|
PLATE PROXIMAL HUM LG LT
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL HUM LG LT
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL HUM LG RT
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL HUM LG RT
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL HUM SM LT
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL HUM SM LT
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL HUM SM RT
|
Facility
|
OP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem Medicaid |
$2,657.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Humana KY Medicaid |
$2,657.23
|
| Rate for Payer: Kentucky WC Medicaid |
$2,684.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,710.54
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL HUM SM RT
|
Facility
|
IP
|
$7,726.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,318.03 |
| Max. Negotiated Rate |
$7,417.68 |
| Rate for Payer: Aetna Commercial |
$5,949.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,026.86
|
| Rate for Payer: Cash Price |
$3,863.38
|
| Rate for Payer: Cigna Commercial |
$6,413.20
|
| Rate for Payer: First Health Commercial |
$7,340.41
|
| Rate for Payer: Humana Commercial |
$6,567.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,335.94
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,702.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,318.03
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,799.54
|
| Rate for Payer: Ohio Health Group HMO |
$5,795.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,181.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,722.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,331.46
|
| Rate for Payer: PHCS Commercial |
$7,417.68
|
| Rate for Payer: United Healthcare All Payer |
$6,799.54
|
|
|
PLATE PROXIMAL LAT HUM 10H L
|
Facility
|
OP
|
$9,135.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.70 |
| Max. Negotiated Rate |
$8,770.22 |
| Rate for Payer: Aetna Commercial |
$7,034.45
|
| Rate for Payer: Anthem Medicaid |
$3,141.75
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,125.81
|
| Rate for Payer: Cash Price |
$4,567.82
|
| Rate for Payer: Cigna Commercial |
$7,582.59
|
| Rate for Payer: First Health Commercial |
$8,678.87
|
| Rate for Payer: Humana Commercial |
$7,765.30
|
| Rate for Payer: Humana KY Medicaid |
$3,141.75
|
| Rate for Payer: Kentucky WC Medicaid |
$3,173.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,204.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,039.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,851.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,308.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,303.60
|
| Rate for Payer: PHCS Commercial |
$8,770.22
|
| Rate for Payer: United Healthcare All Payer |
$8,039.37
|
|
|
PLATE PROXIMAL LAT HUM 10H L
|
Facility
|
IP
|
$9,135.65
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,740.70 |
| Max. Negotiated Rate |
$8,770.22 |
| Rate for Payer: Aetna Commercial |
$7,034.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,125.81
|
| Rate for Payer: Cash Price |
$4,567.82
|
| Rate for Payer: Cigna Commercial |
$7,582.59
|
| Rate for Payer: First Health Commercial |
$8,678.87
|
| Rate for Payer: Humana Commercial |
$7,765.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,491.23
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,742.11
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,740.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,039.37
|
| Rate for Payer: Ohio Health Group HMO |
$6,851.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,308.52
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,948.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,303.60
|
| Rate for Payer: PHCS Commercial |
$8,770.22
|
| Rate for Payer: United Healthcare All Payer |
$8,039.37
|
|
|
PLATE PROXIMAL LAT HUM 10H R
|
Facility
|
OP
|
$11,788.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,536.43 |
| Max. Negotiated Rate |
$11,316.59 |
| Rate for Payer: Aetna Commercial |
$9,076.84
|
| Rate for Payer: Anthem Medicaid |
$4,053.93
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,194.73
|
| Rate for Payer: Cash Price |
$5,894.05
|
| Rate for Payer: Cigna Commercial |
$9,784.13
|
| Rate for Payer: First Health Commercial |
$11,198.70
|
| Rate for Payer: Humana Commercial |
$10,019.89
|
| Rate for Payer: Humana KY Medicaid |
$4,053.93
|
| Rate for Payer: Kentucky WC Medicaid |
$4,095.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,666.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,699.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,536.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,135.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,373.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,841.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,430.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,255.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,133.80
|
| Rate for Payer: PHCS Commercial |
$11,316.59
|
| Rate for Payer: United Healthcare All Payer |
$10,373.54
|
|
|
PLATE PROXIMAL LAT HUM 10H R
|
Facility
|
IP
|
$11,788.11
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,536.43 |
| Max. Negotiated Rate |
$11,316.59 |
| Rate for Payer: Aetna Commercial |
$9,076.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,194.73
|
| Rate for Payer: Cash Price |
$5,894.05
|
| Rate for Payer: Cigna Commercial |
$9,784.13
|
| Rate for Payer: First Health Commercial |
$11,198.70
|
| Rate for Payer: Humana Commercial |
$10,019.89
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,666.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,699.63
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,536.43
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,373.54
|
| Rate for Payer: Ohio Health Group HMO |
$8,841.08
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,430.49
