|
PLATE TIB LAT PROXML R 6H 130M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROXML R 6H 130M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROXML R 8H 162M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROXML R 8H 162M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROX R 10H 194M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROX R 10H 194M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROX R 12H 226M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROX R 12H 226M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROX R 14H 258M
|
Facility
|
IP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LAT PROX R 14H 258M
|
Facility
|
OP
|
$7,215.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,164.72 |
| Max. Negotiated Rate |
$6,927.12 |
| Rate for Payer: Aetna Commercial |
$5,556.13
|
| Rate for Payer: Anthem Medicaid |
$2,481.50
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,628.28
|
| Rate for Payer: Cash Price |
$3,607.88
|
| Rate for Payer: Cigna Commercial |
$5,989.07
|
| Rate for Payer: First Health Commercial |
$6,854.96
|
| Rate for Payer: Humana Commercial |
$6,133.39
|
| Rate for Payer: Humana KY Medicaid |
$2,481.50
|
| Rate for Payer: Kentucky WC Medicaid |
$2,506.75
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,916.91
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,325.22
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,164.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,531.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,349.86
|
| Rate for Payer: Ohio Health Group HMO |
$5,411.81
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,772.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,277.70
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,978.87
|
| Rate for Payer: PHCS Commercial |
$6,927.12
|
| Rate for Payer: United Healthcare All Payer |
$6,349.86
|
|
|
PLATE TIB LEFT LAT
|
Facility
|
OP
|
$7,409.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.81 |
| Max. Negotiated Rate |
$7,113.00 |
| Rate for Payer: Aetna Commercial |
$5,705.22
|
| Rate for Payer: Anthem Medicaid |
$2,548.09
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,779.32
|
| Rate for Payer: Cash Price |
$3,704.69
|
| Rate for Payer: Cigna Commercial |
$6,149.79
|
| Rate for Payer: First Health Commercial |
$7,038.91
|
| Rate for Payer: Humana Commercial |
$6,297.97
|
| Rate for Payer: Humana KY Medicaid |
$2,548.09
|
| Rate for Payer: Kentucky WC Medicaid |
$2,574.02
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,075.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,468.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.81
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,599.21
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,520.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,557.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,927.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,112.47
|
| Rate for Payer: PHCS Commercial |
$7,113.00
|
| Rate for Payer: United Healthcare All Payer |
$6,520.25
|
|
|
PLATE TIB LEFT LAT
|
Facility
|
IP
|
$7,409.38
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.81 |
| Max. Negotiated Rate |
$7,113.00 |
| Rate for Payer: Aetna Commercial |
$5,705.22
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,779.32
|
| Rate for Payer: Cash Price |
$3,704.69
|
| Rate for Payer: Cigna Commercial |
$6,149.79
|
| Rate for Payer: First Health Commercial |
$7,038.91
|
| Rate for Payer: Humana Commercial |
$6,297.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,075.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,468.12
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,222.81
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,520.25
|
| Rate for Payer: Ohio Health Group HMO |
$5,557.03
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,927.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$6,446.16
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$5,112.47
|
| Rate for Payer: PHCS Commercial |
$7,113.00
|
| Rate for Payer: United Healthcare All Payer |
$6,520.25
|
|
|
PLATE TIB LK 3.5M 108M 4 L M-D
|
Facility
|
OP
|
$9,354.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.23 |
| Max. Negotiated Rate |
$8,979.94 |
| Rate for Payer: Aetna Commercial |
$7,202.66
|
| Rate for Payer: Anthem Medicaid |
$3,216.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,296.20
|
| Rate for Payer: Cash Price |
$4,677.05
|
| Rate for Payer: Cigna Commercial |
$7,763.90
|
| Rate for Payer: First Health Commercial |
$8,886.40
|
| Rate for Payer: Humana Commercial |
$7,950.98
|
| Rate for Payer: Humana KY Medicaid |
$3,216.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,249.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,903.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,806.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,281.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,231.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,015.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,483.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,138.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,454.33
|
| Rate for Payer: PHCS Commercial |
$8,979.94
|
| Rate for Payer: United Healthcare All Payer |
$8,231.61
|
|
|
PLATE TIB LK 3.5M 108M 4 L M-D
|
Facility
|
IP
|
$9,354.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.23 |
| Max. Negotiated Rate |
$8,979.94 |
| Rate for Payer: Aetna Commercial |
$7,202.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,296.20
|
| Rate for Payer: Cash Price |
$4,677.05
|
| Rate for Payer: Cigna Commercial |
$7,763.90
|
| Rate for Payer: First Health Commercial |
$8,886.40
|
| Rate for Payer: Humana Commercial |
$7,950.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,903.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,806.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,231.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,015.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,483.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,138.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,454.33
