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem Medicaid |
$3,909.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Humana KY Medicaid |
$3,909.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,949.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,988.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
PLATE PROX HUM HI 4H 90M LT
|
Facility
|
IP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
PLATE PROX HUM HI 4H 90M RT
|
Facility
|
OP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem Medicaid |
$3,909.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Humana KY Medicaid |
$3,909.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,949.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,988.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
PLATE PROX HUM HI 4H 90M RT
|
Facility
|
IP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
PLATE PROX HUM HI 7H 140M LT
|
Facility
|
IP
|
$12,689.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,806.90 |
| Max. Negotiated Rate |
$12,182.09 |
| Rate for Payer: Aetna Commercial |
$9,771.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,897.95
|
| Rate for Payer: Cash Price |
$6,344.84
|
| Rate for Payer: Cigna Commercial |
$10,532.43
|
| Rate for Payer: First Health Commercial |
$12,055.20
|
| Rate for Payer: Humana Commercial |
$10,786.23
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,405.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,364.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,806.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,166.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,517.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,151.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,040.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,755.88
|
| Rate for Payer: PHCS Commercial |
$12,182.09
|
| Rate for Payer: United Healthcare All Payer |
$11,166.92
|
|
|
PLATE PROX HUM HI 7H 140M LT
|
Facility
|
OP
|
$12,689.68
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,806.90 |
| Max. Negotiated Rate |
$12,182.09 |
| Rate for Payer: Aetna Commercial |
$9,771.05
|
| Rate for Payer: Anthem Medicaid |
$4,363.98
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,897.95
|
| Rate for Payer: Cash Price |
$6,344.84
|
| Rate for Payer: Cigna Commercial |
$10,532.43
|
| Rate for Payer: First Health Commercial |
$12,055.20
|
| Rate for Payer: Humana Commercial |
$10,786.23
|
| Rate for Payer: Humana KY Medicaid |
$4,363.98
|
| Rate for Payer: Kentucky WC Medicaid |
$4,408.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,405.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,364.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,806.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,451.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,166.92
|
| Rate for Payer: Ohio Health Group HMO |
$9,517.26
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,151.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,040.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,755.88
|
| Rate for Payer: PHCS Commercial |
$12,182.09
|
| Rate for Payer: United Healthcare All Payer |
$11,166.92
|
|
|
PLATE PROX HUM HI 7H 140M RT
|
Facility
|
IP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
PLATE PROX HUM HI 7H 140M RT
|
Facility
|
OP
|
$11,368.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,410.54 |
| Max. Negotiated Rate |
$10,913.74 |
| Rate for Payer: Aetna Commercial |
$8,753.73
|
| Rate for Payer: Anthem Medicaid |
$3,909.62
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,867.41
|
| Rate for Payer: Cash Price |
$5,684.24
|
| Rate for Payer: Cigna Commercial |
$9,435.84
|
| Rate for Payer: First Health Commercial |
$10,800.06
|
| Rate for Payer: Humana Commercial |
$9,663.21
|
| Rate for Payer: Humana KY Medicaid |
$3,909.62
|
| Rate for Payer: Kentucky WC Medicaid |
$3,949.41
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,322.15
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,389.94
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,410.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,988.06
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,004.26
|
| Rate for Payer: Ohio Health Group HMO |
$8,526.36
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,094.78
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,890.58
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,844.25
|
| Rate for Payer: PHCS Commercial |
$10,913.74
|
| Rate for Payer: United Healthcare All Payer |
$10,004.26
|
|
|
PLATE PROX HUM LO 3H 73M LT
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
PLATE PROX HUM LO 3H 73M LT
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
PLATE PROX HUM LO 3H 73M RT
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
PLATE PROX HUM LO 3H 73M RT
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
PLATE PROX HUM LO 4H 83M LT
|
Facility
|
OP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem Medicaid |
$3,849.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Humana KY Medicaid |
$3,849.04
|
| Rate for Payer: Kentucky WC Medicaid |
$3,888.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,926.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
PLATE PROX HUM LO 4H 83M LT
|
Facility
|
IP
|
$11,192.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,357.70 |
| Max. Negotiated Rate |
$10,744.63 |
| Rate for Payer: Aetna Commercial |
$8,618.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,730.01
|
| Rate for Payer: Cash Price |
$5,596.16
|
| Rate for Payer: Cigna Commercial |
$9,289.63
|
| Rate for Payer: First Health Commercial |
$10,632.70
|
| Rate for Payer: Humana Commercial |
$9,513.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,177.70
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,259.93
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,357.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,849.24
|
| Rate for Payer: Ohio Health Group HMO |
$8,394.24
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,953.86
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,737.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,722.70
|
| Rate for Payer: PHCS Commercial |
$10,744.63
|
| Rate for Payer: United Healthcare All Payer |
$9,849.24
|
|
|
PLATE PROX HUM LO 4H 83M RT
|
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 HUM LO 4H 83M RT
|
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 HUM LO 7H 133M LT
|
Facility
|
OP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem Medicaid |
$4,358.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Humana KY Medicaid |
$4,358.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,403.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,446.39
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
PLATE PROX HUM LO 7H 133M LT
|
Facility
|
IP
|
$12,675.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,802.50 |
| Max. Negotiated Rate |
$12,168.00 |
| Rate for Payer: Aetna Commercial |
$9,759.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,886.50
|
| Rate for Payer: Cash Price |
$6,337.50
|
| Rate for Payer: Cigna Commercial |
$10,520.25
|
| Rate for Payer: First Health Commercial |
$12,041.25
|
| Rate for Payer: Humana Commercial |
$10,773.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,393.50
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,354.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,802.50
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,154.00
|
| Rate for Payer: Ohio Health Group HMO |
$9,506.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,140.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,027.25
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,745.75
|
| Rate for Payer: PHCS Commercial |
$12,168.00
|
| Rate for Payer: United Healthcare All Payer |
$11,154.00
|
|
|
PLATE PROX HUM LO 7H 133M RT
|
Facility
|
OP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem Medicaid |
$4,384.17
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Humana KY Medicaid |
$4,384.17
|
| Rate for Payer: Kentucky WC Medicaid |
$4,428.79
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,472.14
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
|
PLATE PROX HUM LO 7H 133M RT
|
Facility
|
IP
|
$12,748.40
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,824.52 |
| Max. Negotiated Rate |
$12,238.46 |
| Rate for Payer: Aetna Commercial |
$9,816.27
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,943.75
|
| Rate for Payer: Cash Price |
$6,374.20
|
| Rate for Payer: Cigna Commercial |
$10,581.17
|
| Rate for Payer: First Health Commercial |
$12,110.98
|
| Rate for Payer: Humana Commercial |
$10,836.14
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$10,453.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$9,408.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,824.52
|
| Rate for Payer: Ohio Health Choice Commercial |
$11,218.59
|
| Rate for Payer: Ohio Health Group HMO |
$9,561.30
|
| Rate for Payer: Ohio Health Group PPO Differential |
$10,198.72
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$11,091.11
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,796.40
|
| Rate for Payer: PHCS Commercial |
$12,238.46
|
| Rate for Payer: United Healthcare All Payer |
$11,218.59
|
|
