|
PLATE PROXIMAL LAT HUM 5H L
|
Facility
|
OP
|
$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 Medicaid |
$5,349.54
|
| 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: Humana KY Medicaid |
$5,349.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,403.98
|
| 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: Molina Healthcare Medicaid |
$5,456.87
|
| 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
|
|
|
PLATE PROXIMAL LAT HUM 5H R
|
Facility
|
IP
|
$10,143.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.07 |
| Max. Negotiated Rate |
$9,737.82 |
| Rate for Payer: Aetna Commercial |
$7,810.54
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,911.98
|
| Rate for Payer: Cash Price |
$5,071.78
|
| Rate for Payer: Cigna Commercial |
$8,419.15
|
| Rate for Payer: First Health Commercial |
$9,636.38
|
| Rate for Payer: Humana Commercial |
$8,622.03
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,317.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,485.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,043.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,926.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,607.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,114.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,824.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,999.06
|
| Rate for Payer: PHCS Commercial |
$9,737.82
|
| Rate for Payer: United Healthcare All Payer |
$8,926.33
|
|
|
PLATE PROXIMAL LAT HUM 5H R
|
Facility
|
OP
|
$10,143.56
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.07 |
| Max. Negotiated Rate |
$9,737.82 |
| Rate for Payer: Aetna Commercial |
$7,810.54
|
| Rate for Payer: Anthem Medicaid |
$3,488.37
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,911.98
|
| Rate for Payer: Cash Price |
$5,071.78
|
| Rate for Payer: Cigna Commercial |
$8,419.15
|
| Rate for Payer: First Health Commercial |
$9,636.38
|
| Rate for Payer: Humana Commercial |
$8,622.03
|
| Rate for Payer: Humana KY Medicaid |
$3,488.37
|
| Rate for Payer: Kentucky WC Medicaid |
$3,523.87
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$8,317.72
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,485.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,043.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,558.36
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,926.33
|
| Rate for Payer: Ohio Health Group HMO |
$7,607.67
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,114.85
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,824.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,999.06
|
| Rate for Payer: PHCS Commercial |
$9,737.82
|
| Rate for Payer: United Healthcare All Payer |
$8,926.33
|
|
|
PLATE PROXIMAL LAT HUM 6H L
|
Facility
|
OP
|
$17,272.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.69 |
| Max. Negotiated Rate |
$16,581.41 |
| Rate for Payer: Aetna Commercial |
$13,299.67
|
| Rate for Payer: Anthem Medicaid |
$5,939.94
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,472.39
|
| Rate for Payer: Cash Price |
$8,636.15
|
| Rate for Payer: Cigna Commercial |
$14,336.01
|
| Rate for Payer: First Health Commercial |
$16,408.69
|
| Rate for Payer: Humana Commercial |
$14,681.45
|
| Rate for Payer: Humana KY Medicaid |
$5,939.94
|
| Rate for Payer: Kentucky WC Medicaid |
$6,000.40
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,163.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,746.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,181.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,059.12
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,199.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,954.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,817.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,026.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,917.89
|
| Rate for Payer: PHCS Commercial |
$16,581.41
|
| Rate for Payer: United Healthcare All Payer |
$15,199.62
|
|
|
PLATE PROXIMAL LAT HUM 6H L
|
Facility
|
IP
|
$17,272.30
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,181.69 |
| Max. Negotiated Rate |
$16,581.41 |
| Rate for Payer: Aetna Commercial |
$13,299.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$13,472.39
|
| Rate for Payer: Cash Price |
$8,636.15
|
| Rate for Payer: Cigna Commercial |
$14,336.01
|
| Rate for Payer: First Health Commercial |
$16,408.69
|
| Rate for Payer: Humana Commercial |
$14,681.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$14,163.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$12,746.96
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$5,181.69
|
| Rate for Payer: Ohio Health Choice Commercial |
$15,199.62
|
| Rate for Payer: Ohio Health Group HMO |
$12,954.23
|
| Rate for Payer: Ohio Health Group PPO Differential |
$13,817.84
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$15,026.90
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$11,917.89
|
