|
PLATE PROX TIBIAL LOCKNG 14H R
|
Facility
|
OP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem Medicaid |
$2,490.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Humana KY Medicaid |
$2,490.91
|
| Rate for Payer: Kentucky WC Medicaid |
$2,516.26
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,540.89
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
|
PLATE PROX TIBIAL LOCKNG 14H R
|
Facility
|
IP
|
$7,243.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,172.94 |
| Max. Negotiated Rate |
$6,953.40 |
| Rate for Payer: Aetna Commercial |
$5,577.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,649.63
|
| Rate for Payer: Cash Price |
$3,621.56
|
| Rate for Payer: Cigna Commercial |
$6,011.79
|
| Rate for Payer: First Health Commercial |
$6,880.96
|
| Rate for Payer: Humana Commercial |
$6,156.65
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,939.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,345.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,172.94
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,373.95
|
| Rate for Payer: Ohio Health Group HMO |
$5,432.34
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,794.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,301.51
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,997.75
|
| Rate for Payer: PHCS Commercial |
$6,953.40
|
| Rate for Payer: United Healthcare All Payer |
$6,373.95
|
|
|
PLATE PROX TIBIAL LOCKNG 4H LT
|
Facility
|
IP
|
$7,005.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.65 |
| Max. Negotiated Rate |
$6,725.29 |
| Rate for Payer: Aetna Commercial |
$5,394.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.30
|
| Rate for Payer: Cash Price |
$3,502.76
|
| Rate for Payer: Cigna Commercial |
$5,814.57
|
| Rate for Payer: First Health Commercial |
$6,655.23
|
| Rate for Payer: Humana Commercial |
$5,954.68
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.65
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.80
|
| Rate for Payer: PHCS Commercial |
$6,725.29
|
| Rate for Payer: United Healthcare All Payer |
$6,164.85
|
|
|
PLATE PROX TIBIAL LOCKNG 4H LT
|
Facility
|
OP
|
$7,005.51
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,101.65 |
| Max. Negotiated Rate |
$6,725.29 |
| Rate for Payer: Aetna Commercial |
$5,394.24
|
| Rate for Payer: Anthem Medicaid |
$2,409.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,464.30
|
| Rate for Payer: Cash Price |
$3,502.76
|
| Rate for Payer: Cigna Commercial |
$5,814.57
|
| Rate for Payer: First Health Commercial |
$6,655.23
|
| Rate for Payer: Humana Commercial |
$5,954.68
|
| Rate for Payer: Humana KY Medicaid |
$2,409.19
|
| Rate for Payer: Kentucky WC Medicaid |
$2,433.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,744.52
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,170.07
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,101.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,457.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,164.85
|
| Rate for Payer: Ohio Health Group HMO |
$5,254.13
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,604.41
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,094.79
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,833.80
|
| Rate for Payer: PHCS Commercial |
$6,725.29
|
| Rate for Payer: United Healthcare All Payer |
$6,164.85
|
|
|
PLATE PROX TIBIAL LOCKNG 4H RT
|
Facility
|
OP
|
$6,706.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.04 |
| Max. Negotiated Rate |
$6,438.52 |
| Rate for Payer: Aetna Commercial |
$5,164.23
|
| Rate for Payer: Anthem Medicaid |
$2,306.47
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.30
|
| Rate for Payer: Cash Price |
$3,353.40
|
| Rate for Payer: Cigna Commercial |
$5,566.64
|
| Rate for Payer: First Health Commercial |
$6,371.45
|
| Rate for Payer: Humana Commercial |
$5,700.77
|
| Rate for Payer: Humana KY Medicaid |
$2,306.47
|
| Rate for Payer: Kentucky WC Medicaid |
$2,329.94
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,352.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,365.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.69
|
| Rate for Payer: PHCS Commercial |
$6,438.52
|
| Rate for Payer: United Healthcare All Payer |
$5,901.98
|
|
|
PLATE PROX TIBIAL LOCKNG 4H RT
|
Facility
|
IP
|
$6,706.79
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,012.04 |
| Max. Negotiated Rate |
$6,438.52 |
| Rate for Payer: Aetna Commercial |
$5,164.23
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,231.30
|
| Rate for Payer: Cash Price |
$3,353.40
|
| Rate for Payer: Cigna Commercial |
$5,566.64
|
| Rate for Payer: First Health Commercial |
$6,371.45
|
| Rate for Payer: Humana Commercial |
$5,700.77
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,499.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,949.61
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,012.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,901.98
|
| Rate for Payer: Ohio Health Group HMO |
$5,030.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,365.43
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,834.91
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,627.69
|
| Rate for Payer: PHCS Commercial |
$6,438.52
|
| Rate for Payer: United Healthcare All Payer |
$5,901.98
|
|
|
PLATE PROX TIBIAL LOCKNG 6H LT
|
Facility
|
OP
|
$8,461.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.38 |
| Max. Negotiated Rate |
$8,122.83 |
| Rate for Payer: Aetna Commercial |
$6,515.19
|
| Rate for Payer: Anthem Medicaid |
$2,909.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,599.80
|
| Rate for Payer: Cash Price |
$4,230.64
|
| Rate for Payer: Cigna Commercial |
$7,022.86
|
| Rate for Payer: First Health Commercial |
$8,038.22
|
| Rate for Payer: Humana Commercial |
$7,192.09
|
| Rate for Payer: Humana KY Medicaid |
$2,909.83
|
| Rate for Payer: Kentucky WC Medicaid |
$2,939.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,938.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,244.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,538.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,968.22
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,445.93
|
| Rate for Payer: Ohio Health Group HMO |
$6,345.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,769.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,838.28
|
| Rate for Payer: PHCS Commercial |
$8,122.83
|
| Rate for Payer: United Healthcare All Payer |
$7,445.93
|
|
|
PLATE PROX TIBIAL LOCKNG 6H LT
|
Facility
|
IP
|
$8,461.28
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,538.38 |
| Max. Negotiated Rate |
$8,122.83 |
| Rate for Payer: Aetna Commercial |
$6,515.19