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,255.66
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,133.80
|
| Rate for Payer: PHCS Commercial |
$11,316.59
|
| Rate for Payer: United Healthcare All Payer |
$10,373.54
|
|
|
PLATE PROXIMAL LAT HUM 12H L
|
Facility
|
IP
|
$9,564.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.23 |
| Max. Negotiated Rate |
$9,181.53 |
| Rate for Payer: Aetna Commercial |
$7,364.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,459.99
|
| Rate for Payer: Cash Price |
$4,782.04
|
| Rate for Payer: Cigna Commercial |
$7,938.19
|
| Rate for Payer: First Health Commercial |
$9,085.89
|
| Rate for Payer: Humana Commercial |
$8,129.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,842.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,058.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,416.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,173.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,651.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,320.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,599.22
|
| Rate for Payer: PHCS Commercial |
$9,181.53
|
| Rate for Payer: United Healthcare All Payer |
$8,416.40
|
|
|
PLATE PROXIMAL LAT HUM 12H L
|
Facility
|
OP
|
$9,564.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.23 |
| Max. Negotiated Rate |
$9,181.53 |
| Rate for Payer: Aetna Commercial |
$7,364.35
|
| Rate for Payer: Anthem Medicaid |
$3,289.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,459.99
|
| Rate for Payer: Cash Price |
$4,782.04
|
| Rate for Payer: Cigna Commercial |
$7,938.19
|
| Rate for Payer: First Health Commercial |
$9,085.89
|
| Rate for Payer: Humana Commercial |
$8,129.48
|
| Rate for Payer: Humana KY Medicaid |
$3,289.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,322.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,842.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,058.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,355.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,416.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,173.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,651.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,320.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,599.22
|
| Rate for Payer: PHCS Commercial |
$9,181.53
|
| Rate for Payer: United Healthcare All Payer |
$8,416.40
|
|
|
PLATE PROXIMAL LAT HUM 12H R
|
Facility
|
OP
|
$9,564.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.23 |
| Max. Negotiated Rate |
$9,181.53 |
| Rate for Payer: Aetna Commercial |
$7,364.35
|
| Rate for Payer: Anthem Medicaid |
$3,289.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,459.99
|
| Rate for Payer: Cash Price |
$4,782.04
|
| Rate for Payer: Cigna Commercial |
$7,938.19
|
| Rate for Payer: First Health Commercial |
$9,085.89
|
| Rate for Payer: Humana Commercial |
$8,129.48
|
| Rate for Payer: Humana KY Medicaid |
$3,289.09
|
| Rate for Payer: Kentucky WC Medicaid |
$3,322.56
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,842.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,058.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,355.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,416.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,173.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,651.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,320.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,599.22
|
| Rate for Payer: PHCS Commercial |
$9,181.53
|
| Rate for Payer: United Healthcare All Payer |
$8,416.40
|
|
|
PLATE PROXIMAL LAT HUM 12H R
|
Facility
|
IP
|
$9,564.09
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,869.23 |
| Max. Negotiated Rate |
$9,181.53 |
| Rate for Payer: Aetna Commercial |
$7,364.35
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,459.99
|
| Rate for Payer: Cash Price |
$4,782.04
|
| Rate for Payer: Cigna Commercial |
$7,938.19
|
| Rate for Payer: First Health Commercial |
$9,085.89
|
| Rate for Payer: Humana Commercial |
$8,129.48
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,842.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,058.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,869.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,416.40
|
| Rate for Payer: Ohio Health Group HMO |
$7,173.07
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,651.27
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,320.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,599.22
|
| Rate for Payer: PHCS Commercial |
$9,181.53
|
| Rate for Payer: United Healthcare All Payer |
$8,416.40
|
|
|
PLATE PROXIMAL LAT HUM 3H L
|
Facility
|
OP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem Medicaid |
$2,861.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Humana KY Medicaid |
$2,861.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
PLATE PROXIMAL LAT HUM 3H L
|
Facility
|
IP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
PLATE PROXIMAL LAT HUM 3H R
|
Facility
|
OP
|
$8,448.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,534.65 |
| Max. Negotiated Rate |
$8,110.88 |
| Rate for Payer: Aetna Commercial |
$6,505.60
|
| Rate for Payer: Anthem Medicaid |
$2,905.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,590.09
|
| Rate for Payer: Cash Price |
$4,224.41
|
| Rate for Payer: Cigna Commercial |
$7,012.53
|
| Rate for Payer: First Health Commercial |
$8,026.39
|
| Rate for Payer: Humana Commercial |
$7,181.51
|
| Rate for Payer: Humana KY Medicaid |
$2,905.55
|
| Rate for Payer: Kentucky WC Medicaid |
$2,935.12
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,928.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,235.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,963.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,434.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,336.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,759.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,350.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,829.69