| Rate for Payer: PHCS Commercial |
$16,581.41
|
| Rate for Payer: United Healthcare All Payer |
$15,199.62
|
|
|
PLATE PROXIMAL LAT HUM 6H R
|
Facility
|
OP
|
$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 Medicaid |
$5,349.54
|
| 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: Humana KY Medicaid |
$5,349.54
|
| Rate for Payer: Kentucky WC Medicaid |
$5,403.98
|
| 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: Molina Healthcare Medicaid |
$5,456.87
|
| 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
|
|
|
PLATE PROXIMAL LAT HUM 6H R
|
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
|
|
|
PLATE PROXIMAL LAT HUM 8H L
|
Facility
|
OP
|
$13,937.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.24 |
| Max. Negotiated Rate |
$13,379.98 |
| Rate for Payer: Aetna Commercial |
$10,731.86
|
| Rate for Payer: Anthem Medicaid |
$4,793.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,871.23
|
| Rate for Payer: Cash Price |
$6,968.74
|
| Rate for Payer: Cigna Commercial |
$11,568.11
|
| Rate for Payer: First Health Commercial |
$13,240.61
|
| Rate for Payer: Humana Commercial |
$11,846.86
|
| Rate for Payer: Humana KY Medicaid |
$4,793.10
|
| Rate for Payer: Kentucky WC Medicaid |
$4,841.88
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,428.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,285.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,181.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,889.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,264.98
|
| Rate for Payer: Ohio Health Group HMO |
$10,453.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,149.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,125.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,616.86
|
| Rate for Payer: PHCS Commercial |
$13,379.98
|
| Rate for Payer: United Healthcare All Payer |
$12,264.98
|
|
|
PLATE PROXIMAL LAT HUM 8H L
|
Facility
|
IP
|
$13,937.48
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,181.24 |
| Max. Negotiated Rate |
$13,379.98 |
| Rate for Payer: Aetna Commercial |
$10,731.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$10,871.23
|
| Rate for Payer: Cash Price |
$6,968.74
|
| Rate for Payer: Cigna Commercial |
$11,568.11
|
| Rate for Payer: First Health Commercial |
$13,240.61
|
| Rate for Payer: Humana Commercial |
$11,846.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,428.73
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,285.86
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,181.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,264.98
|
| Rate for Payer: Ohio Health Group HMO |
$10,453.11
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,149.98
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,125.61
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,616.86
|
| Rate for Payer: PHCS Commercial |
$13,379.98
|
| Rate for Payer: United Healthcare All Payer |
$12,264.98
|
|
|
PLATE PROXIMAL LAT HUM 8H R
|
Facility
|
OP
|
$8,803.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,641.05 |
| Max. Negotiated Rate |
$8,451.36 |
| Rate for Payer: Aetna Commercial |
$6,778.69
|
| Rate for Payer: Anthem Medicaid |
$3,027.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.73
|
| Rate for Payer: Cash Price |
$4,401.75
|
| Rate for Payer: Cigna Commercial |
$7,306.90
|
| Rate for Payer: First Health Commercial |
$8,363.33
|
| Rate for Payer: Humana Commercial |
$7,482.98
|
| Rate for Payer: Humana KY Medicaid |
$3,027.52
|
| Rate for Payer: Kentucky WC Medicaid |
$3,058.34
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,088.27
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,747.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,042.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,659.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,074.41
|
| Rate for Payer: PHCS Commercial |
$8,451.36
|
| Rate for Payer: United Healthcare All Payer |
$7,747.08
|
|
|
PLATE PROXIMAL LAT HUM 8H R
|
Facility
|
IP
|
$8,803.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,641.05 |
| Max. Negotiated Rate |
$8,451.36 |
| Rate for Payer: Aetna Commercial |
$6,778.69
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,866.73
|
| Rate for Payer: Cash Price |
$4,401.75
|
| Rate for Payer: Cigna Commercial |
$7,306.90
|
| Rate for Payer: First Health Commercial |
$8,363.33
|
| Rate for Payer: Humana Commercial |
$7,482.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,218.87
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,496.98
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,641.05
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,747.08
|
| Rate for Payer: Ohio Health Group HMO |
$6,602.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,042.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,659.05
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,074.41
|
| Rate for Payer: PHCS Commercial |
$8,451.36
|
| Rate for Payer: United Healthcare All Payer |