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,599.80
|
| Rate for Payer: Cash Price |
$4,230.64
|
| Rate for Payer: Cigna Commercial |
$7,022.86
|
| Rate for Payer: First Health Commercial |
$8,038.22
|
| Rate for Payer: Humana Commercial |
$7,192.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,938.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,244.42
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,538.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,445.93
|
| Rate for Payer: Ohio Health Group HMO |
$6,345.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$6,769.02
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,361.31
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,838.28
|
| Rate for Payer: PHCS Commercial |
$8,122.83
|
| Rate for Payer: United Healthcare All Payer |
$7,445.93
|
|
|
PLATE PROX TIBIAL LOCKNG 6H RT
|
Facility
|
OP
|
$6,754.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,026.30 |
| Max. Negotiated Rate |
$6,484.15 |
| Rate for Payer: Aetna Commercial |
$5,200.83
|
| Rate for Payer: Anthem Medicaid |
$2,322.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,268.37
|
| Rate for Payer: Cash Price |
$3,377.16
|
| Rate for Payer: Cigna Commercial |
$5,606.09
|
| Rate for Payer: First Health Commercial |
$6,416.60
|
| Rate for Payer: Humana Commercial |
$5,741.17
|
| Rate for Payer: Humana KY Medicaid |
$2,322.81
|
| Rate for Payer: Kentucky WC Medicaid |
$2,346.45
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,538.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,984.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,026.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,369.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,943.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,065.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,876.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,660.48
|
| Rate for Payer: PHCS Commercial |
$6,484.15
|
| Rate for Payer: United Healthcare All Payer |
$5,943.80
|
|
|
PLATE PROX TIBIAL LOCKNG 6H RT
|
Facility
|
IP
|
$6,754.32
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,026.30 |
| Max. Negotiated Rate |
$6,484.15 |
| Rate for Payer: Aetna Commercial |
$5,200.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,268.37
|
| Rate for Payer: Cash Price |
$3,377.16
|
| Rate for Payer: Cigna Commercial |
$5,606.09
|
| Rate for Payer: First Health Commercial |
$6,416.60
|
| Rate for Payer: Humana Commercial |
$5,741.17
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,538.54
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,984.69
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,026.30
|
| Rate for Payer: Ohio Health Choice Commercial |
$5,943.80
|
| Rate for Payer: Ohio Health Group HMO |
$5,065.74
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,403.46
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,876.26
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,660.48
|
| Rate for Payer: PHCS Commercial |
$6,484.15
|
| Rate for Payer: United Healthcare All Payer |
$5,943.80
|
|
|
PLATE PROX TIBIAL LOCKNG 8H LT
|
Facility
|
OP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem Medicaid |
$2,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Humana KY Medicaid |
$2,443.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE PROX TIBIAL LOCKNG 8H LT
|
Facility
|
IP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE PROX TIBIAL LOCKNG 8H RT
|
Facility
|
IP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE PROX TIBIAL LOCKNG 8H RT
|
Facility
|
OP
|
$7,103.95
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,131.18 |
| Max. Negotiated Rate |
$6,819.79 |
| Rate for Payer: Aetna Commercial |
$5,470.04
|
| Rate for Payer: Anthem Medicaid |
$2,443.05
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,541.08
|
| Rate for Payer: Cash Price |
$3,551.98
|
| Rate for Payer: Cigna Commercial |
$5,896.28
|
| Rate for Payer: First Health Commercial |
$6,748.75
|
| Rate for Payer: Humana Commercial |
$6,038.36
|
| Rate for Payer: Humana KY Medicaid |
$2,443.05
|
| Rate for Payer: Kentucky WC Medicaid |
$2,467.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,825.24
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,242.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,131.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,492.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,251.48
|
| Rate for Payer: Ohio Health Group HMO |
$5,327.96
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,683.16
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,180.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,901.73
|
| Rate for Payer: PHCS Commercial |
$6,819.79
|
| Rate for Payer: United Healthcare All Payer |
$6,251.48
|
|
|
PLATE PROX WDG 3MM TI LCK 00MM
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 00MM
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 2.0M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 2.0M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 2.5M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 2.5M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 3.0M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 3.0M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 3.5M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 3.5M
|
Facility
|
OP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem Medicaid |
$1,842.01
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Humana KY Medicaid |
$1,842.01
|
| Rate for Payer: Kentucky WC Medicaid |
$1,860.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,878.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
|
PLATE PROX WDG 3MM TI LCK 4.0M
|
Facility
|
IP
|
$5,356.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$5,142.00 |
| Rate for Payer: Aetna Commercial |
$4,124.31
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,177.88
|
| Rate for Payer: Cash Price |
$2,678.12
|
| Rate for Payer: Cigna Commercial |
$4,445.69
|
| Rate for Payer: First Health Commercial |
$5,088.44
|
| Rate for Payer: Humana Commercial |
$4,552.81
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,392.12
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,952.91
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,606.88
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,713.50
|
| Rate for Payer: Ohio Health Group HMO |
$4,017.19
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,285.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,659.94
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,695.81
|
| Rate for Payer: PHCS Commercial |
$5,142.00
|
| Rate for Payer: United Healthcare All Payer |
$4,713.50
|
|
