|
PLATE TIB LK PM-D 3.5*98 7 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 PM-D 3.5*98 7 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 L LT BUTTRESS 4X86MM
|
Facility
|
OP
|
$3,337.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.29 |
| Max. Negotiated Rate |
$3,204.12 |
| Rate for Payer: Aetna Commercial |
$2,569.97
|
| Rate for Payer: Anthem Medicaid |
$1,147.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.34
|
| Rate for Payer: Cash Price |
$1,668.81
|
| Rate for Payer: Cigna Commercial |
$2,770.22
|
| Rate for Payer: First Health Commercial |
$3,170.74
|
| Rate for Payer: Humana Commercial |
$2,836.98
|
| Rate for Payer: Humana KY Medicaid |
$1,147.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.96
|
| Rate for Payer: PHCS Commercial |
$3,204.12
|
| Rate for Payer: United Healthcare All Payer |
$2,937.11
|
|
|
PLATE TIB L LT BUTTRESS 4X86MM
|
Facility
|
IP
|
$3,337.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.29 |
| Max. Negotiated Rate |
$3,204.12 |
| Rate for Payer: Aetna Commercial |
$2,569.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.34
|
| Rate for Payer: Cash Price |
$1,668.81
|
| Rate for Payer: Cigna Commercial |
$2,770.22
|
| Rate for Payer: First Health Commercial |
$3,170.74
|
| Rate for Payer: Humana Commercial |
$2,836.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.96
|
| Rate for Payer: PHCS Commercial |
$3,204.12
|
| Rate for Payer: United Healthcare All Payer |
$2,937.11
|
|
|
PLATE TIB L RT BUTTRESS 4X86MM
|
Facility
|
IP
|
$3,337.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.29 |
| Max. Negotiated Rate |
$3,204.12 |
| Rate for Payer: Aetna Commercial |
$2,569.97
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.34
|
| Rate for Payer: Cash Price |
$1,668.81
|
| Rate for Payer: Cigna Commercial |
$2,770.22
|
| Rate for Payer: First Health Commercial |
$3,170.74
|
| Rate for Payer: Humana Commercial |
$2,836.98
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.29
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.96
|
| Rate for Payer: PHCS Commercial |
$3,204.12
|
| Rate for Payer: United Healthcare All Payer |
$2,937.11
|
|
|
PLATE TIB L RT BUTTRESS 4X86MM
|
Facility
|
OP
|
$3,337.62
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,001.29 |
| Max. Negotiated Rate |
$3,204.12 |
| Rate for Payer: Aetna Commercial |
$2,569.97
|
| Rate for Payer: Anthem Medicaid |
$1,147.81
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$2,603.34
|
| Rate for Payer: Cash Price |
$1,668.81
|
| Rate for Payer: Cigna Commercial |
$2,770.22
|
| Rate for Payer: First Health Commercial |
$3,170.74
|
| Rate for Payer: Humana Commercial |
$2,836.98
|
| Rate for Payer: Humana KY Medicaid |
$1,147.81
|
| Rate for Payer: Kentucky WC Medicaid |
$1,159.49
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$2,736.85
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$2,463.16
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,001.29
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,170.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$2,937.11
|
| Rate for Payer: Ohio Health Group HMO |
$2,503.22
|
| Rate for Payer: Ohio Health Group PPO Differential |
$2,670.10
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$2,903.73
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,302.96
|
| Rate for Payer: PHCS Commercial |
$3,204.12
|
| Rate for Payer: United Healthcare All Payer |
$2,937.11
|
|
|
PLATE TIB MED POSTR L 4H 64M
|
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 MED POSTR L 4H 64M
|
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 MED POSTR L 6H 86M
|
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 MED POSTR L 6H 86M
|
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 MED POSTR R 4H 64M
|
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 MED POSTR R 4H 64M
|
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 MED POSTR R 6H 86M
|
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 MED POSTR R 6H 86M
|
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 OPN WDG TI OST 10.00
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 10.00
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 11.00
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 11.00
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 12.5
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 12.5
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 15.0
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 15.0
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 17.5
|
Facility
|
IP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 17.5
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
|
PLATE TIB OPN WDG TI OST 5M
|
Facility
|
OP
|
$6,832.50
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
27000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,049.75 |
| Max. Negotiated Rate |
$6,559.20 |
| Rate for Payer: Aetna Commercial |
$5,261.02
|
| Rate for Payer: Anthem Medicaid |
$2,349.70
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,329.35
|
| Rate for Payer: Cash Price |
$3,416.25
|
| Rate for Payer: Cigna Commercial |
$5,670.98
|
| Rate for Payer: First Health Commercial |
$6,490.88
|
| Rate for Payer: Humana Commercial |
$5,807.62
|
| Rate for Payer: Humana KY Medicaid |
$2,349.70
|
| Rate for Payer: Kentucky WC Medicaid |
$2,373.61
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,602.65
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,042.39
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,049.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,396.84
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,012.60
|
| Rate for Payer: Ohio Health Group HMO |
$5,124.38
|
| Rate for Payer: Ohio Health Group PPO Differential |
$5,466.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$5,944.27
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$4,714.43
|
| Rate for Payer: PHCS Commercial |
$6,559.20
|
| Rate for Payer: United Healthcare All Payer |
$6,012.60
|
|