$7,747.08
|
|
|
PLATE PROX LAT HUM TS 3H L
|
Facility
|
IP
|
$9,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,783.40 |
| Max. Negotiated Rate |
$8,906.88 |
| Rate for Payer: Aetna Commercial |
$7,144.06
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,236.84
|
| Rate for Payer: Cash Price |
$4,639.00
|
| Rate for Payer: Cigna Commercial |
$7,700.74
|
| Rate for Payer: First Health Commercial |
$8,814.10
|
| Rate for Payer: Humana Commercial |
$7,886.30
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,607.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,847.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,164.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,071.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,401.82
|
| Rate for Payer: PHCS Commercial |
$8,906.88
|
| Rate for Payer: United Healthcare All Payer |
$8,164.64
|
|
|
PLATE PROX LAT HUM TS 3H L
|
Facility
|
OP
|
$9,278.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,783.40 |
| Max. Negotiated Rate |
$8,906.88 |
| Rate for Payer: Aetna Commercial |
$7,144.06
|
| Rate for Payer: Anthem Medicaid |
$3,190.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,236.84
|
| Rate for Payer: Cash Price |
$4,639.00
|
| Rate for Payer: Cigna Commercial |
$7,700.74
|
| Rate for Payer: First Health Commercial |
$8,814.10
|
| Rate for Payer: Humana Commercial |
$7,886.30
|
| Rate for Payer: Humana KY Medicaid |
$3,190.70
|
| Rate for Payer: Kentucky WC Medicaid |
$3,223.18
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,607.96
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,847.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,783.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,254.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,164.64
|
| Rate for Payer: Ohio Health Group HMO |
$6,958.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,422.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,071.86
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,401.82
|
| Rate for Payer: PHCS Commercial |
$8,906.88
|
| Rate for Payer: United Healthcare All Payer |
$8,164.64
|
|
|
PLATE PROX LAT HUM TS 3H R
|
Facility
|
OP
|
$14,135.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,240.70 |
| Max. Negotiated Rate |
$13,570.23 |
| Rate for Payer: Aetna Commercial |
$10,884.46
|
| Rate for Payer: Anthem Medicaid |
$4,861.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,025.81
|
| Rate for Payer: Cash Price |
$7,067.83
|
| Rate for Payer: Cigna Commercial |
$11,732.60
|
| Rate for Payer: First Health Commercial |
$13,428.88
|
| Rate for Payer: Humana Commercial |
$12,015.31
|
| Rate for Payer: Humana KY Medicaid |
$4,861.25
|
| Rate for Payer: Kentucky WC Medicaid |
$4,910.73
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,591.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,432.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,240.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,958.79
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,439.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,601.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,308.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,298.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,753.61
|
| Rate for Payer: PHCS Commercial |
$13,570.23
|
| Rate for Payer: United Healthcare All Payer |
$12,439.38
|
|
|
PLATE PROX LAT HUM TS 3H R
|
Facility
|
IP
|
$14,135.66
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,240.70 |
| Max. Negotiated Rate |
$13,570.23 |
| Rate for Payer: Aetna Commercial |
$10,884.46
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,025.81
|
| Rate for Payer: Cash Price |
$7,067.83
|
| Rate for Payer: Cigna Commercial |
$11,732.60
|
| Rate for Payer: First Health Commercial |
$13,428.88
|
| Rate for Payer: Humana Commercial |
$12,015.31
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,591.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,432.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,240.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,439.38
|
| Rate for Payer: Ohio Health Group HMO |
$10,601.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,308.53
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,298.02
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,753.61
|
| Rate for Payer: PHCS Commercial |
$13,570.23
|
| Rate for Payer: United Healthcare All Payer |
$12,439.38
|
|
|
PLATE PROX LAT HUM TS 5H L
|
Facility
|
IP
|
$14,139.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,241.80 |
| Max. Negotiated Rate |
$13,573.76 |
| Rate for Payer: Aetna Commercial |
$10,887.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,028.68
|
| Rate for Payer: Cash Price |
$7,069.66
|
| Rate for Payer: Cigna Commercial |
$11,735.64
|
| Rate for Payer: First Health Commercial |
$13,432.36
|
| Rate for Payer: Humana Commercial |
