|
PLATE TIB LK P-D 3.5*72 5 R
|
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 TIBLK PL-D 3.5M 107M 7 L
|
Facility
|
OP
|
$4,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$4,200.96 |
| Rate for Payer: Aetna Commercial |
$3,369.52
|
| Rate for Payer: Anthem Medicaid |
$1,504.91
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.28
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cigna Commercial |
$3,632.08
|
| Rate for Payer: First Health Commercial |
$4,157.20
|
| Rate for Payer: Humana Commercial |
$3,719.60
|
| Rate for Payer: Humana KY Medicaid |
$1,504.91
|
| Rate for Payer: Kentucky WC Medicaid |
$1,520.22
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,312.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,535.10
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,850.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.44
|
| Rate for Payer: PHCS Commercial |
$4,200.96
|
| Rate for Payer: United Healthcare All Payer |
$3,850.88
|
|
|
PLATE TIBLK PL-D 3.5M 107M 7 L
|
Facility
|
IP
|
$4,376.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,312.80 |
| Max. Negotiated Rate |
$4,200.96 |
| Rate for Payer: Aetna Commercial |
$3,369.52
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,413.28
|
| Rate for Payer: Cash Price |
$2,188.00
|
| Rate for Payer: Cigna Commercial |
$3,632.08
|
| Rate for Payer: First Health Commercial |
$4,157.20
|
| Rate for Payer: Humana Commercial |
$3,719.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,588.32
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,229.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,312.80
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,850.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,282.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,500.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,807.12
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,019.44
|
| Rate for Payer: PHCS Commercial |
$4,200.96
|
| Rate for Payer: United Healthcare All Payer |
$3,850.88
|
|
|
PLATE TIB LK PL-D 3.5M 131M 9L
|
Facility
|
IP
|
$4,517.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,355.33 |
| Max. Negotiated Rate |
$4,337.04 |
| Rate for Payer: Aetna Commercial |
$3,478.67
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,523.84
|
| Rate for Payer: Cash Price |
$2,258.88
|
| Rate for Payer: Cigna Commercial |
$3,749.73
|
| Rate for Payer: First Health Commercial |
$4,291.86
|
| Rate for Payer: Humana Commercial |
$3,840.09
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,704.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,334.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,355.33
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,975.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,388.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,614.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,930.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,117.25
|
| Rate for Payer: PHCS Commercial |
$4,337.04
|
| Rate for Payer: United Healthcare All Payer |
$3,975.62
|
|
|
PLATE TIB LK PL-D 3.5M 131M 9L
|
Facility
|
OP
|
$4,517.75
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,355.33 |
| Max. Negotiated Rate |
$4,337.04 |
| Rate for Payer: Aetna Commercial |
$3,478.67
|
| Rate for Payer: Anthem Medicaid |
$1,553.65
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,523.84
|
| Rate for Payer: Cash Price |
$2,258.88
|
| Rate for Payer: Cigna Commercial |
$3,749.73
|
| Rate for Payer: First Health Commercial |
$4,291.86
|
| Rate for Payer: Humana Commercial |
$3,840.09
|
| Rate for Payer: Humana KY Medicaid |
$1,553.65
|
| Rate for Payer: Kentucky WC Medicaid |
$1,569.47
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,704.55
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,334.10
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,355.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,584.83
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,975.62
|
| Rate for Payer: Ohio Health Group HMO |
$3,388.31
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,614.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,930.44
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$3,117.25
|
| Rate for Payer: PHCS Commercial |
$4,337.04
|
| Rate for Payer: United Healthcare All Payer |
$3,975.62
|
|
|
PLATE TIB LK PL-D 3.5M 59M 3 L
|
Facility
|
OP
|
$4,011.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.45 |
| Max. Negotiated Rate |
$3,851.04 |
| Rate for Payer: Aetna Commercial |
$3,088.86
|
| Rate for Payer: Anthem Medicaid |
$1,379.55
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,128.97
|
| Rate for Payer: Cash Price |
$2,005.75
|
| Rate for Payer: Cigna Commercial |
$3,329.55
|
| Rate for Payer: First Health Commercial |
$3,810.93
|
| Rate for Payer: Humana Commercial |
$3,409.78
|
| Rate for Payer: Humana KY Medicaid |
$1,379.55
|
| Rate for Payer: Kentucky WC Medicaid |
$1,393.60
