|
PLATE TIB LK A-D 3.5MM 74MM 3
|
Facility
|
OP
|
$5,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.40 |
| Max. Negotiated Rate |
$5,134.08 |
| Rate for Payer: Aetna Commercial |
$4,117.96
|
| Rate for Payer: Anthem Medicaid |
$1,839.18
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,171.44
|
| Rate for Payer: Cash Price |
$2,674.00
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: First Health Commercial |
$5,080.60
|
| Rate for Payer: Humana Commercial |
$4,545.80
|
| Rate for Payer: Humana KY Medicaid |
$1,839.18
|
| Rate for Payer: Kentucky WC Medicaid |
$1,857.90
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,385.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,946.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,876.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,706.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,011.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,652.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,690.12
|
| Rate for Payer: PHCS Commercial |
$5,134.08
|
| Rate for Payer: United Healthcare All Payer |
$4,706.24
|
|
|
PLATE TIB LK A-D 3.5MM 74MM 3
|
Facility
|
IP
|
$5,348.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,604.40 |
| Max. Negotiated Rate |
$5,134.08 |
| Rate for Payer: Aetna Commercial |
$4,117.96
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,171.44
|
| Rate for Payer: Cash Price |
$2,674.00
|
| Rate for Payer: Cigna Commercial |
$4,438.84
|
| Rate for Payer: First Health Commercial |
$5,080.60
|
| Rate for Payer: Humana Commercial |
$4,545.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,385.36
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,946.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,604.40
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,706.24
|
| Rate for Payer: Ohio Health Group HMO |
$4,011.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,278.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,652.76
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,690.12
|
| Rate for Payer: PHCS Commercial |
$5,134.08
|
| Rate for Payer: United Healthcare All Payer |
$4,706.24
|
|
|
PLATE TIB LK L-P 3.5*93 6 L
|
Facility
|
OP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem Medicaid |
$1,948.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Humana KY Medicaid |
$1,948.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK L-P 3.5*93 6 L
|
Facility
|
IP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK L-P 3.5M 4H 68M R
|
Facility
|
OP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem Medicaid |
$1,901.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Humana KY Medicaid |
$1,901.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,940.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK L-P 3.5M 4H 68M R
|
Facility
|
IP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK L-P 3.5M 68M 4 R
|
Facility
|
OP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem Medicaid |
$1,901.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Humana KY Medicaid |
$1,901.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,940.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK L-P 3.5M 68M 4 R
|
Facility
|
IP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK L-P 3.5M 93M 6 R
|
Facility
|
OP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem Medicaid |
$1,948.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Humana KY Medicaid |
$1,948.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK L-P 3.5M 93M 6 R
|
Facility
|
IP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK M-D 3.5M 127M 6 L
|
Facility
|
OP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem Medicaid |
$1,948.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Humana KY Medicaid |
$1,948.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK M-D 3.5M 127M 6 L
|
Facility
|
IP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK M-D 3.5M 127M 6 R
|
Facility
|
OP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem Medicaid |
$1,948.28
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Humana KY Medicaid |
$1,948.28
|
| Rate for Payer: Kentucky WC Medicaid |
$1,968.11
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,987.37
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK M-D 3.5M 127M 6 R
|
Facility
|
IP
|
$5,665.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.58 |
| Max. Negotiated Rate |
$5,438.64 |
| Rate for Payer: Aetna Commercial |
$4,362.24
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,418.90
|
| Rate for Payer: Cash Price |
$2,832.62
|
| Rate for Payer: Cigna Commercial |
$4,702.16
|
| Rate for Payer: First Health Commercial |
$5,381.99
|
| Rate for Payer: Humana Commercial |
$4,815.46
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,645.51
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,180.95
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,699.58
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,985.42
|
| Rate for Payer: Ohio Health Group HMO |
$4,248.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,532.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,928.77