$12,018.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,594.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,434.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,241.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,442.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,604.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,311.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,301.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,756.14
|
| Rate for Payer: PHCS Commercial |
$13,573.76
|
| Rate for Payer: United Healthcare All Payer |
$12,442.61
|
|
|
PLATE PROX LAT HUM TS 5H L
|
Facility
|
OP
|
$14,139.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,241.80 |
| Max. Negotiated Rate |
$13,573.76 |
| Rate for Payer: Aetna Commercial |
$10,887.28
|
| Rate for Payer: Anthem Medicaid |
$4,862.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,028.68
|
| Rate for Payer: Cash Price |
$7,069.66
|
| Rate for Payer: Cigna Commercial |
$11,735.64
|
| Rate for Payer: First Health Commercial |
$13,432.36
|
| Rate for Payer: Humana Commercial |
$12,018.43
|
| Rate for Payer: Humana KY Medicaid |
$4,862.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4,912.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,594.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,434.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,241.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,960.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,442.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,604.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,311.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,301.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,756.14
|
| Rate for Payer: PHCS Commercial |
$13,573.76
|
| Rate for Payer: United Healthcare All Payer |
$12,442.61
|
|
|
PLATE PROX LAT HUM TS 5H R
|
Facility
|
IP
|
$5,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.70 |
| Max. Negotiated Rate |
$5,154.24 |
| Rate for Payer: Aetna Commercial |
$4,134.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,187.82
|
| Rate for Payer: Cash Price |
$2,684.50
|
| Rate for Payer: Cigna Commercial |
$4,456.27
|
| Rate for Payer: First Health Commercial |
$5,100.55
|
| Rate for Payer: Humana Commercial |
$4,563.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,402.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,962.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,610.70
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,724.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,671.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,704.61
|
| Rate for Payer: PHCS Commercial |
$5,154.24
|
| Rate for Payer: United Healthcare All Payer |
$4,724.72
|
|
|
PLATE PROX LAT HUM TS 5H R
|
Facility
|
OP
|
$5,369.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,610.70 |
| Max. Negotiated Rate |
$5,154.24 |
| Rate for Payer: Aetna Commercial |
$4,134.13
|
| Rate for Payer: Anthem Medicaid |
$1,846.40
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,187.82
|
| Rate for Payer: Cash Price |
$2,684.50
|
| Rate for Payer: Cigna Commercial |
$4,456.27
|
| Rate for Payer: First Health Commercial |
$5,100.55
|
| Rate for Payer: Humana Commercial |
$4,563.65
|
| Rate for Payer: Humana KY Medicaid |
$1,846.40
|
| Rate for Payer: Kentucky WC Medicaid |
$1,865.19
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,402.58
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,962.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,610.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,883.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,724.72
|
| Rate for Payer: Ohio Health Group HMO |
$4,026.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,295.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,671.03
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,704.61
|
| Rate for Payer: PHCS Commercial |
$5,154.24
|
| Rate for Payer: United Healthcare All Payer |
$4,724.72
|
|
|
PLATE PROX LAT HUM TS 8H L
|
Facility
|
IP
|
$14,139.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,241.80 |
| Max. Negotiated Rate |
$13,573.76 |
| Rate for Payer: Aetna Commercial |
$10,887.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,028.68
|
| Rate for Payer: Cash Price |
$7,069.66
|
| Rate for Payer: Cigna Commercial |
$11,735.64
|
| Rate for Payer: First Health Commercial |
$13,432.36
|
| Rate for Payer: Humana Commercial |
$12,018.43
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,594.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,434.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,241.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,442.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,604.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,311.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,301.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,756.14
|
| Rate for Payer: PHCS Commercial |
$13,573.76
|
| Rate for Payer: United Healthcare All Payer |
$12,442.61
|
|