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,289.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,960.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,203.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,407.23
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,530.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,008.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,209.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,490.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,767.93
|
| Rate for Payer: PHCS Commercial |
$3,851.04
|
| Rate for Payer: United Healthcare All Payer |
$3,530.12
|
|
|
PLATE TIB LK PL-D 3.5M 59M 3 L
|
Facility
|
IP
|
$4,011.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,203.45 |
| Max. Negotiated Rate |
$3,851.04 |
| Rate for Payer: Aetna Commercial |
$3,088.86
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,128.97
|
| Rate for Payer: Cash Price |
$2,005.75
|
| Rate for Payer: Cigna Commercial |
$3,329.55
|
| Rate for Payer: First Health Commercial |
$3,810.93
|
| Rate for Payer: Humana Commercial |
$3,409.78
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,289.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,960.49
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,203.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,530.12
|
| Rate for Payer: Ohio Health Group HMO |
$3,008.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,209.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,490.01
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,767.93
|
| Rate for Payer: PHCS Commercial |
$3,851.04
|
| Rate for Payer: United Healthcare All Payer |
$3,530.12
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 L
|
Facility
|
IP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 L
|
Facility
|
OP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem Medicaid |
$1,279.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Humana KY Medicaid |
$1,279.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 R
|
Facility
|
IP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE TIB LK PL-D 3.5M 62M 5 R
|
Facility
|
OP
|
$3,721.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,116.38 |
| Max. Negotiated Rate |
$3,572.40 |
| Rate for Payer: Aetna Commercial |
$2,865.36
|
| Rate for Payer: Anthem Medicaid |
$1,279.74
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,902.57
|
| Rate for Payer: Cash Price |
$1,860.62
|
| Rate for Payer: Cigna Commercial |
$3,088.64
|
| Rate for Payer: First Health Commercial |
$3,535.19
|
| Rate for Payer: Humana Commercial |
$3,163.06
|
| Rate for Payer: Humana KY Medicaid |
$1,279.74
|
| Rate for Payer: Kentucky WC Medicaid |
$1,292.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,051.43
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,746.28
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,116.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,305.41
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,274.70
|
| Rate for Payer: Ohio Health Group HMO |
$2,790.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,977.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,237.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,567.66
|
| Rate for Payer: PHCS Commercial |
$3,572.40
|
| Rate for Payer: United Healthcare All Payer |
$3,274.70
|
|
|
PLATE TIB LK PL-D 3.5M 71M 4 L
|
Facility
|
OP
|
$4,133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.90 |
| Max. Negotiated Rate |
$3,967.68 |
| Rate for Payer: Aetna Commercial |
$3,182.41
|
| Rate for Payer: Anthem Medicaid |
$1,421.34
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.74
|
| Rate for Payer: Cash Price |
$2,066.50
|
| Rate for Payer: Cigna Commercial |
$3,430.39
|
| Rate for Payer: First Health Commercial |
$3,926.35
|
| Rate for Payer: Humana Commercial |
$3,513.05
|
| Rate for Payer: Humana KY Medicaid |
$1,421.34
|
| Rate for Payer: Kentucky WC Medicaid |
$1,435.80
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.90
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,449.86
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.77
|
| Rate for Payer: PHCS Commercial |
$3,967.68
|
| Rate for Payer: United Healthcare All Payer |
$3,637.04
|
|
|
PLATE TIB LK PL-D 3.5M 71M 4 L
|
Facility
|
IP
|
$4,133.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,239.90 |
| Max. Negotiated Rate |
$3,967.68 |
| Rate for Payer: Aetna Commercial |
$3,182.41
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,223.74
|
| Rate for Payer: Cash Price |
$2,066.50
|
| Rate for Payer: Cigna Commercial |
$3,430.39
|
| Rate for Payer: First Health Commercial |
$3,926.35
|
| Rate for Payer: Humana Commercial |
$3,513.05
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,389.06
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,050.15
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,239.90
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,637.04
|
| Rate for Payer: Ohio Health Group HMO |
$3,099.75
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,306.40
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,595.71