|
| Rate for Payer: PHCS Commercial |
$8,979.94
|
| Rate for Payer: United Healthcare All Payer |
$8,231.61
|
|
|
PLATE TIB LK 3.5M 108M 4 R M-D
|
Facility
|
OP
|
$9,354.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.23 |
| Max. Negotiated Rate |
$8,979.94 |
| Rate for Payer: Aetna Commercial |
$7,202.66
|
| Rate for Payer: Anthem Medicaid |
$3,216.87
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,296.20
|
| Rate for Payer: Cash Price |
$4,677.05
|
| Rate for Payer: Cigna Commercial |
$7,763.90
|
| Rate for Payer: First Health Commercial |
$8,886.40
|
| Rate for Payer: Humana Commercial |
$7,950.98
|
| Rate for Payer: Humana KY Medicaid |
$3,216.87
|
| Rate for Payer: Kentucky WC Medicaid |
$3,249.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,903.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,806.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,281.42
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,231.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,015.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,483.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,138.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,454.33
|
| Rate for Payer: PHCS Commercial |
$8,979.94
|
| Rate for Payer: United Healthcare All Payer |
$8,231.61
|
|
|
PLATE TIB LK 3.5M 108M 4 R M-D
|
Facility
|
IP
|
$9,354.10
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,806.23 |
| Max. Negotiated Rate |
$8,979.94 |
| Rate for Payer: Aetna Commercial |
$7,202.66
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,296.20
|
| Rate for Payer: Cash Price |
$4,677.05
|
| Rate for Payer: Cigna Commercial |
$7,763.90
|
| Rate for Payer: First Health Commercial |
$8,886.40
|
| Rate for Payer: Humana Commercial |
$7,950.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,670.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,903.33
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,806.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,231.61
|
| Rate for Payer: Ohio Health Group HMO |
$7,015.57
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,483.28
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,138.07
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,454.33
|
| Rate for Payer: PHCS Commercial |
$8,979.94
|
| Rate for Payer: United Healthcare All Payer |
$8,231.61
|
|
|
PLATE TIBLK 3.5M123M 8 L A-L-D
|
Facility
|
OP
|
$9,529.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.90 |
| Max. Negotiated Rate |
$9,148.48 |
| Rate for Payer: Aetna Commercial |
$7,337.85
|
| Rate for Payer: Anthem Medicaid |
$3,277.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,433.14
|
| Rate for Payer: Cash Price |
$4,764.83
|
| Rate for Payer: Cigna Commercial |
$7,909.63
|
| Rate for Payer: First Health Commercial |
$9,053.19
|
| Rate for Payer: Humana Commercial |
$8,100.22
|
| Rate for Payer: Humana KY Medicaid |
$3,277.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,310.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,032.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,858.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,343.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,386.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,147.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,623.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,290.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,575.47
|
| Rate for Payer: PHCS Commercial |
$9,148.48
|
| Rate for Payer: United Healthcare All Payer |
$8,386.11
|
|
|
PLATE TIBLK 3.5M123M 8 L A-L-D
|
Facility
|
IP
|
$9,529.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.90 |
| Max. Negotiated Rate |
$9,148.48 |
| Rate for Payer: Aetna Commercial |
$7,337.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,433.14
|
| Rate for Payer: Cash Price |
$4,764.83
|
| Rate for Payer: Cigna Commercial |
$7,909.63
|
| Rate for Payer: First Health Commercial |
$9,053.19
|
| Rate for Payer: Humana Commercial |
$8,100.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,032.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,858.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,386.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,147.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,623.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,290.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,575.47
|
| Rate for Payer: PHCS Commercial |
$9,148.48
|
| Rate for Payer: United Healthcare All Payer |
$8,386.11
|
|
|
PLATE TIB LK 3.5M 123M 8 L L-P
|
Facility
|
OP
|
$8,786.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.07 |
| Max. Negotiated Rate |
$8,435.41 |
| Rate for Payer: Aetna Commercial |
$6,765.91
|
| Rate for Payer: Anthem Medicaid |
$3,021.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.77
|
| Rate for Payer: Cash Price |
$4,393.45
|
| Rate for Payer: Cigna Commercial |
$7,293.12
|
| Rate for Payer: First Health Commercial |
$8,347.55
|
| Rate for Payer: Humana Commercial |
$7,468.86
|
| Rate for Payer: Humana KY Medicaid |
$3,021.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,205.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,732.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,590.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,029.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,644.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,062.95
|
| Rate for Payer: PHCS Commercial |
$8,435.41
|
| Rate for Payer: United Healthcare All Payer |
$7,732.46
|
|
|
PLATE TIB LK 3.5M 123M 8 L L-P
|
Facility
|
IP
|
$8,786.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.07 |
| Max. Negotiated Rate |
$8,435.41 |
| Rate for Payer: Aetna Commercial |
$6,765.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.77
|
| Rate for Payer: Cash Price |
$4,393.45
|
| Rate for Payer: Cigna Commercial |
$7,293.12
|
| Rate for Payer: First Health Commercial |
$8,347.55