|
PLATE PROX LAT HUM TS 8H L
|
Facility
|
OP
|
$14,139.33
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,241.80 |
| Max. Negotiated Rate |
$13,573.76 |
| Rate for Payer: Aetna Commercial |
$10,887.28
|
| Rate for Payer: Anthem Medicaid |
$4,862.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,028.68
|
| Rate for Payer: Cash Price |
$7,069.66
|
| Rate for Payer: Cigna Commercial |
$11,735.64
|
| Rate for Payer: First Health Commercial |
$13,432.36
|
| Rate for Payer: Humana Commercial |
$12,018.43
|
| Rate for Payer: Humana KY Medicaid |
$4,862.52
|
| Rate for Payer: Kentucky WC Medicaid |
$4,912.00
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,594.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,434.83
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,241.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,960.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,442.61
|
| Rate for Payer: Ohio Health Group HMO |
$10,604.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,311.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,301.22
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,756.14
|
| Rate for Payer: PHCS Commercial |
$13,573.76
|
| Rate for Payer: United Healthcare All Payer |
$12,442.61
|
|
|
PLATE PROX LAT HUM TS 8H R
|
Facility
|
IP
|
$12,011.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,603.44 |
| Max. Negotiated Rate |
$11,531.00 |
| Rate for Payer: Aetna Commercial |
$9,248.82
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,368.94
|
| Rate for Payer: Cash Price |
$6,005.73
|
| Rate for Payer: Cigna Commercial |
$9,969.51
|
| Rate for Payer: First Health Commercial |
$11,410.89
|
| Rate for Payer: Humana Commercial |
$10,209.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,849.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,864.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,603.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,570.08
|
| Rate for Payer: Ohio Health Group HMO |
$9,008.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,609.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,449.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,287.91
|
| Rate for Payer: PHCS Commercial |
$11,531.00
|
| Rate for Payer: United Healthcare All Payer |
$10,570.08
|
|
|
PLATE PROX LAT HUM TS 8H R
|
Facility
|
OP
|
$12,011.46
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,603.44 |
| Max. Negotiated Rate |
$11,531.00 |
| Rate for Payer: Aetna Commercial |
$9,248.82
|
| Rate for Payer: Anthem Medicaid |
$4,130.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$9,368.94
|
| Rate for Payer: Cash Price |
$6,005.73
|
| Rate for Payer: Cigna Commercial |
$9,969.51
|
| Rate for Payer: First Health Commercial |
$11,410.89
|
| Rate for Payer: Humana Commercial |
$10,209.74
|
| Rate for Payer: Humana KY Medicaid |
$4,130.74
|
| Rate for Payer: Kentucky WC Medicaid |
$4,172.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,849.40
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,864.46
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,603.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,213.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$10,570.08
|
| Rate for Payer: Ohio Health Group HMO |
$9,008.59
|
| Rate for Payer: Ohio Health Group PPO Differential |
$9,609.17
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$10,449.97
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$8,287.91
|
| Rate for Payer: PHCS Commercial |
$11,531.00
|
| Rate for Payer: United Healthcare All Payer |
$10,570.08
|
|
|
PLATE PROX LAT TIBIA 10H L
|
Facility
|
IP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
|
PLATE PROX LAT TIBIA 10H L
|
Facility
|
OP
|
$14,154.01
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,246.20 |
| Max. Negotiated Rate |
$13,587.85 |
| Rate for Payer: Aetna Commercial |
$10,898.59
|
| Rate for Payer: Anthem Medicaid |
$4,867.56
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$11,040.13
|
| Rate for Payer: Cash Price |
$7,077.00
|
| Rate for Payer: Cigna Commercial |
$11,747.83
|
| Rate for Payer: First Health Commercial |
$13,446.31
|
| Rate for Payer: Humana Commercial |
$12,030.91
|
| Rate for Payer: Humana KY Medicaid |
$4,867.56
|
| Rate for Payer: Kentucky WC Medicaid |
$4,917.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$11,606.29
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$10,445.66
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$4,246.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,965.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$12,455.53
|
| Rate for Payer: Ohio Health Group HMO |
$10,615.51
|
| Rate for Payer: Ohio Health Group PPO Differential |
$11,323.21
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$12,313.99
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$9,766.27
|
| Rate for Payer: PHCS Commercial |
$13,587.85
|
| Rate for Payer: United Healthcare All Payer |
$12,455.53
|
|