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,851.77
|
| Rate for Payer: PHCS Commercial |
$3,967.68
|
| Rate for Payer: United Healthcare All Payer |
$3,637.04
|
|
|
PLATE TIB LK PL-D 3.5M 74M 6 L
|
Facility
|
OP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem Medicaid |
$1,335.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Humana KY Medicaid |
$1,335.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE TIB LK PL-D 3.5M 74M 6 L
|
Facility
|
IP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE TIB LK PL-D 3.5M 74M 6 R
|
Facility
|
IP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE TIB LK PL-D 3.5M 74M 6 R
|
Facility
|
OP
|
$3,883.25
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,164.97 |
| Max. Negotiated Rate |
$3,727.92 |
| Rate for Payer: Aetna Commercial |
$2,990.10
|
| Rate for Payer: Anthem Medicaid |
$1,335.45
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,028.93
|
| Rate for Payer: Cash Price |
$1,941.62
|
| Rate for Payer: Cigna Commercial |
$3,223.10
|
| Rate for Payer: First Health Commercial |
$3,689.09
|
| Rate for Payer: Humana Commercial |
$3,300.76
|
| Rate for Payer: Humana KY Medicaid |
$1,335.45
|
| Rate for Payer: Kentucky WC Medicaid |
$1,349.04
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,184.26
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,865.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,164.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,362.24
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,417.26
|
| Rate for Payer: Ohio Health Group HMO |
$2,912.44
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,106.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,378.43
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,679.44
|
| Rate for Payer: PHCS Commercial |
$3,727.92
|
| Rate for Payer: United Healthcare All Payer |
$3,417.26
|
|
|
PLATE TIB LK PL-D 3.5M 83M 5 L
|
Facility
|
IP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE TIB LK PL-D 3.5M 83M 5 L
|
Facility
|
OP
|
$4,254.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,276.35 |
| Max. Negotiated Rate |
$4,084.32 |
| Rate for Payer: Aetna Commercial |
$3,275.97
|
| Rate for Payer: Anthem Medicaid |
$1,463.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,318.51
|
| Rate for Payer: Cash Price |
$2,127.25
|
| Rate for Payer: Cigna Commercial |
$3,531.24
|
| Rate for Payer: First Health Commercial |
$4,041.78
|
| Rate for Payer: Humana Commercial |
$3,616.32
|
| Rate for Payer: Humana KY Medicaid |
$1,463.12
|
| Rate for Payer: Kentucky WC Medicaid |
$1,478.01
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,488.69
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,139.82
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,276.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,492.48
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,743.96
|
| Rate for Payer: Ohio Health Group HMO |
$3,190.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,403.60
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,701.41
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,935.61
|
| Rate for Payer: PHCS Commercial |
$4,084.32
|
| Rate for Payer: United Healthcare All Payer |
$3,743.96
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 L
|
Facility
|
IP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 L
|
Facility
|
OP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem Medicaid |
$1,388.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Humana KY Medicaid |
$1,388.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 R
|
Facility
|
IP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE TIB LK PL-D 3.5M 86M 7 R
|
Facility
|
OP
|
$4,038.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,211.55 |
| Max. Negotiated Rate |
$3,876.96 |
| Rate for Payer: Aetna Commercial |
$3,109.64
|
| Rate for Payer: Anthem Medicaid |
$1,388.84
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,150.03
|
| Rate for Payer: Cash Price |
$2,019.25
|
| Rate for Payer: Cigna Commercial |
$3,351.95
|
| Rate for Payer: First Health Commercial |
$3,836.57
|
| Rate for Payer: Humana Commercial |
$3,432.72
|
| Rate for Payer: Humana KY Medicaid |
$1,388.84
|
| Rate for Payer: Kentucky WC Medicaid |
$1,402.97
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,311.57
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,980.41
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,211.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,416.71
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,553.88
|
| Rate for Payer: Ohio Health Group HMO |
$3,028.88
|
| Rate for Payer: Ohio Health Group PPO Differential |
$3,230.80
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$3,513.49
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,786.57
|
| Rate for Payer: PHCS Commercial |
$3,876.96
|
| Rate for Payer: United Healthcare All Payer |
$3,553.88
|
|
|
PLATE TIB LK PM-D 3.5*64 4 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 PM-D 3.5*64 4 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
|
|