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,909.02
|
| Rate for Payer: PHCS Commercial |
$5,438.64
|
| Rate for Payer: United Healthcare All Payer |
$4,985.42
|
|
|
PLATE TIB LK M-D 3.5M 89M 3 L
|
Facility
|
OP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem Medicaid |
$1,901.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Humana KY Medicaid |
$1,901.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,940.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK M-D 3.5M 89M 3 L
|
Facility
|
IP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK M-D 3.5M 89M 3 R
|
Facility
|
IP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK M-D 3.5M 89M 3 R
|
Facility
|
OP
|
$5,530.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,659.08 |
| Max. Negotiated Rate |
$5,309.04 |
| Rate for Payer: Aetna Commercial |
$4,258.29
|
| Rate for Payer: Anthem Medicaid |
$1,901.85
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$4,313.60
|
| Rate for Payer: Cash Price |
$2,765.12
|
| Rate for Payer: Cigna Commercial |
$4,590.11
|
| Rate for Payer: First Health Commercial |
$5,253.74
|
| Rate for Payer: Humana Commercial |
$4,700.71
|
| Rate for Payer: Humana KY Medicaid |
$1,901.85
|
| Rate for Payer: Kentucky WC Medicaid |
$1,921.21
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$4,534.81
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$4,081.32
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,659.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,940.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$4,866.62
|
| Rate for Payer: Ohio Health Group HMO |
$4,147.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$4,424.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$4,811.32
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,815.87
|
| Rate for Payer: PHCS Commercial |
$5,309.04
|
| Rate for Payer: United Healthcare All Payer |
$4,866.62
|
|
|
PLATE TIB LK PD 3.5*47 3 L
|
Facility
|
IP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE TIB LK PD 3.5*47 3 L
|
Facility
|
OP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem Medicaid |
$1,465.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Humana KY Medicaid |
$1,465.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE TIB LK P-D 3.5*47 3 R
|
Facility
|
IP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE TIB LK P-D 3.5*47 3 R
|
Facility
|
OP
|
$4,261.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,278.38 |
| Max. Negotiated Rate |
$4,090.80 |
| Rate for Payer: Aetna Commercial |
$3,281.16
|
| Rate for Payer: Anthem Medicaid |
$1,465.44
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,323.78
|
| Rate for Payer: Cash Price |
$2,130.62
|
| Rate for Payer: Cigna Commercial |
$3,536.84
|
| Rate for Payer: First Health Commercial |
$4,048.19
|
| Rate for Payer: Humana Commercial |
$3,622.06
|
| Rate for Payer: Humana KY Medicaid |
$1,465.44
|
| Rate for Payer: Kentucky WC Medicaid |
$1,480.36
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,494.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,144.80
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,278.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,494.85
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,749.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,195.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,409.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,707.29
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,940.26
|
| Rate for Payer: PHCS Commercial |
$4,090.80
|
| Rate for Payer: United Healthcare All Payer |
$3,749.90
|
|
|
PLATE TIB LK P-D 3.5*72 5 L
|
Facility
|
IP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE TIB LK P-D 3.5*72 5 L
|
Facility
|
OP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem Medicaid |
$1,523.48
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Humana KY Medicaid |
$1,523.48
|
| Rate for Payer: Kentucky WC Medicaid |
$1,538.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,554.04
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
|
PLATE TIB LK P-D 3.5*72 5 R
|
Facility
|
IP
|
$4,430.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,329.00 |
| Max. Negotiated Rate |
$4,252.80 |
| Rate for Payer: Aetna Commercial |
$3,411.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,455.40
|
| Rate for Payer: Cash Price |
$2,215.00
|
| Rate for Payer: Cigna Commercial |
$3,676.90
|
| Rate for Payer: First Health Commercial |
$4,208.50
|
| Rate for Payer: Humana Commercial |
$3,765.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,632.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,269.34
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,329.00
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,898.40
|
| Rate for Payer: Ohio Health Group HMO |
$3,322.50
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,544.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,854.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,056.70
|
| Rate for Payer: PHCS Commercial |
$4,252.80
|
| Rate for Payer: United Healthcare All Payer |
$3,898.40
|
|