|
| Rate for Payer: PHCS Commercial |
$8,110.88
|
| Rate for Payer: United Healthcare All Payer |
$7,434.97
|
|
|
PLATE PROXIMAL LAT HUM 3H R
|
Facility
|
IP
|
$8,448.83
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,534.65 |
| Max. Negotiated Rate |
$8,110.88 |
| Rate for Payer: Aetna Commercial |
$6,505.60
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,590.09
|
| Rate for Payer: Cash Price |
$4,224.41
|
| Rate for Payer: Cigna Commercial |
$7,012.53
|
| Rate for Payer: First Health Commercial |
$8,026.39
|
| Rate for Payer: Humana Commercial |
$7,181.51
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,928.04
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,235.24
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,534.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,434.97
|
| Rate for Payer: Ohio Health Group HMO |
$6,336.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,759.06
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,350.48
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,829.69
|
| Rate for Payer: PHCS Commercial |
$8,110.88
|
| Rate for Payer: United Healthcare All Payer |
$7,434.97
|
|
|
PLATE PROXIMAL LAT HUM 4H L
|
Facility
|
IP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
PLATE PROXIMAL LAT HUM 4H L
|
Facility
|
OP
|
$8,321.70
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.51 |
| Max. Negotiated Rate |
$7,988.83 |
| Rate for Payer: Aetna Commercial |
$6,407.71
|
| Rate for Payer: Anthem Medicaid |
$2,861.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,490.93
|
| Rate for Payer: Cash Price |
$4,160.85
|
| Rate for Payer: Cigna Commercial |
$6,907.01
|
| Rate for Payer: First Health Commercial |
$7,905.61
|
| Rate for Payer: Humana Commercial |
$7,073.44
|
| Rate for Payer: Humana KY Medicaid |
$2,861.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,890.96
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,823.79
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,141.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,496.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,919.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,323.10
|
| Rate for Payer: Ohio Health Group HMO |
$6,241.27
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,657.36
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,239.88
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,741.97
|
| Rate for Payer: PHCS Commercial |
$7,988.83
|
| Rate for Payer: United Healthcare All Payer |
$7,323.10
|
|
|
PLATE PROXIMAL LAT HUM 4H R
|
Facility
|
IP
|
$8,285.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.61 |
| Max. Negotiated Rate |
$7,953.96 |
| Rate for Payer: Aetna Commercial |
$6,379.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.60
|
| Rate for Payer: Cash Price |
$4,142.69
|
| Rate for Payer: Cigna Commercial |
$6,876.87
|
| Rate for Payer: First Health Commercial |
$7,871.11
|
| Rate for Payer: Humana Commercial |
$7,042.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,794.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.61
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,291.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,214.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.91
|
| Rate for Payer: PHCS Commercial |
$7,953.96
|
| Rate for Payer: United Healthcare All Payer |
$7,291.13
|
|
|
PLATE PROXIMAL LAT HUM 4H R
|
Facility
|
OP
|
$8,285.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,485.61 |
| Max. Negotiated Rate |
$7,953.96 |
| Rate for Payer: Aetna Commercial |
$6,379.74
|
| Rate for Payer: Anthem Medicaid |
$2,849.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,462.60
|
| Rate for Payer: Cash Price |
$4,142.69
|
| Rate for Payer: Cigna Commercial |
$6,876.87
|
| Rate for Payer: First Health Commercial |
$7,871.11
|
| Rate for Payer: Humana Commercial |
$7,042.57
|
| Rate for Payer: Humana KY Medicaid |
$2,849.34
|
| Rate for Payer: Kentucky WC Medicaid |
$2,878.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,794.01
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,114.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,485.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,906.51
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,291.13
|
| Rate for Payer: Ohio Health Group HMO |
$6,214.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,628.30
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,208.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,716.91
|
| Rate for Payer: PHCS Commercial |
$7,953.96
|
| Rate for Payer: United Healthcare All Payer |
$7,291.13
|
|
|
PLATE PROXIMAL LAT HUM 5H L
|
Facility
|
IP
|
$15,555.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,666.65 |
| Max. Negotiated Rate |
$14,933.28 |
| Rate for Payer: Aetna Commercial |
$11,977.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$12,133.29
|
| Rate for Payer: Cash Price |
$7,777.75
|
| Rate for Payer: Cigna Commercial |
$12,911.07
|
| Rate for Payer: First Health Commercial |
$14,777.73
|
| Rate for Payer: Humana Commercial |
$13,222.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$12,755.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$11,479.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,666.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$13,688.84
|
| Rate for Payer: Ohio Health Group HMO |
$11,666.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$12,444.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$13,533.28
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$10,733.30
|
| Rate for Payer: PHCS Commercial |
$14,933.28
|
| Rate for Payer: United Healthcare All Payer |
$13,688.84
|
|