|
| Rate for Payer: Humana Commercial |
$7,468.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,205.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,732.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,590.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,029.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,644.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,062.95
|
| Rate for Payer: PHCS Commercial |
$8,435.41
|
| Rate for Payer: United Healthcare All Payer |
$7,732.46
|
|
|
PLATE TIBLK 3.5M123M 8 R A-L-D
|
Facility
|
IP
|
$9,529.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.90 |
| Max. Negotiated Rate |
$9,148.48 |
| Rate for Payer: Aetna Commercial |
$7,337.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,433.14
|
| Rate for Payer: Cash Price |
$4,764.83
|
| Rate for Payer: Cigna Commercial |
$7,909.63
|
| Rate for Payer: First Health Commercial |
$9,053.19
|
| Rate for Payer: Humana Commercial |
$8,100.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,032.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,858.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,386.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,147.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,623.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,290.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,575.47
|
| Rate for Payer: PHCS Commercial |
$9,148.48
|
| Rate for Payer: United Healthcare All Payer |
$8,386.11
|
|
|
PLATE TIBLK 3.5M123M 8 R A-L-D
|
Facility
|
OP
|
$9,529.67
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,858.90 |
| Max. Negotiated Rate |
$9,148.48 |
| Rate for Payer: Aetna Commercial |
$7,337.85
|
| Rate for Payer: Anthem Medicaid |
$3,277.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,433.14
|
| Rate for Payer: Cash Price |
$4,764.83
|
| Rate for Payer: Cigna Commercial |
$7,909.63
|
| Rate for Payer: First Health Commercial |
$9,053.19
|
| Rate for Payer: Humana Commercial |
$8,100.22
|
| Rate for Payer: Humana KY Medicaid |
$3,277.25
|
| Rate for Payer: Kentucky WC Medicaid |
$3,310.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,814.33
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$7,032.90
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,858.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,343.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,386.11
|
| Rate for Payer: Ohio Health Group HMO |
$7,147.25
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,623.74
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,290.81
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,575.47
|
| Rate for Payer: PHCS Commercial |
$9,148.48
|
| Rate for Payer: United Healthcare All Payer |
$8,386.11
|
|
|
PLATE TIB LK 3.5M 123M 8 R L-P
|
Facility
|
IP
|
$8,786.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.07 |
| Max. Negotiated Rate |
$8,435.41 |
| Rate for Payer: Aetna Commercial |
$6,765.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.77
|
| Rate for Payer: Cash Price |
$4,393.45
|
| Rate for Payer: Cigna Commercial |
$7,293.12
|
| Rate for Payer: First Health Commercial |
$8,347.55
|
| Rate for Payer: Humana Commercial |
$7,468.86
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,205.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.07
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,732.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,590.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,029.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,644.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,062.95
|
| Rate for Payer: PHCS Commercial |
$8,435.41
|
| Rate for Payer: United Healthcare All Payer |
$7,732.46
|
|
|
PLATE TIB LK 3.5M 123M 8 R L-P
|
Facility
|
OP
|
$8,786.89
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,636.07 |
| Max. Negotiated Rate |
$8,435.41 |
| Rate for Payer: Aetna Commercial |
$6,765.91
|
| Rate for Payer: Anthem Medicaid |
$3,021.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,853.77
|
| Rate for Payer: Cash Price |
$4,393.45
|
| Rate for Payer: Cigna Commercial |
$7,293.12
|
| Rate for Payer: First Health Commercial |
$8,347.55
|
| Rate for Payer: Humana Commercial |
$7,468.86
|
| Rate for Payer: Humana KY Medicaid |
$3,021.81
|
| Rate for Payer: Kentucky WC Medicaid |
$3,052.57
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,205.25
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,484.72
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,636.07
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,082.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$7,732.46
|
| Rate for Payer: Ohio Health Group HMO |
$6,590.17
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,029.51
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$7,644.59
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,062.95
|
| Rate for Payer: PHCS Commercial |
$8,435.41
|
| Rate for Payer: United Healthcare All Payer |
$7,732.46
|
|
|
PLATE TIB LK 3.5M 134M 6 L M-D
|
Facility
|
IP
|
$9,408.12
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,822.44 |
| Max. Negotiated Rate |
$9,031.80 |
| Rate for Payer: Aetna Commercial |
$7,244.25
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,338.33
|
| Rate for Payer: Cash Price |
$4,704.06
|
| Rate for Payer: Cigna Commercial |
$7,808.74
|
| Rate for Payer: First Health Commercial |
$8,937.71
|
| Rate for Payer: Humana Commercial |
$7,996.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,714.66
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,943.19
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,822.44
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,279.15
|
| Rate for Payer: Ohio Health Group HMO |
$7,056.09
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,526.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,185.06
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,491.60
|
| Rate for Payer: PHCS Commercial |
$9,031.80
|
| Rate for Payer: United Healthcare All Payer |
$8,279.15
|
|
